Inter-rater Research Articles

Equivalence of in-person and videoconference administration of the Physical and Neurological Examination of Subtle Signs (PANESS) timed motor section

ABSTRACT Demand for telehealth services has increased in many settings as a means of reducing patient burden and increasing access to care. It is therefore critical to understand if clinical tools validated for in-person use are feasible to administer via telehealth and, if so, how results may vary from those obtained in-person. The Revised Physical and Neurological Examination of Subtle Signs (PANESS) is a validated assessment of pediatric neuromotor functioning that is sensitive to detecting motor dysfunction in youth. The Timed Motor section of the PANESS is an ideal candidate for telehealth administration given its strong inter-rater reliability when scored via video review. Here, we preliminarily examined the feasibility of administering the Timed Motor section of PANESS via videoconferencing and its equivalence with in-person administration. We administered the Timed Motor section of the PANESS in-person and via videoconferencing in 25 typically developing youth ages 10–18 (including n = 11 who had clinically recovered from concussion). All were able to complete the assessment via videoconference. We observed moderate to excellent reliability of scores obtained in-person and via videoconference (intraclass correlations ranging from .743 to .971). Results suggest that the Timed Motor Section of the PANESS can be administered remotely in typically developing youth (including those with a history of concussion) and that the scores obtained are stable with in-person scores. Future work is needed to examine the feasibility and equivalence of telehealth-based PANESS administration in clinical settings and patient populations.

Inter-rater reliability of Mechanical Diagnosis and Therapy (MDT) in evaluating and classifying chronic pelvic pain syndrome

ABSTRACT Introduction Chronic pelvic pain syndrome (CPPS) involves complex interactions between the musculoskeletal system, nervous system, and psychosocial factors. A major challenge in managing CPPS is the lack of reliable assessment and classification systems. The Mechanical Diagnosis and Therapy (MDT) is a widely used and reliable classification system for assessing and managing painful musculoskeletal conditions affecting the spine and extremities. This study’s primary objective was to assess the inter-rater reliability of the MDT assessment in diagnosing CPPS using clinical vignettes. Secondary objectives included determining the prevalence of MDT classification categories. Methods Five MDT clinicians classified clinical vignettes into three categories: 1) Spinal Derangement, 2) Pelvic Floor Contractile Dysfunction, or 3) MDT OTHER subgroups. The vignettes were developed from the McKenzie Pelvic Pain Assessment Form. Inter-rater reliability among clinicians was calculated using the Fleiss kappa statistic with 95% confidence intervals, and Cohen’s kappa examined reliability between pairs of raters. Results A total of 76 vignettes were developed (40 females and 36 males). Good inter-rater reliability was found among clinicians (Fleiss kappa = 0.616, 95% CI = 0.598–0.633, p < 0.001). Inter-rater reliability was higher when classifying female vignettes (Fleiss kappa = 0.658, 95% CI = 0.634, 0.682) than male vignettes (Fleiss kappa = 0.546, 95% CI = 0.519, 0.573). The most common classification was Spinal Derangement (57%), followed by MDT OTHER subgroups (26%) and Pelvic Floor Contractile Dysfunction (17%). Conclusions The study indicates good inter-rater reliability among MDT clinicians in classifying pelvic pain syndrome. However, clinical vignettes may not fully capture the complexities of real participant interactions, potentially inflating agreement. Future studies should incorporate direct observation of real participant encounters alongside clinical vignettes to improve validity.

Comparative Analysis of Information Quality in Pediatric Otorhinolaryngology: Clinicians, Residents, and Large Language Models.

