Prevalence And Bias Adjusted Kappa Research Articles

Validation of the NOVA score for the consumption of ultra-processed foods by young women of Medellín, Colombia.

Ultra-processed foods (UPFs) are associated with deterioration in dietary quality and the development of chronic diseases. The NOVA score, developed in Brazil to assess UPF consumption quickly and inexpensively, is adapted and validated here using a sample of 203 young women from Medellín, Colombia. Food consumption was evaluated using 24-hour dietary recall and with the NOVA-UPF score. Food items were classified using the NOVA categories. The energy consumed from UPFs and its percentage of the total energy consumed was estimated. The association between the NOVA-UPF score and the percentage of energy from UPF (%UPF/E) was evaluated. Both variables were categorized into quintiles and concordance was estimated using prevalence and bias-adjusted kappa (PABAK). A regression model was used to assess the association between the NOVA-UPF score and critical nutrients. The mean NOVA-UPF score among study participants was 4.5, with 27% of the total energy they consumed coming from UPFs. There was a positive, linear association between the NOVA-UPF score and %UPF/E (p < 0.001) and substantial agreement (PABAK = 0.75) in the classification of participants between UPF energy quintiles and NOVA-UPF score quintiles. The NOVA-UPF score was positively and significantly associated with sodium, total fat, and saturated fat intake. We conclude that the adapted NOVA-UPF score may help monitor the consumption of UPFs among young women in Medellín.

Accuracy of Wireless Pulse Oximeter on Preterm or

Monitoring heart rate (HR) and oxygen saturation (SpO2) in infants is essential in the neonatal intensive care unit. Wireless pulse oximeter technology has been advancing but with limited accuracy data on preterm infants. This observational study compared HR and SpO2 of the wireless Owlet Smart Sock 3 (OSS3) to the wired Masimo SET (Masimo) pulse oximeter in preterm or <2.5 kg infants. Twenty-eight eligible infants were enrolled. They weighed between 1.7 and 2.5 kg and were without anomalies or medical instability. OSS3 and Masimo simultaneously monitored HR and SpO2 for 60 minutes. The data were aligned by time epoch and filtered for poor tracings. The agreement was compared using the Pearson's correlation coefficient, the Bland-Altman method, average root mean square (ARMS), and prevalence and bias adjusted kappa (PABAK) analyses. Two infants' data were excluded due to motion artifacts or device failures. The corrected gestational age and current weights were 35 ± 3 weeks and 2.0 ± 0.2 kg (mean ± standard deviation), respectively. Over 21 hours of data showed that HR was strongly correlated between the two devices (r = 0.98, p < 0.001), with a difference of -1.3 beats per minute (bpm) and the limit of agreement (LOA) -6.3 to 3.4 bpm based on the Bland-Altman method. SpO2 was positively correlated between the two devices (r = 0.71, p < 0.001) with a SpO2 bias of 0.3% (LOA: -4.6 to 4.5%). The estimated ARMS of OSS3 compared with Masimo was 2.3% for SpO2 in the 70 to 100% range. The precision decreased with lower SpO2. A strong agreement (PABAK = 0.94) was between the two devices on whether SpO2 was above or below 90%. OSS3 provided comparable HR and SpO2 accuracy to Masimo in preterm or <2.5 kg infants. Motion artifacts, lack of arterial blood gas comparisons, and lack of racial and ethnic diversity are the study limitations. More OSS3 data on the Lower HR and SpO2 ranges were needed before implementing inpatient use. · Pulse oximeters are vital for monitoring preterm infants' HR and SpO2 levels.. · Limited data exist on the accuracy of the wireless OSS3 on preterm infants.. · This observational study found that the OSS3 is comparable to the Masimo SET in measuring HR and SpO2 in preterm or <2.5 kg infants..

Intra- and interobserver agreement of rectal cancer staging with MRI.

