Interobserver Agreement Kappa Coefficient Research Articles

Evaluation of the Quality and Reliability of YouTube Videos on Gender Dysphoria

Purpose: Many people search for information on YouTube on almost every medical topic. The aim of this study was to assess the quality and reliability of YouTube videos concerning Gender Dysphoria. Methods: We searched for Gender Dysphoria on YouTube on June 7, 2023 and conducted a detailed evaluation of the first 100 unique English videos by two expert observers. The videos were evaluated using modified DISCERN scale, Global Quality Scale (GQS), and Video Power Index (VPI). Results: The kappa coefficient for interobserver agreement was 0.892. For all 100 videos, the median value of the modified DISCERN score was 2.5 (1-4.8), and GQS score was 3 (1-5), and 68% of the videos rated as poor to moderate reliability and quality (modified DISCERN score ≤3, GQS ≤3). Reliable videos were uploaded by professional sources in a higher rate than unreliable videos (48% vs 12%, p

Breakthrough of dual-phase CT angiography features of carotid web and its correlation with ischemic stroke

PurposeTo investigate the diagnostic value of dual phase CT angiography (CTA) in carotid web and its correlation with ischemic stroke. MethodsThe imaging data of 726 patients with cervical CTA from January 2015 to November 2019 in Taizhou People's hospital were retrospectively and consecutively analyzed. A total of 16 patients with 23 carotid webs were obtained. The location, morphology and clinical data of 16 patients were observed. Carotid web was identified by two experienced radioimaging experts according to the characteristics of a thin intraluminal filling defect along the posterior wall of the carotid bulb on sagittal CTA and a septum structure in arteries on axial CTA. ResultsIn the arterial phase, 23 carotid webs in 16 patients showed membrane like separation in the lumen of the posterior wall of the carotid bulb, and one web extended into the internal and external carotid arteries in a "Y" shape. There were 9 males and 7 females. In venous phase, 16 carotid webs showed linear enhancement, and 15 sites showed delayed emptying of contrast medium at the lateral margin. Five patients were acute or chronic ischemic stroke. The kappa coefficient for interobserver agreement in diagnosing carotid web was 0.79. ConclusionDual-phase CTA is effective and reliable method to identifying carotid webs, which may be associated with ischemic stroke.

Pediatric thrower's elbow: maturation-dependent MRI findings in symptomatic baseball players.

Elbow pain is common among youth baseball players and elbow MRI is increasingly utilized to complement the clinical assessment. To characterize, according to skeletal maturity, findings on elbow MRI from symptomatic youth baseball players. This IRB-approved, HIPAA-compliant retrospective study included pediatric (<18years of age) baseball players with elbow pain who underwent MRI examinations between 2010 and 2021. Two radiologists, blinded to the outcome, independently reviewed examinations to categorize skeletal maturity and to identify osseous and soft tissue findings with consensus used to resolve discrepancies. Findings were compared between skeletally immature and mature patients and logistic regression models identified predictors of surgery. This study included 130 children (115 boys, 15 girls): 85 skeletally immature and 45 mature (12.8±2.3 and 16.2±1.0years, respectively, p<0.01). Kappa coefficient for interobserver agreement on MRI findings ranged from 0.64 to 0.96. Skeletally immature children, when compared to mature children, were more likely to have elbow effusion (27%, 23/85 vs 9%, 4/45; p=0.03), medial epicondyle marrow edema (53%, 45/85 vs 16%, 7/45; p<0.01), avulsion fracture (19%, 16/85 vs 2%, 1/45; p=0.02), and juvenile osteochondritis dissecans (OCD, 22%, 19/85 vs 7%, 3/45; p=0.04), whereas skeletally mature children were more likely to have sublime tubercle marrow edema (49%, 22/45 vs 11%, 9/85; p<0.01) and triceps tendinosis (40%, 18/45 vs 20%, 17/85; p=0.03). Intra-articular body (OR=4.2, 95% CI 1.5-47.8, p=0.02) and osteochondritis dissecans (OR=3.7, 95% CI 1.1-11.9, p=0.03) were independent predictors for surgery. Differential patterns of elbow MRI findings were observed among symptomatic pediatric baseball players based on regional skeletal maturity. Intra-articular body and osteochondritis dissecans were independent predictors of surgery.