Pediatric otorhinolaryngology (ORL) addresses complex conditions in children, requiring a tailored approach for patients and families. With artificial intelligence (AI) gaining traction in medical applications, this study evaluates the quality of information provided by large language models (LLMs) in comparison to clinicians, identifying strengths and limitations in the field of pediatric ORL. Comparative blinded study. Controlled research environment using LLMs. Fifty-four items of increasing difficulty, namely 18 theoretical questions, 18 clinical scenarios, and 18 patient questions, were posed to ChatGPT-3.5, -4.0, -4o, Claude-3, Gemini, Perplexity, Copilot, a second-year resident, and an expert in the field of pediatric ORL. The Quality Analysis of Medical Artificial Intelligence (QAMAI) tool was used for blinded evaluation of the quality of medical information by a panel of expert members from the Young Otolaryngologists Group of the Italian Society of ORL and the International Federation of ORL Societies. LLMs performed comparably to specialist in theoretical and standardized clinical scenarios, with Bing Copilot achieving the highest QAMAI scores. However, AI responses lacked transparency in citing reliable sources and were less effective in addressing patient-centered questions. Poor interrater agreement among reviewers highlighted challenges in distinguishing human-generated from AI-generated responses. Rhinology topics received the highest scores, whereas laryngology and patient-centered questions showed lower agreement and performance. LLMs show promise as supportive resources in pediatric ORL, particularly in theoretical learning and standardized cases. However, significant limitations remain, including source transparency and contextual communication in patient interactions. Human oversight is essential to mitigate risks. Future developments should focus on refining AI capabilities for evidence-based and empathetic communication to support both clinicians and families.

Utility of Pelvis CT to Assess Occult Intertrochanteric Extension of Greater Trochanteric Fractures.

To determine if CT differences of bone density between the injured and non-injured femora in patients with greater trochanteric fractures can be used to identify intertrochanteric extension. Design: Retrospective cohort series. Multi-hospital academic institution. Included were patients over a 7-year period (1/2014-12/2021) with greater trochanteric fractures (OTA/AO 31A1.1) without evident intertrochanteric extension on CT that also underwent pelvis MRI to assess for occult intertrochanteric extension. The primary outcome measures were CT findings of intertrochanteric curvilinear density (CL) and subtrochanteric bone density (ST) in the injured femur in patients with greater trochanteric fractures. CT findings (CL and ST) were compared to the patient's MRI, which was the reference standard for occult intertrochanteric fractures. The MRI determined presence of occult intertrochanteric extension (MRI ITE) and if present, MRI determined fracture extension into the intertrochanteric region, were categorized as 1) less than 50% or 2) 50% or greater. Descriptive statistics, sensitivity, specificity and inter-rater reliability were calculated assessing the presence of the CT findings of CL and ST, compared to reference standard MRI ITE. Sensitivity and specificity for CL and ST were calculated for 1) any degree of MRI ITE (<50% and >50%) and 2) only MRI ITE 50% or greater. Eighty-one patients (54 females, 27 males, mean age 82, range 54-102) were included. Fourteen (17%) patients had no MRI ITE, 11 (14%) patients had <50% MRI ITE and 56 (69%) patients had ≥50% MRI ITE. The presence of CL on CT corresponded to any MRI ITE (<50% and >50%) with sensitivity of 55.2%, specificity 100%, PPV 100%, and NPV 31.8%. In patients with MRI ITE 50% or greater only and CL presence, specificity was 92% and sensitivity was 62.5%. Presence of ST on CT was associated with any MRI ITE with sensitivity of 34.3%, specificity 100%, PPV 100% and NPV 24.1%. Patients with MRI ITE 50% or greater and ST presence, specificity was 96% and sensitivity was 39%. In patients with apparent isolated greater trochanteric fractures, the presence of curvilinear intertrochanteric and subtrochanteric density in the medullary bone in the injured femur on pelvis CT was highly predictive of intertrochanteric extension. Patients with these CT findings in the injured femur on pelvis CT can be assumed to have intertrochanteric extension and treated accordingly, obviating the need for MRI. The absence of the curvilinear intertrochanteric and subtrochanteric densities did not rule-out possible intertrochanteric extension, and MRI can be further considered in this population. Diagnostic Level II.

Validation of the Language ENvironment Analysis in Swedish Children.

The Language ENvironment Analysis (LENA) is a technological tool designed for comprehensive recordings and automated analysis of young children's daily language and auditory environments. LENA recordings play a crucial role in both clinical interventions and research, offering insights into the amount of spoken language children are exposed to in their homes, including adult word count (AWC) and child vocalization count (CVC). Although LENA was initially developed for American English, it has been validated in various other languages. This study aimed to evaluate the reliability of LENA in a Swedish context by comparing its automatic estimates with human transcriptions. Thirty-six children aged 11-29 months participated in the validation study. A total of 540 min (9 hr) of recordings were transcribed by one experienced speech-language pathologist and two special educators. Interrater agreement over 150 min was notably higher for CVC (intraclass correlation coefficient [ICC] = .97, 95% confidence interval [CI] [.91, .99], r = .96, p < .001) compared to AWC, which yielded an ICC of .82 (95% CI [.15, .96], r = .80, p = .006). Both estimated CVC and AWC (n = 36) were significantly correlated with human transcriptions (r = .79 and .82, respectively; p < .001). The findings align with prior validation studies, indicating that LENA is suitable for use in a Swedish context, particularly for families with children aged 11-29 months. Nonetheless, additional validation studies are necessary, particularly focusing on younger infants, to enhance our understanding of the tool's reliability in preverbal children and their caregivers.