Reliable preoperative staging of rectal cancers is crucial for treatment decision making. To assess the intra- and inter-observer agreement of rectal cancer staging, including the sub-categories, with magnetic resonance imaging (MRI). The study includes 85 patients (35.3% women; mean age = 62.2 ± 11.2 years) who underwent MRI for rectal cancer staging between August 2020 and April 2021. All the stored images were evaluated independently by two radiologists with 10-15 years of experience. For intra-observer agreement, the evaluations were done two months apart. Analyses were made using kappa, prevalence and bias-adjusted kappa (PABAK), and intraclass correlation coefficient (ICC), where appropriate. There was a substantial inter-observer agreement for tumor localization (kappa = 0.665, PABAK = 0.682), mesorectal fascia invasion (kappa = 0.663, PABAK = 0.822), internal and external sphincter involvement (kappa 0.804 and 0.751, PABAK 0.859 and 0.929, respectively), and moderate to substantial agreement for M-staging (kappa = 0.451, PABAK = 0.742) and extramural vascular invasion (kappa = 0.569, PABAK = 0.741). There was also a good inter-observer agreement for T staging and N staging (ICC = 0.862, 95% confidence interval [CI] = 0.788-0.911; and ICC = 0.841, 95% CI = 0.595-0.922, respectively). As expected, intra-observer agreement was better than inter-observer agreement. Intra- and inter-observer agreement for MRI staging of rectal cancers using the structured reporting template is good.

Point of care testing using rapid automated antigen testing for SARS-COV-2 in care homes – an exploratory safety, usability and diagnostic agreement evaluation

Introduction Successful adoption of POCTs (Point-of-Care tests) for COVID-19 in care homes requires the identification of ideal use cases and a full understanding of the contextual and usability factors that affect test results and minimise biosafety risks. This paper presents a scoping-usability and test performance study of a microfluidic immunofluorescence assay for COVID-19 in care homes. Methods A mixed-methods evaluation was conducted in four UK care homes to scope usability and to assess the agreement with qRT-PCR. A dry run with luminescent dye was conducted to explore biosafety issues. Results The agreement analysis was conducted on 227 asymptomatic participants (159 staff and 68 residents) and 14 symptomatic participants (5 staff and 9 residents). Asymptomatic specimens showed 50% (95% CI:1.3%−98.7%) positive agreement and 96% (95% CI: 92.5%−98.1%) negative agreement with overall prevalence and bias-adjusted Kappa (PABAK) of 0.911 (95% CI: 0.857−0.965). Symptomatic specimens showed 83.3% (95% CI: 35.9%−99.6%) positive agreement and 100% (95% CI: 63.1%−100%) negative agreement with overall prevalence and bias-adjusted Kappa (PABAK) of 0.857 (95% CI: 0.549−1). The dry run highlighted four main sources of contamination that led to the modification of the standard operating procedures. Simulation post-modification showed no further evidence of contamination. Conclusion Careful consideration of biosafety issues and contextual factors associated with care home are mandatory for safe use the POCT. Whilst POCT may have some utility for ruling out COVID-19, further diagnostic accuracy evaluations are needed to promote effective adoption.

Interrater Reliability of National Institutes of Health Traumatic Brain Injury Imaging Common Data Elements for Brain Magnetic Resonance Imaging in Mild Traumatic Brain Injury.

The National Institutes of Health/National Institute of Neurological Disorders and Stroke (NIH-NINDS) Traumatic Brain Injury (TBI) Imaging Common Data Elements (CDEs) are standardized definitions for pathological intracranial lesions based on their appearance on neuroimaging studies. The NIH-NINDS TBI Imaging CDEs were designed to be as consistent as possible with the U.S. Food and Drug Administration (FDA) definition of biomarkers as "an indicator of normal biological processes, pathogenic processes, or biological responses to an exposure or intervention." However, the FDA qualification process for biomarkers requires proof of reliable biomarker test measurements. We determined the interrater reliability of TBI Imaging CDEs on subacute brain magnetic resonance imaging (MRI) performed on 517 mild TBI patients presenting to 11 U.S. level 1 trauma centers. Three U.S. board-certified neuroradiologists independently evaluated brain MRI performed 2 weeks post-injury for the following CDEs: traumatic axonal injury (TAI), diffuse axonal injury (DAI), and brain contusion. We found very high interrater agreement for brain contusion, with prevalence- and bias-adjusted kappa (PABAK) values for pairs of readers from 0.92 [95% confidence interval, 0.88-0.95] to 0.94 [0.90-0.96]. We found intermediate agreement for TAI and DAI, with PABAK values of 0.74-0.78 [0.70-0.82]. The near-perfect agreement for subacute brain contusion is likely attributable to the high conspicuity and distinctive appearance of these lesions on T1-weighted images. Interrater agreement for TAI and DAI was lower, because signal void in small vascular structures, and artifactual foci of signal void, can be difficult to distinguish from the punctate round or linear areas of slight hemorrhage that are a common hallmark of TAI/DAI on MRI.

Interobserver agreement in interpretation of chest radiographs for pediatric community acquired pneumonia: Findings of the pedCAPNETZ-cohort.