Etiologic and prognostic value of external carotid artery thrombus detection during endovascular therapy for anterior circulation proximal occlusions.

An early understanding of stroke mechanism may improve treatment and outcome in patients presenting with large vessel occlusion stroke (LVOS) treated with mechanical thrombectomy (MT). We aimed to investigate whether spontaneous external carotid artery (ECA) embolism detection during MT is associated with stroke etiology and clinical outcome. We retrospectively reviewed our prospectively maintained institutional database including consecutive patients with anterior circulation LVOS treated with MT between January 2015 and August 2020. An ECA embolus was detected in 68 of 1298 patients (5.2%). The kappa coefficient for interobserver agreement was 0.89 (95% confidence interval [CI] 0.82-0.95). ECA embolism was significantly associated with intracranial internal carotid artery (ICA) occlusion (p< 0.001), cardioembolic etiology (p< 0.001) and a lower clot burden score (p< 0.001). Day-1 variation of National Institutes of Health Stroke Scale score (adjusted odds ratio [OR] -2.7, 95% CI -4.9 to 0.3; p= 0.021) and delta Alberta Stroke Program Early Computed Tomography Score (adjusted OR 0.9, 95% CI 0.2 to 1.5; p= 0.004) were worse among patients with ECA emboli. There was no significant difference in 90-day functional outcome between groups (adjusted OR 0.8, 95% CI 0.42 to 1.52; p= 0.50). In patients with anterior circulation LVOS treated with MT, ECA embolism was significantly associated with cardioembolic etiology, high thrombus burden and proximal intracranial ICA occlusions. This underexplored angiographic pattern might provide a valuable etiologic clue to the underlying cause of anterior circulation LVOS and may also help determine the appropriate revascularization strategy.

Validation of the AO Spine Sacral Classification System: Reliability Among Surgeons Worldwide

To (1) demonstrate that the AO Spine Sacral Classification System can be reliably applied by general orthopaedic surgeons and subspecialists universally around the world and (2) delineate those injury subtypes that are most difficult to classify reliably to refine the classification before evaluating clinical outcomes. Agreement study. All-level trauma centers, worldwide. One hundred seventy-two members of the AO Trauma and AO Spine community. The AO Sacral Classification System was applied by each surgeon to 26 cases in 2 independent assessments performed 3 weeks apart. Interobserver reliability and intraobserver reproducibility. A total of 8097 case assessments were performed. The kappa coefficient for interobserver agreement for all cases was 0.72/0.75 (assessment 1/assessment 2), representing substantial reliability. When comparing classification grading (A/B/C) regardless of subtype, the kappa coefficient was 0.84/0.85, corresponding to excellent reliability. The kappa coefficients for interobserver reliability were 0.95/0.93 for type A fractures, 0.78/0.79 for type B fractures, and 0.80/0.83 for type C fractures. The overall kappa statistic for intraobserver reliability was 0.82 (range 0.18-1.00), representing excellent reproducibility. When only evaluating morphology type (A/B/C), the average kappa value was 0.87 (range 0.18-1.00), representing excellent reproducibility. The AO Spine Sacral Classification System is universally reliable among general orthopaedic surgeons and subspecialists worldwide, with substantial interobserver and excellent intraobserver reliability.

An intact boundary between the tumor and inner hypoechoic layer discriminates T1 lesions among sessile elevated gallbladder cancers.