Comparison of preoperative radiographic measurements for femoral shaft fractures: a study on canal diameter measurement methods.

This study sought to determine the most reliable preoperative method for measuring canal diameter in femoral shaft fractures to optimize intramedullary nailing outcomes. We retrospectively analyzed 164 patients treated with intramedullary nailing at University Hospital from October 2017 to December 2019. Each patient's canal diameter was measured using five techniques: simple anteroposterior (AP) radiography, simple lateral radiography, AP scanogram with a scano rod, lateral scanogram with a scano rod, and computed tomography (CT). Error was calculated as preoperative measurement minus actual nail diameter. Interobserver reliability was assessed with Cohen's Kappa coefficient and paired t tests, with subgroup analyses for isthmus fractures and osteoporosis. CT yielded the smallest error (-0.34 ± 0.87mm and 0.25 ± 1.39mm across observers), with Kappa values of 0.61-0.85 indicating substantial reliability. Only CT showed significant error differences for isthmus fractures (p < 0.05). No method differed significantly with osteoporosis (p > 0.05). Preoperative plans adjusted in 18% of scano rod cases due to discrepancies exceeding 2mm. CT offers the highest reliability, particularly for isthmus fractures, while scanograms outperform simple radiography, with AP views superior to lateral views. Further investigation is needed into osteoporosis effects on measurement accuracy.

Evaluation of the reliability, usefulness, quality and readability of ChatGPT's responses on Scoliosis.

This study evaluates the reliability, usefulness, quality, and readability of ChatGPT's responses to frequently asked questions aboutscoliosis. Sixteen frequently asked questions, identified through an analysis of Google Trends data and clinical feedback, were presented to ChatGPT for evaluation. Two independent experts assessed the responses using a 7-point Likert scale for reliability and usefulness. Additionally,the overall quality was also rated using the Global Quality Scale (GQS).To assess readability, various established metrics were employed, including the Flesch Reading Ease score(FRE), the Simple Measure of Gobbledygook(SMOG) Index, the Coleman-Liau Index(CLI), the Gunning Fog Index(GFI), the Flesch-Kinkaid Grade Level(FKGL), the FORCAST Grade Level, and the Automated Readability Index(ARI). The mean reliability scores were 4.68 ± 0.73 (Median: 5, IQR 4-5), while the mean usefulness scores were 4.84 ± 0.84 (Median: 5, IQR 4-5).Additionally the mean GQS scores were 4.28 ± 0.58 (Median: 4, IQR 4-5). Inter-rater reliability analysis using the Intraclass correlation coefficient showed excellent agreement: 0.942 for reliability, 0.935 for usefulness, and 0.868 for GQS. While general informational questions received high scores, responses to treatment-specific and personalized inquiries required greater depth and comprehensiveness. Readability analysis indicated that ChatGPT's responses required at least a high school senior to college-level reading ability. ChatGPT provides reliable, useful, and moderate quality information onscoliosis but has limitations in addressing treatment-specific and personalized inquiries. Caution is essential when using Artificial Intelligence (AI) in patient education and medical decision-making.