Although chest radiograph (CXR) is commonly used in diagnosing pediatric community acquired pneumonia (pCAP), limited data on interobserver agreement among radiologists exist. PedCAPNETZ is a prospective, observational, and multicenter study on pCAP. N = 233 CXR from patients with clinical diagnosis of pCAP were retrieved and n = 12 CXR without pathological findings were added. All CXR were interpreted by a radiologist at the site of recruitment and by two external, blinded pediatric radiologists. To evaluate interobserver agreement, the reporting of presence or absence of pCAP in CXR was analyzed, and prevalence and bias-adjusted kappa (PABAK) statistical testing was applied. Overall, n = 190 (82%) of CXR were confirmed as pCAP by two external pediatric radiologists. Compared with patients with pCAP negative CXR, patients with CXR-confirmed pCAP displayed higher C-reactive protein levels and a longer duration of symptoms before enrollment (p < .007). Further parameters, that is, age, respiratory rate, and oxygen saturation showed no significant difference. The interobserver agreement between the onsite radiologists and each of the two independent pediatric radiologists for the presence of pCAP was poor to fair (69%; PABAK = 0.39% and 76%; PABAK = 0.53, respectively). The concordance between the external radiologists was fair (81%; PABAK = 0.62). With regard to typical CXR findings for pCAP, chance corrected interrater agreement was highest for pleural effusions, infiltrates, and consolidations and lowest for interstitial patterns and peribronchial thickening. Our data show a poor interobserver agreement in the CXR-based diagnosis of pCAP and emphasized the need for harmonized interpretation standards.

Do tender joints in active psoriatic arthritis reflect inflammation assessed by ultrasound and magnetic resonance imaging?

To investigate the association between clinical joint tenderness and intra- and periarticular inflammation as assessed by ultrasound and magnetic resonance imaging (MRI) in patients with active psoriatic arthritis (PsA) and to explore if the associations differ according to patient-reported outcomes (PROs) and structural damage. Forty-one patients with active PsA and hand involvement had 76/78 joints examined for swelling/tenderness and ultrasound and MRI of 24 and 12 finger joints, respectively. Synovitis, tenosynovitis, periarticular inflammation and erosions were assessed using OMERACT definitions and scoring systems. Correlation between imaging inflammation sum-scores (intra-and periarticular) and tender/swollen joint counts were calculated using Spearman's rho, agreement at joint level was examined using prevalence and bias adjusted kappa (PABAK). Subgroup analyses explored the influence of PROs and radiographic erosive disease on these associations. No significant correlations were found between tender or swollen joint counts and imaging inflammation sum-scores (rho=-0.31-0.38). In patients with higher level of overall pain, disability and lower self-reported mental health, a tendency towards negative correlations were found. At joint level, intra- and periarticular imaging inflammatory lesions had slight agreement with joint tenderness (PABAK=0.02-0.19) and slight to moderate with swelling (PABAK=0.16-0.54). For tender joints, agreement with imaging inflammation was even weaker in patients with either high overall pain scores, high disability scores, and/or non-erosive disease. Joint tenderness had low association with imaging signs of inflammation in PsA patients, particularly in patients with high self-reported pain, disability and low mental health, indicating that tenderness is influenced by other parameters than local inflammation.

Is point-of-care testing feasible and safe in care homes in England? An exploratory usability and accuracy evaluation of a point-of-care polymerase chain reaction test for SARS-CoV-2.

IntroductionReliable rapid testing for COVID-19 is needed in care homes to reduce the risk of outbreaks and enable timely care. This study aimed to examine the usability and test performance of a point of care polymerase chain reaction (PCR) test for detection of SARS-CoV-2 (POCKITTM Central) in care homes.MethodsPOCKITTM Central was evaluated in a purposeful sample of four UK care homes. Test agreement with laboratory real-time PCR and usability and used errors were assessed.ResultsNo significant usability-related hazards emerged, and the sources of error identified were found to be amendable with minor changes in training or test workflow. POCKITTM Central has acceptable sensitivity and specificity based on RT-PCR as the reference standard, especially for symptomatic cases.Asymptomatic specimens showed 83.3% (95% confidence interval (CI): 35.9–99.6%) positive agreement and 98.7% negative agreement (95% CI: 96.2–99.7%), with overall prevalence and bias-adjusted kappa (PABAK) of 0.965 (95% CI: 0.932– 0.999). Symptomatic specimens showed 100% (95% CI: 2.5–100%) positive agreement and 100% negative agreement (95% CI: 85.8–100%), with overall PABAK of 1.Recommendations are provided to mitigate the frequency of occurrence of the residual use errors observed. Integration pathways were discussed to identify opportunities and limitations of adopting POCKIT™ Central for screening and diagnostic testing purposes.ConclusionsPoint-of-care PCR testing in care homes can be considered with appropriate preparatory steps and safeguards. Further diagnostic accuracy evaluations and in-service evaluation studies should be conducted, if the test is to be implemented more widely, to build greater certainty on this initial exploratory analysis.