The depth of invasion determines the surgical method for treating gallbladder cancer (GBC). However, the preoperative correct diagnosis of invasion depth, especially discrimination of T1 lesions among sessile elevated GBCs, is difficult. We investigated the utility of preoperative endoscopic ultrasound (EUS) findings for diagnosing the invasion depth. We studied a sessile elevated GBC specimen diagnosed as a T1 lesion before developing our study protocol. EUS evidenced an intact boundary between the tumor and the inner hypoechoic layer (the intact boundary sign). To evaluate the potential of using this sign to diagnose T1 GBC as a primary outcome indicator, we retrospectively analyzed patients who underwent surgical resection of sessile elevated GBCs between April 2009 and March 2020. Of the 26 surgically resected sessile elevated GBC specimens, 20 were included and six were excluded due to difficulty in evaluating the overall tumor or layer structure. The Kappa coefficient for interobserver agreement regarding the intact boundary sign was 0.733. The sensitivity and specificity of the sign for diagnosing T1 lesions were 0.857 and 1.000, respectively. This new EUS finding could guide the accurate diagnosis of T1 lesions in patients with sessile elevated GBC.

Optimization of paranasal sinus CT procedure: Ultra-low dose CT as a roadmap for pre-functional endoscopic sinus surgery.

To assess image quality and radiation dose associated with ultra-low dose CT protocol for patients with benign paranasal sinus diseases undergoing functional endoscopic surgery (FESS). We scanned the head portion of Alderson RANDO phantom on a second generation, dual-source, multidetector-row CT scanner (Siemens Definition Flash) using standard-dose and five low-dose protocols. Two radiologists assessed the image quality for each protocol to determine best ultra-low-dose protocols for imaging patients with benign paranasal sinus diseases undergoing FESS. The ultra-low-dose CT protocols were then used for scanning. Thereafter, 40 adult patients (age range 18-54years, M:F 23:17) were scanned with the four low dose scanning protocols (10 patients per protocol). On both transverse and coronal reformatted CT images, two radiologists assessed visibility of key anatomic landmarks for FESS on a 2-point scale (1=clear and complete visualization; 2=suboptimal visualization). Data were analyzed with descriptive statistics and Cohen's kappa coefficient for interobserver agreement. In phantom study, the lowest dose scan protocol (CTDIvol 2.1mGy, 70kV, 75 mAs) was unacceptable due to poor image quality. For patient studies, both radiologists gave acceptable image quality scores for ultra-low-dose scan protocol with axial scan mode, automatic tube potential selection and tube current modulation (CTDIvol 2.2mGy; DLP 22.9mGy.cm) with up to 60% lower dose compared to prior standard-dose CT (CTDIvol 5.3mGy; DLP 73.5mGy.cm). Ultra-low-dose CT protocol provides sufficient image quality for scanning patients undergoing functional endoscopic surgery for benign paranasal sinus diseases.

Detection of Carotid Webs by CT Angiography, High-Resolution MRI, and Ultrasound.

We sought to examine carotid webs (intimal variant fibromuscular dysplasia) by studying their clinical features and imaging profiles. All patients (n = 893) of the Department of Neurology at Beijing Tiantan Hospital between January and December 2019 were retrospectively reviewed for computed tomography angiography (CTA), high-resolution magnetic resonance imaging (HRMRI), and Doppler ultrasound data. Carotid webs were identified by two experienced neuroimaging experts according to the characteristics of a thin intraluminal filling defect along the posterior wall of the carotid bulb on sagittal CTA and a septum structure in arteries on axial CTA. We found eight carotid web patients by CTA and Doppler ultrasound. Four of eight (50%) carotid webs were observed in the bilateral carotid arteries and other four of eight (50%) were ipsilateral. The mean age of the 8 patients was 50.75 (range 38-65) years; two were in women. Six of 8 patients (75%) with carotid webs had acute ischemic stroke. Two-thirds of patients with ischemic stroke were treated with carotid revascularization. Doppler ultrasound indicated that the septum projected into the carotid arteries in all patients. Half of the carotid web patients underwent HRMRI, showing features consistent with CTA findings. The Cohen's kappa coefficient for interobserver agreement in diagnosing carotid webs was .76. Doppler ultrasound combined with CTA and HRMRI is effective and reliable method to identifying carotid webs, which may be associated with stroke.