Child eating disorder examination (ChEDE) interview and child eating disorder examination questionnaire (ChEDE-Q): psychometric properties of the Italian versions

PurposeTo examine the psychometric characteristics of the Italian language versions of the child eating disorder examination (ChEDE) interview and child eating disorder examination questionnaire (ChEDE-Q).MethodsChEDE (from EDE 17th edition) and ChEDE-Q were first translated, and then administered to 147 patients with eating disorders under the age of 18, along with 80 age-matched controls. Their internal consistency (Cronbach alpha), inter-rater reliability (Spearman rho), short-term (7–23 days) test–retest reliability (Spearman rho), and criterion validity (group differences by Mann–Whitney U) were evaluated.ResultsPatients with eating disorders displayed significantly higher ChEDE/ChEDE-Q scores than age-matched controls, demonstrating the adequate criterion validity of the instrument (all subscales and global scores significant at p < 0.001). Internal consistency was high for all original ChEDE/ChEDE-Q subscales (minimum Cronbach alpha 0.752), apart from Eating Concerns (minimum Cronbach alpha 0.591). Inter-rater reliability was excellent for global ChEDE/ChEDE-Q scores and each subscale (minimum Spearman rho 0.999). Test–retest reliability was excellent for global ChEDE/ChEDE-Q scores and each subscale (minimum Spearman rho 0.791).ConclusionsThe Italian versions of the ChEDE interview and ChEDE-Q exhibited excellent psychometric properties and may, therefore, be recommended for the assessment of Italian patients with eating disorders less than 18 years old, both in clinical practice and research settings.Level of evidence III evidence obtained from cohort or case–control analytic studies.

Methodological Components for Evaluating Intervention Effectiveness of SOS Feeding Approach: A Feasibility Study

Background/Objectives: There is a paucity of research that explores the effectiveness of the Sequential Oral Sensory (SOS) Approach to Feeding. The purpose of this feasibility study was to evaluate the necessary components for the implementation of a treatment effectiveness study on the Sequential Oral Sensory (SOS) Approach to Feeding. The primary aims were to develop a fidelity measure, determine the feasibility of video coding, create an observational coding scheme, and determine if the outcome measures were sensitive to change. Methods: Over a 4-year period, data were collected from twelve participants aged 4 to 8 years with developmental disorders, with the assistance of four occupational therapy doctoral students. A fidelity measure was created, and inter-rater reliability was established among the four coders. Videotapes were collected at home and in the clinic. A behavioral coding system, consistent with the SOS Steps to Eating hierarchy, was developed for scoring feeding behaviors. Results: The preliminary inter-rater reliability was reported, and the coding results were represented graphically. Two additional outcome measures were piloted—a visual analog scale (VAS) and the Parenting Stress Index (PSI). The VAS was sensitive to changes in each parent’s ability to support their child, as well as in each client’s progress. The PSI also showed sensitivity to changes in the decline of parent-reported stress and child stress indices. Conclusions: Findings demonstrate fidelity to the SOS Approach, as well as sensitive outcomes, using behavioral coding and parent-reported measures. These evidence-based tools and procedures offer researchers and clinicians objective and meaningful feeding outcomes.

A New Automated Ultrasound Quantification of Urethral Mobility for Stress Urinary Incontinence: A Feasibility Study.

Stress urinary incontinence (SUI) is a prevalent condition that can significantly affect quality of life. Urethral mobility is an important factor in SUI and transperineal ultrasound (TPUS) imaging can provide clear visualization of this movement; however, its quantification has been limited. An automated system to track and quantify urethral movement could provide richer information and reduce inter-observer effects on measurements. As proof-of-concept for technique development, we used TPUS cine loops obtained on commercial scanners (GE Healthcare and Philips Healthcare) from consented research volunteers. We developed the tracking software based on fundamental concepts from computer vision, specifically corner detection and optical flow-based tracking algorithms. In doing so we account for inadvertent probe movements by using the symphysis pubis as a reference coordinate system. The system successfully tracks the motion of the urethra during Valsalva maneuvers. It accurately captures and quantifies complex movements, including directional shifts, rotations, displacement vectors of different structures, and the trajectory of motion. These measurements are corrected for any probe movement. We demonstrated the system's efficiency and reliability in near real-time analysis across various ultrasound platforms and video formats. The intraclass correlation coefficients exceeded 0.89 and 0.5 for intra- and inter-rater reliability, respectively. By providing detailed, objective measurements of urogenital movement, this approach has potential to advance the understanding, diagnosis and treatment of SUI, which in turn, can help tailor more effective treatment strategies. This methodology paper confirms the feasibility of automated quantification of urethral mobility.