The reliability and distribution of foot osteoarthritis assessed by ultrasound and clinical examination in a hand osteoarthritis cohort

Purpose: Foot osteoarthritis (OA) is a disabling and painful disease with similar prevalence to knee OA. To date, foot OA has been largely ignored in the OA research society. There are guidelines regarding the diagnosis of hand and knee OA, but no such recommendations are available for foot OA. Clinical markers of foot posture, range of motion, inspection and palpation have shown limited ability to discriminate persons with and without radiographic OA in the midfoot. Ultrasound may be a useful tool for the assessment of OA features in the foot. Recently, the OMERACT Ultrasound Task Force proposed definitions of inflammatory and structural lesions in the foot, but more research is needed before ultrasound can be recommended for the assessment of structural features in the foot. No studies have explored the frequency of joint involvement using ultrasound in comparison to clinical examination. Hence, the aims of the current study were to compare reliability and distribution of ultrasound-detected and clinical features of foot OA. Methods: The Nor-Hand study is an observational cohort where 300 patients with hand OA (89% women, median (IQR) 61 (57-66) years old) were recruited. The current analyses include cross-sectional data from the baseline examination. A trained medical student (CMF) performed the ultrasound examination of the feet using a General Electric (GE) Logic E9 ultrasound machine with a 6-15Mz probe. The bilateral tibiotalar, talonavicular, 1st and 2nd to 3rd naviculocuneiform, 1st to 4th tarsometatarsal (TMT), 1st metatarsalphalangeal (MTP), 1st interphalangeal (IP), lateral subtalar, medial subtalar and the calcaneocuboid joints were scored for the presence of grey-scale synovitis, power Doppler signals and osteophytes on 0-3 semi-quantitative scales (0=no, 1=mild, 2=moderate, and 3=severe pathology). Ten patients were also examined by a rheumatologist with extensive ultrasound experience (HBH) to evaluate the inter-observer reliability. An experienced rheumatologist (BSC) examined the bilateral tibiotalar, talonavicular, 1st and 2nd naviculocuneiform, 1st to 4th TMT, 1st MTP and subtalar joints for the absence/presence of soft tissue swelling and bony enlargement. A rheumatology fellow performed the joint evaluation if BSC was not available. Ten patients were examined by both the experienced rheumatologist and the rheumatology fellow to evaluate inter-observer reliability. We calculated the inter-observer reliability for ultrasound and clinical examination in all foot joints using prevalence and bias adjusted kappa (PABAK) values due to low frequency of OA in many foot joints. We then compared the pattern of OA features in individual foot joints in the left and right foot by ultrasound and the frequency of sonographic joint involvement in comparison to clinical examination using Chi square tests. Results: Good to excellent inter-observer reliability by PABAK was observed for all ultrasound features (grey-scale synovitis: 0.78; osteophytes: 0.82; power-Doppler activity: 0.98). Similar good inter-observer reliability was found for clinical assessment of the foot with PABAK values ranging from moderate to excellent (bony enlargement: 0.90, soft tissue swelling: 0.99). By ultrasound, OA was most prevalent in the MTP1, IP1, talonavicular and subtalar joints (Table 1). Overall, osteophytes and synovitis were numerically more prevalent in the right foot compared to the left foot (Table 1). Clinical bony enlargement was most common in MTP1 and TMT1-2. Clinical soft tissue swelling was uncommon in all joints with the highest prevalence in the MTP1 joints. Ultrasound-detected osteophytes and grey scale synovitis were more common than clinically observed bony enlargement and soft tissue swelling in most foot/ankle joints (Table 2). In the MTP1 joints, clinical examination detected more frequent bony enlargement, whereas ultrasound was more sensitive in the detection of synovitis (both grey-scale synovitis and power Doppler activity) in comparison with soft tissue swelling by clinical examination. Conclusions: We found good inter-reader reliability for ultrasonographic and clinical examination of OA features in patients with foot OA. Ultrasonographic features of OA were more prevalent in the right than left foot, and most frequent in the MTP1, IP1 and talonavicular joints. In most individual foot joints, ultrasound detected more osteophytes than clinical examination found bony enlargements. The high prevalence of synovitis in the MTP1 joint may reflect normal increased effusion in this joint.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Reliability of remote post-mortem veterinary meat inspections in pigs using augmented-reality live-stream video software