Magnifying endoscopy with narrow-band image for diagnosing diffuse type of gastric antral vascular ectasia in cirrhotic patients.

Gastric antral vascular ectasia (GAVE) and portal hypertensive gastropathy (PHG) can cause gastrointestinal bleeding in cirrhotic patients. Distinguishing diffuse-type GAVE and severe PHG is important but difficult by conventional endoscopy and endoscopic biopsy. The aim of this study is to evaluate the value of magnifying endoscopy with narrow-band image for diagnosing diffuse-type GAVE in cirrhotic patients. From January 2010 to December 2013, cirrhotic patients with diffuse red spots of stomach in suspicion of diffuse-type GAVE on conventional endoscopy in a tertiary medical center were included. The detection of diffuse red spots on magnifying endoscopy with narrow-band image (NBI) was classified into ring-pattern which suggested GAVE and mosaic-pattern which suggested non-GAVE. The golden diagnosis of GAVE was based on histological criteria of GAVE score ≥3 by any one of two endoscopic sessions. Total 27 cirrhotic patients were included. Twenty-two patients reached the diagnosis of GAVE and five patients were diagnosed of non-GAVE by histology. The diagnostic rate of conventional endoscopy was 81.5% (22/27). The positive rate of initial endoscopic biopsy was 77.2%. On magnifying endoscopy with NBI, the sensitivity, specificity, positive, negative predicted rate and accuracy of ring-pattern for the diagnosis of GAVE were 100, 90, 96.4, 100 and 97.3%. Kappa coefficient of inter-observer agreement for differentiating the ring and mosaic-pattern was 0.92. The efficacy and accuracy of magnifying endoscopy with NBI for diagnosing diffuse-type GAVE in cirrhotic patients have been demonstrated. It can avoid repeated endoscopy to confirm diagnosis and obviate the invasive biopsy in cirrhotic patients.

Systematic review with meta-analysis: ultra-thin gastroscopy compared to conventional gastroscopy for the diagnosis of oesophageal varices in people with cirrhosis.

Haemorrhage from ruptured oesophageal varices is a common cause of death in people with cirrhosis. Guidelines recommend screening for varices at time of cirrhosis diagnosis and throughout the course of the disease. Conventional gastroscopy is the criterion standard for variceal screening; however, is invasive, costly, and carries risks related to use of sedation. Ultra-thin gastroscopy (using endoscopes with a shaft diameter ≤6mm) has been proposed as an alternative method of variceal screening that mitigates these risks. To determine the diagnostic accuracy of ultra-thin gastroscopy compared to conventional gastroscopy for the diagnosis of varices in people with cirrhosis. MEDLINE, EMBASE and Cochrane library databases were searched for studies that evaluated the accuracy of ultra-thin gastroscopy compared to conventional gastroscopy in the diagnosis of oesophageal varices. Ten studies, 7 in known cirrhosis, with 752 participants were included in this systematic review. The overall prevalence of oesophageal varices was 42%. On bivariate modelling, pooled estimates of sensitivity and specificity were 98% (95% CI 93%-99%) and 96% (95% CI 91%-99%) respectively. The positive and negative likelihood ratios were 28 (95% CI 10.7-73.2) and 0.02 (95% CI 0.01-0.72) respectively. Kappa coefficient for inter-observer agreement for any varices ranged from 0.45 to 0.90. No serious adverse events related to ultra-thin gastroscopy were reported. Ultra-thin gastroscopy is accurate in the diagnosis of oesophageal varices, safe and well tolerated. It is a valid alternative to conventional gastroscopy for the screening and surveillance of varices in people with cirrhosis.