Qualitative Coding with GPT-4

This study explores the potential of the large language model GPT-4 as an automated tool for qualitative data analysis by educational researchers, exploring which techniques are most successful for different types of constructs. Specifically, we assess three different prompt engineering strategies — Zero-shot, Few-shot, and Few-shot with contextual information — as well as the use of embeddings. We do so in the context of qualitatively coding three distinct educational datasets: Algebra I semi-personalized tutoring session transcripts, student observations in a game-based learning environment, and debugging behaviours in an introductory programming course. We evaluated the performance of each approach based on its inter-rater agreement with human coders and explored how different methods vary in effectiveness depending on a construct’s degree of clarity, concreteness, objectivity, granularity, and specificity. Our findings suggest that while GPT-4 can code a broad range of constructs, no single method consistently outperforms the others, and the selection of a particular method should be tailored to the specific properties of the construct and context being analyzed. We also found that GPT-4 has the most difficulty with the same constructs than human coders find more difficult to reach inter-rater reliability on.

Birth plans: Developing a shared medical decision aid tool

Objective(s)Birth plans appeared at the end of the twentieth century, enabling women to express their expectations towards childbirth. This reflects a rising demand for patients to take a proactive role in their medical care. This study aimed to collaboratively develop a medical decision aid with expectant mothers to prepare them better for the events surrounding their child’s birth.Study DesignFive topics frequently addressed in birth plans were identified by both patients’ associations, using semi-structured interview with representatives of women’s associations, and professionals, using an online poll. Initially, work groups with perinatal care professionals drafted items designed to guide expectant mothers in developing their birth plans and actively participating in childbirth decisions. Subsequently, we used a modified Delphi-consensus in three rounds to retain the most relevant items. The first two rounds engaged a multidisciplinary team of professionals, while the third involved expectant mothers from two maternity wards in Lyon, France. Items that received a rating between 3 (good value) and 4 (excellent value) on a 4-point scale by more than 75% of participants were deemed consensual. The study assessed inter-rater agreement using the Fleiss kappa score.ResultsThe professional work groups proposed a total of 124 items distributed across five themes: analgesia during labour, drug administration before and during labour, events in the delivery room, initial neonatal care, and perineal protection. Ultimately, 65.3% of the initial 124 items were deemed relevant by both the experts and the expectant mothers. Notably, the most significant differences in consensus centered around analgesia and the complexity of information. Non-medicinal analgesic methods were favored by mothers-to-be but not by professionals. Conversely, detailed information on delayed cord clamping were favored by experts.ConclusionsA modified Delphi consensus was used to create with expectant mothers a decision aid tool to help them write their birth projects, addressing five main topics that are frequently reported in the literature. We now need to test this tool in clinical practice to assess its relevance in routine obstetrics consultation.

Maladaptive daydreaming should be included as a dissociative disorder in psychiatric manuals: position paper.

Maladaptive daydreaming is a distinct syndrome in which the main symptom is excessive vivid fantasising that causes clinically significant distress and functional impairment in academic, vocational and social domains. Unlike normal daydreaming, maladaptive daydreaming is persistent, compulsive and detrimental to one's life. It involves detachment from reality in favour of intense emotional engagement with alternative realities and often includes specific features such as psychomotor stereotypies (e.g. pacing in circles, jumping or shaking one's hands), mouthing dialogues, facial gestures or enacting fantasy events. Comorbidity is common, but existing disorders do not account for the phenomenology of the symptoms. Whereas non-specific therapy is ineffective, targeted treatment seems promising. Thus, we propose that maladaptive daydreaming be considered a formal syndrome in psychiatric taxonomies, positioned within the dissociative disorders category. Maladaptive daydreaming satisfactorily meets criteria for conceptualisation as a psychiatric syndrome, including reliable discrimination from other disorders and solid interrater agreement. It involves significant dissociative aspects, such as disconnection from perception, behaviour and sense of self, and has some commonalities with but is not subsumed under existing dissociative disorders. Formal recognition of maladaptive daydreaming as a dissociative disorder will encourage awareness of a growing problem and spur theoretical, research and clinical developments.

Agreement Between Nail Psoriasis Severity Index Scores by a Convolutional Neural Network and Dermatologists: A Retrospective Study at an Academic New York City Institution.

Nail psoriasis (NP) affects up to 90% and 86% of patients with cutaneous psoriasis and psoriatic arthritis, respectively, with a significant impact on quality-of-life. The Nail Psoriasis Severity Index (NAPSI) is infrequently used in clinical practice owing to its labor-intensive nature and variable interobserver reliability. The objective of this study was to assess performance and inter-reader agreement between artificial intelligence (AI)-determined NAPSI scores and dermatologist-assigned scores. This cross-sectional study used clinical images of psoriatic fingernails captured retrospectively at a specialized nail clinic in New York City. A convolutional neural network (CNN) model was trained and utilized for NAPSI classification of psoriatic fingernail clinical images, with seven dermatologist nail experts scoring identical images. The primary outcome was the interclass correlation coefficient (ICC), using a one-way analysis of variance (ANOVA) fixed effects model for the single-rater absolute agreement, between the average NAPSI score determined by the dermatologists and the AI. In total, 240 images of psoriatic fingernails were included. The ICC for overall NAPSI, matrix (NAPSIm), and bed (NAPSIb) scores among the dermatologists were 0.43 (95% confidence interval [CI] 0.33-0.55), 0.56 (95% CI 0.46-0.67), and 0.53 (95% CI 0.43-0.65), respectively. Comparing the AI algorithm-assigned NAPSI, NAPSIm, and NAPSIb scores with the average dermatologist-assigned scores, ICCs were 0.81 (95% CI 0.74-0.86), 0.75 (95% CI 0.65-0.82), and 0.81 (95% CI 0.74-0.86), respectively. We found an excellent correlation between AI-derived NAPSI scores and dermatologist-assigned scores, underscoring the potential of CNNs to improve accuracy and reliability in NAPSI scoring. The limitations of this study include the small sample size, undetermined CNN diagnostic accuracy, incomplete data, and potential racial/ethnic minority group underrepresentation.

Two-dimensional Speckle Tracking Echocardiography and Fetal Cardiac Performance During Fetoscopic Repair of Myelomeningocele.

Two-dimensional Speckle Tracking Echocardiography and Fetal Cardiac Performance During Fetoscopic Repair of Myelomeningocele.

A comparative study of digital and conventional occlusal indicators: Accuracy and reliability of the T-Scan Novus, wax occlusogram, and articulating silk in clinical application.

A comparative study of digital and conventional occlusal indicators: Accuracy and reliability of the T-Scan Novus, wax occlusogram, and articulating silk in clinical application.

Splenial Angle on Axial T1 and FLAIR MRI Images and Idiopathic Normal Pressure Hydrocephalus.

The splenial angle (SA), measured on axial DTI colour fractional anisotropy MRI, outperformed the callosal angle (CA) in predicting idiopathic normal pressure hydrocephalus (NPH) patients from those with Alzheimer's dementia, Parkinson's disease (PD) and healthy controls (HC). We investigated its reliability and classification performance on more commonly acquired T1 MPRAGE and FLAIR images. SA was measured on axial MPRAGE and FLAIR images in 57 subjects (19 NPH, PD and HC each) by two raters, and compared across groups. Receiver operating characteristics (ROC) analysis was used to assess its classification performance differentiating NPH from non-NPH groups, in comparison to the CA. Inter-rater reliability for SA were excellent (intraclass correlation coefficients ≥0.91). SA was effective in differentiating NPH from non-NPH patients on MPRAGE and FLAIR images (p < 0.001). Its ROC curves showed excellent performance classifying NPH from HC (AUC 1) and PD (AUC >0.93) groups, and were highly comparable to those for CA (1; 0.947). Angles wider than 60° and narrower than 45° robustly (100%) excluded and predicted NPH from HC, respectively. The narrower 45° cutoff yielded better sensitivity (84.2-89.5%) in differentiating NPH from PD patients. The SA on MPRAGE/FLAIR images showed excellent inter-rater reliability and classification performance predicting NPH from non-NPH groups, rivalling those of the CA. The SA on MPRAGE and FLAIR images is reproducible and shows excellent diagnostic performance differentiating NPH from non-NPH groups, with potential to replace the CA in NPH screening given its accessibility on routine axial neuroimaging.

Investigation of Pressure Injuries With Visual ChatGPT Integration: A Descriptive Cross-Sectional Study.