Real-time safety audits in a neonatal unit

Abstract Background Random audits are a safety tool to help in the prevention of adverse events, but they have not been widely used in hospitals. The aim of the study was to determine, through random safety audits, whether the information and material required for resuscitation were available for each patient in a neonatal intensive care unit and determine if factors related to the patient, time or location affect the implementation of the recommendations. Material and methods Prospective observational study conducted in a level III-C neonatal intensive care unit during the year 2012. The evaluation of written information on the endotracheal tube, mask and ambu bag prepared of each patient and laryngoscopes of the emergency trolley were included within a broader audit of technological resources and study procedures. The technological resources and procedures were randomly selected twice a week for audit. Appropriate overall use was defined when all evaluated variables were correctly programmed in the same procedure. Results A total of 296 audits were performed. The kappa coefficient of inter-observer agreement was 0.93. The rate of appropriate overall use of written information and material required for resuscitation was 62.50% (185/296). Mask and ambu bag prepared for each patient was the variable with better compliance (97.3%, P = .001). Significant differences were found with improved usage during weekends vs. working-day (73.97 vs. 58.74%, P = .01), and the rest of the year vs. 3rd quarter (66.06 vs. 52%, P = .02). Conclusions Only in 62.5% of cases was the information and the material necessary to attend to a critical situation urgently easily available. Opportunities for improvement were identified through the audits.

Does pre-operative magnetic resonance imaging of the lumbar multifidus muscle predict clinical outcomes following lumbar spinal decompression for symptomatic spinal stenosis?

To investigate whether pre-operative magnetic resonance imaging (MRI) of the lumbar multifidus muscle (LMM) would predict clinical outcomes following lumbar spinal decompression for symptomatic spinal stenosis. A prospective cohort of patients with symptomatic neurogenic claudication, documented spinal stenosis on pre-operative MRI underwent spinal decompression. All subjects completed standardised outcome measures (Core Outcome Measures Index (COMI), Oswestry Disability Index (ODI v2.1) pre-operatively, 1 and 2years post-surgery. Surgery was performed using a standardised lumbar spinous process osteotomy for access, followed by a decompression of the central canal, lateral recess and foraminal zones as indicated by the pre-operative MRI. Lumbar MRI scans were evaluated by two independent observers who assessed the axial CSA of the LMM bilaterally and the degree of muscle atrophy according to the Kader classification (2000). Changes in COMI and ODI scores at 1 and 2years were investigated for statistically significant correlations with CSA of LMM and Kader grading. Statistical analyses utilised Student's t test, kappa coefficient for inter-observer agreement and Bland-Altman Limits of Agreement (BALOA). 66 patients (41 female) aged between 29 and 86years underwent single-level decompression in 44, two-level decompression in 16 and three-level decompression in 6 cases. No significant correlation was observed between improvements in ODI and COMI relative to age, degree of stenosis, posterior fat thickness or psoas CSA. Those subjects with the greatest LMM atrophy relative to psoas CSA and L5 vertebral body area on pre-operative MRI had the least absolute improvement in both ODI and COMI scores (p=0.006). Reduced LMM CSA (<8.5cm2) and muscle atrophy were associated with less favourable outcomes following lumbar spinal decompression. Pre-operative CSA of LMM appeared to be a more reliable predictor of post-operative clinical outcomes compared to the Kader Grading Score. This is the first study to investigate the prognostic value of pre-operative MRI appearance and CSA of LMM with respect to post-operative outcome following lumbar decompression surgery. Healthy pre-operative LMM is associated with better outcomes following lumbar spinal decompression.