This study aimed to assess the performance of Visual ChatGPT in staging pressure injuries using real patient images, compare it to manual staging by expert nurses, and evaluate its applicability as a supportive tool in wound care management. This study used a descriptive and comparative cross-sectional design. The study analysed 155 patient pressure injury images from a hospital database, staged by expert nurses and Visual ChatGPT using the National Pressure Injury Advisory Panel guidelines. Visual ChatGPT's performance was tested in two scenarios: with images only and with images plus wound characteristics. Diagnostic performance was evaluated, including sensitivity, specificity, accuracy, and inter-rater agreement (Kappa). Expert nurses demonstrated superior accuracy and specificity across most pressure injury stages. Visual ChatGPT performed comparably in early-stage pressure injuries, especially when wound characteristics were included, but struggled with unstageable and deep-tissue pressure injuries. Visual ChatGPT shows potential as an artificial intelligence tool for pressure injury staging and wound management in nursing. However, improvements are necessary for complex cases, ensuring that artificial intelligence complements clinical judgement. Visual ChatGPT can serve as an innovative artificial intelligence tool in clinical settings, assisting less experienced nurses and those in areas with limited wound care specialists in staging and managing pressure injuries. The STROBE checklist was followed for reporting cross-sectional studies in line with the relevant EQUATOR guidelines. No patient or public contribution.

Relationship between the time course of Burden of Amplitudes and Epileptiform Discharges scores and relapse in children with infantile epileptic spasms syndrome.

For patients with infantile epileptic spasms syndrome (IESS) who have achieved remission of epileptic spasms (ES), indicators of how well the electroencephalographic (EEG) state should be maintained during follow-up are not available. We hypothesized that the time course of the Burden of Amplitudes and Epileptiform Discharges (BASED) score after ES remission is associated with ES relapse. This study aimed to investigate the association between ES relapse and BASED scores at the time of initial ES remission and during the subsequent follow-up period. We collected clinical and digital EEG data at four hospitals from patients with IESS who achieved initial ES remission. The BASED score was evaluated using EEGs obtained before remission, during remission, and after remission. The scoring was performed independently by the three reviewers, who were blinded to each other's scores. We analyzed the associations between clinical factors, BASED score, maximum BASED score, and ES relapse. Data were collected from 44 patients aged 4-8 months at disease onset, which included 33 nonrelapsed and 11 relapsed patients. We assessed the BASED score of 262 EEGs. Structural etiology (p = .002) and the development of seizure other than ES (p = .04) were positively associated with ES relapse. Whereas BASED score before and at remission was not associated with relapse, a maximum BASED score of ≥3 during the postremission period was significantly associated with relapse (p < .001, odds ratio = 100). In multivariate analysis, only maximum BASED score ≥3 during this period remained significantly associated with relapse (p = .001, odds ratio = 76). The interrater reliability of the BASED score was high, with a quadratically weighted kappa coefficient of .93. A maximum BASED score of ≥3 during postremission indicates a risk for ES relapse in patients with IESS.

HPV-related cancer prevention among people experiencing housing instability: A systematic review.

HPV-related cancer is highly preventable through HPV vaccination and cancer screening, but people experiencing homelessness or housing instability (PEH) may not engage in these behaviors due to conflicting priorities. This systematic review synthesized and estimated HPV-related cancer prevention behaviors among PEH. Using PRISMA guidelines, articles published before 2023 were located via PubMed, Ovid/Medline, CINAHL, and Embase. Full-text, peer-reviewed studies that measured HPV-related cancer prevention in any sample of people experiencing homelessness were included. Two researchers abstracted data independently, with high interrater reliability (>90%). Results were narratively summarized with consensus, and proportions were compared using preventive behavior. After reviewing 405 articles, we included 18 articles from the U.S. from 1998-2022. There were 6,674 people (e.g., women, youth, men who have sex with men) experiencing homelessness assessed for HPV-related cancer prevention behaviors. Pooled prevalence was approximately 59.8% (±6%) for cervical cancer screening in the last 3 years and 42.9% (±4.7%) for HPV vaccination initiation. Other factors related to housing instability and HPV-related cancer prevention included gender, sexual trauma, and procedural pain, with mixed results for housing status and HPV knowledge. Findings demonstrate the varied adherence to HPV-related cancer prevention, with rates consistently below recommended World Health Organization guidelines. Future studies should adjust for specific risk factors in modeling that may be associated with or modified by the effects of homelessness and evaluate upstream prevention (e.g., vaccination) and other types of HPV-related cancer (e.g., anal cancer).