Auditorías de seguridad en tiempo real en una unidad neonatal

BackgroundRandom audits are a safety tool to help in the prevention of adverse events, but they have not been widely used in hospitals. The aim of the study was to determine, through random safety audits, whether the information and material required for resuscitation were available for each patient in a neonatal intensive care unit and determine if factors related to the patient, time or location affect the implementation of the recommendations. Material and methods:Prospective observational study conducted in a level III-C neonatal intensive care unit during the year 2012. The evaluation of written information on the endotracheal tube, mask and ambu bag prepared of each patient and laryngoscopes of the emergency trolley were included within a broader audit of technological resources and study procedures. The technological resources and procedures were randomly selected twice a week for audit. Appropriate overall use was defined when all evaluated variables were correctly programmed in the same procedure. ResultsA total of 296 audits were performed. The kappa coefficient of inter-observer agreement was 0.93. The rate of appropriate overall use of written information and material required for resuscitation was 62.50% (185/296). Mask and ambu bag prepared for each patient was the variable with better compliance (97.3%, P=.001). Significant differences were found with improved usage during weekends versus working-day (73.97 vs. 58.74%, P=.01), and the rest of the year versus 3rd quarter (66.06 vs. 52%, P=.02). ConclusionsOnly in 62.5% of cases was the information and the material necessary to attend to a critical situation urgently easily available. Opportunities for improvement were identified through the audits.

Accuracy of digitally enhanced images compared with unprocessed digital images in the detection of external root resorption

This study was for comparing the accuracy of processed digital images (reverse-contrast and colorization) with that of unprocessed digital images in detection of external root resorption (ERR). Eighty single-rooted human teeth were selected for this study. Mild, moderate, and severe ERR were simulated on 20 teeth each, and 20 were left untreated. Digital images using the paralleling technique were made, and three types of images were finally produced: unprocessed, reverse-contrast, and colorized. Three experienced dentists examined the images. The Wilson confidence intervals were calculated to analyze the diagnostic data. The kappa statistic was used to determine interobserver agreement. For unprocessed images, the rate of correct classification of mild and moderate to severe ERR was 88.3 and 80.0 %, respectively. The corresponding rate for reverse-contrast images was 81.7 and 80.0 %, and that for colorized images was 93.3 and 80.0 %, respectively. The sensitivity of unprocessed images in the detection of mild and moderate to severe ERR was 0.93 and 0.84, respectively. The corresponding sensitivity for reverse-contrast images was 0.83 and 0.84, and that for colorized images was 0.93 and 0.84, respectively. The specificity of unprocessed, reverse-contrast, and colorized images was 0.90, 0.92, and 1.00, respectively. The kappa coefficient for interobserver agreement was 0.86 for unprocessed images, 0.88 for reverse-contrast images, and 0.89 for colorized images. The difference between the sensitivity and specificity of unprocessed, reverse-contrast, and colorized images was not statistically significant (p > 0.05). The three techniques were of similar and desirable accuracy in detection of ERR.

Robust and Reproducible Quantification of the Extent of Chest Radiographic Abnormalities (And It’s Free!)

RationaleObjective, reproducible quantification of the extent of abnormalities seen on a chest radiograph would improve the user-friendliness of a previously proposed severity scoring system for pulmonary tuberculosis and could be helpful in monitoring response to therapy, including in clinical trials.MethodsIn this study we report the development and evaluation of a simple tool using free image editing software (GIMP) to accurately and reproducibly quantify the area of affected lung on the chest radiograph of tuberculosis patients. As part of a pharmacokinetic study in Lima, Peru, a chest radiograph was performed on patients with pulmonary tuberculosis and this was subsequently photographed using a digital camera. The GIMP software was used by two independent and trained readers to estimate the extent of affected lung (expressed as a percentage of total lung area) in each radiograph and the resulting radiographic SCORE.Results56 chest radiographs were included in the reading analysis. The Intraclass correlation coefficient (ICC) between the 2 observers was 0.977 (p<0.001) for the area of lung affected and was 0.955 (p<0.001) for the final score; and the kappa coefficient of Interobserver agreement for both the area of lung affected and the score were 0.9 (p<0.001) and 0.86 (p<0.001) respectively.ConclusionsThis high level of between-observer agreement suggests that this freely available software could constitute a simple and useful tool for robust evaluation of individual and serial chest radiographs.

Auditing of Monitoring and Respiratory Support Equipment in a Level III-C Neonatal Intensive Care Unit.

Background. Random safety audits (RSAs) are a safety tool but have not been widely used in hospitals. Objectives. To determine the frequency of proper use of equipment safety mechanisms in relation to monitoring and mechanical ventilation by performing RSAs. The study also determined whether factors related to the patient, time period, or characteristics of the area of admission influenced how the device safety systems were used. Methods. A prospective observational study was conducted in a level III-C Neonatal Intensive Care Unit (NICU) during 2012. 87 days were randomly selected. Appropriate overall use was defined when all evaluated variables were correctly programmed in the audited device. Results. A total of 383 monitor and ventilator audits were performed. The Kappa coefficient of interobserver agreement was 0.93. The rate of appropriate overall use of the monitors and respiratory support equipment was 33.68%. Significant differences were found with improved usage during weekends, OR 1.85 (1.12–3.06, p = 0.01), and during the late shift (3 pm to 10 pm), OR 1.59 (1.03–2.4, p = 0.03). Conclusions. Equipment safety systems of monitors and ventilators are not properly used. To improve patient safety, we should identify which alarms are really needed and where the difficulties lie for the correct alarm programming.

PO-0613 Real Time Safety Auditing Of Monitoring And Respiratory Support In A Tertiary Neonatal Intensive Care Unit

<h3>Background</h3> Real time safety auditing (RTSA) has not been widely used in hospitals. There is insufficient information on its use as a tool for patient safety. <h3>Aim</h3> To determine the frequency of appropriate use of the security systems in technological equipment for monitoring and respiratory support through RTSA. To estimate whether the characteristics of the patient, time or location influence the frequency of appropriate use. <h3>Methods</h3> Prospective observational study conducted during 2012 in a tertiary NICU. 115 days were randomly selected. Two monitoring or respiratory devices were randomly selected each study day. Information about time, location and patient characteristics was collected. Appropriate use was defined as all evaluated items correctly programmed on the same device. <h3>Results</h3> A total of 94 pulse oximeter, 104 multi-measurement monitor, 53 conventional ventilator, 64 high frequency oscillatory ventilator and 68 CPAP audits were performed. Kappa coefficient of inter-observer agreement was 0.93. Audits revealed appropriate use of equipment in 33.68% of cases. During non-working days it was 43.02% compared to 30.98% on working days (p 0.03). During afternoon shifts it was 38.65% compared to 30% on morning shifts (p 0.07). Patient characteristics, location and month did not have a significant influence. In the adjusted analysis the OR of appropriate use for non-working days was 1.85 (1.11–3.06) and for afternoon shifts 1.59 (1.03–2.47). <h3>Conclusions</h3> Frequency of appropriate use of security systems in the equipment surveyed was low. Surprisingly, when there are fewer doctors in the unit (non-working days and afternoons) the use of technology improves.

Intraobserver and Interobserver Variability in Diagnosing Scapholunate Dissociation by Cineradiography

To evaluate the intraobserver and interobserver variability in diagnosing scapholunate dissociation (SLD) by wrist cineradiography. A musculoskeletal radiologist, hand surgeon, and trauma surgeon assessed the records of 50 consecutive wrist cineradiographies performed in 25 patients. Fluoroscopy was performed on the unaffected and affected wrist and consisted of radiographer-controlled passive flexion-extension and passive radial-ulnar deviation in both posteroanterior and lateral projections. To determine the intraobserver variability, the 3 reviewers reassessed all wrist cineradiographies 6 months after their first assessment. The kappa coefficient for interobserver agreement was calculated using the jackknife method. The Cohen kappa was used to assess intraobserver variability. The interobserver variability for diagnosing SLD by cineradiography was excellent (κ = 0.84). The intraobserver variability for the hand surgeon was excellent (κ = 0.80), and was good for the radiologist (κ = 0.72) and the trauma surgeon (κ = 0.76). Cineradiography is a promising and helpful, noninvasive tool for diagnosing SLD. It is widely available and has relatively low costs. Conventional radiographs remain essential in the primary workup for suspected SLD. However, we recommend cineradiography when an SLD is clinically suspected. Diagnostic III.

Reproducibility in Echocardiographic Two‐ and Three‐Dimensional Mitral Valve Assessment

Three-dimensional transesophageal echocardiography (3DTEE) has been demonstrated to provide more accurate information than two-dimensional transesophageal echocardiography (2DTEE) in the localization of mitral valve prolapse (MVP). However, most studies have been single-rater studies. Few results were tested for inter-observer variability with a single second rater. This multicenter study aimed to determine reliability of 2D and 3DTEE mitral valve evaluations by calculating inter-observer agreement between various echocardiographers. Fifteen observers from 4 institutions in Germany and Switzerland interpreted 2D and 3DTEE images from 6 patients selected to represent a large spectrum of MVP diversity. Surgical findings served as reference. Individual assessments of MVP and ruptured chordae tendineae (ChR) pathology were compared by calculating Randolph's free-marginal multirater kappa coefficient. Accuracy of MVP evaluation with 3DTEE was 83.9%, CI [81.0%; 86.8%] and 78.7% CI [76.6% 80.8%] with 2DTEE. Flail leaflets with chordal ruptures were described correctly in 91.1%, CI [85.8, 96.4] with 3D compared to 71.1%, CI [65.0, 77.2] with 2DTEE. The multirater kappa coefficient of inter-observer agreement among all 15 observers was κ = 0.65/0.58 for 3D/2D evaluation of MVP and κ = 0.70/0.54 for detection of ChR. Three-dimensional assessment of MVP was superior to 2DTEE, although the accuracy of both 3DTEE and 2DTEE was found to be lower than previously published. 3D MVP assessment is less operator dependent than 2DTEE evaluation. Although validity has been demonstrated before, we provide evidence that 3DTEE is reproducible among 15 observers and is a reliable method for MVP evaluation.

Optical coherence tomography in the assessment of suspicious oral lesions: An immediate ex vivo study

Optical coherence tomography (OCT) is an evolving optical technology that is capable of delivering real-time, high-resolution signatures of tissue. The purpose of this immediate ex vivo prospective clinical study was: (1) to assess the sensitivity and specificity of OCT on biopsy material in identifying potentially malignant and malignant oral lesions, (2) to determine the inter-observer agreement in the analysis of specific image parameters, and (3) to find out the oral epithelial thickness for different pathology groups. This prospective study involved 125 suspicious oral lesions from 125 patients. The lesions were surgically biopsied and subjected to OCT in the immediate ex vivo phase. Two independent readers (surgeon and pathologist) examined the OCT images and assessed several cellular features including keratin layer, epithelial layer, basement membrane and lamina propria, and recorded their findings using special OCT reading score. The sensitivity, specificity and accuracy of OCT to predict "the future need for surgical biopsy in case of any similar lesion" were calculated. The epithelial thickness was also measured. The degree of agreement between the two readers was recorded. The pathological diagnosis revealed that the majority of lesions demonstrated microinvasive carcinomas (n=43). Forty-one had different degree of dysplasia. Benign oral lesions were less common and included 22 keratosis, 11 non-specific lesions, 6 mucocels and 2 papillomas. Optical coherence tomography achieved a sensitivity of 85% and a specificity of 78% in the assessment of oral potentially malignant and malignant disorders. The positive and negative predictive values were 86.5% and 77.5%, respectively. The accuracy was 82% and the kappa coefficient of inter-observer agreement was 0.72 on "the need for biopsy". OCT imaging of oral lesions provided valuable information on the oral epithelial thickness. This study proposes that OCT can accurately identify wide spectrum of oral tissue pathologies. Further studies can assess the role of OCT in evaluating and guiding surgical biopsies and monitoring disease.