Official meat inspections at remotely situated, small-scale slaughter houses and game handlings establishments fare associated with a relatively high cost of official control per inspected animal. By performing veterinary meat inspections via live-streamed video, this cost could be lowered. We aimed to evaluate how veterinary meat inspections at slaughter can be conducted remotely with the help of a camera-equipped non-veterinary technician on site. Specialized software and augmented reality technology were used. The remote inspection was compared to standard on-site veterinary meat inspection at a large-scale slaughter plant for pigs in Sweden during 2019. The remote and on-site inspectors recorded findings in 400 carcasses and organs arrested for further inspection. The comparison was based primarily on percentage agreement, Cohen's kappa and prevalence- and bias-adjusted kappa (PABAK) as measures of agreement and reliability. The remote method was shown to display a high level of agreement for clear, easily distinguished findings (e.g. tail lesions, with an agreement of 92.3%, Cohen's kappa of 0.77 and PABAK of 0.85). For more vague findings and subjective decisions, the performance was slightly lower (e.g. whether or not to condemn a carcass completely, with agreement 75.2%, Cohen's kappa 0.32 and PABAK 0.50). Remote inspection appears to constitute a viable alternative for post-mortem meat inspection in pigs, given a sufficiently standardized method of inspection and sufficient inspection times. The performance of remote inspection probably depends on which persons use the method.

Housing deterioration: a multi-dimensional index and validation in shared refugee accommodation

Abstract Background Asylum seekers and refugees (ASR) are struggling for residential autonomy while awaiting the results of their asylum case. As housing is a known upstream determinant of and fundamental resource for health, it is important to monitor housing quality of state-provided shared refugee accommodation. We constructed, validated and field-tested a new and quick-to-apply index to measure the degree of Small-area Housing Environment Deterioration (SHED). Methods Conceptualizing housing quality as characteristics and maintenance of physical environment, we developed the SHED based on the “Broken Windows”-index (BWI). We conducted a validation study with seven raters at two time points, assessing measures of inter-/intra-rater reliability and internal consistency, complemented by cognitive interviews. Further, we field-tested the index in a random sample of 58 shared refugee accommodations and assessed its convergent validity against ASR's satisfaction with their living places (EUROHIS QOL). Results SHED assesses five domains (windows/glass, walls/roof, garbage, graffiti, outside spaces), complemented by a rating of the overall living environment. The validation study delivered an 'almost perfect' prevalence- and bias-adjusted Kappa (PABAK) of 0.87 (0.82-0.91) for intra-rater, 'substantial' to 'almost perfect' PABAK's between 0.71 (0.52-0.91) and 0.91 (0.87-0.91) depending on the rater (all p &amp;lt; 0.001), and a Cronbach's α of 0.80. The index's construct validity is based on the BWI and converges with the ASR's subjective satisfaction with their living places. Cognitive interviewees enjoyed the simplicity and speed of the SHED and guided the creation of a manual for future use. Conclusions The index demonstrated high measures on objectivity, reliability, and internal consistency. It proved its applicability in a field-test and showed convergent validity with ASR's satisfaction with their living place within shared refugee accommodation. Key messages We have constructed an objective, reliable, internally consistent and valid index assessing the degree of deterioration of small-area housing environment. SHED offers opportunities for monitoring the physical quality of collective accommodation centres and filling the research gap on associations between housing quality and health.

The application of artificial intelligence (AI) techniques to identify frailty within a residential aged care administrative data set

IntroductionResearch has shown that frailty, a geriatric syndrome associated with an increased risk of negative outcomes for older people, is highly prevalent among residents of residential aged care facilities (also called long term care facilities or nursing homes). However, progress on effective identification of frailty within residential care remains at an early stage, necessitating the development of new methods for accurate and efficient screening. ObjectivesWe aimed to determine the effectiveness of artificial intelligence (AI) algorithms in accurately identifying frailty among residents aged 75 years and over in comparison with a calculated electronic Frailty Index (eFI) based on a routinely-collected residential aged care administrative data set drawn from 10 residential care facilities located in Queensland, Australia. A secondary objective included the identification of best-performing candidate algorithms. MethodsWe designed a frailty prediction system based on the eFI identification of frailty, allocating 84.5 % and 15.5 % of the data to training and test data sets respectively. We compared the performance of 18 specific scenarios to predict frailty against eFI based on unique combinations of three ML algorithms (support vector machines [SVM], decision trees [DT] and K-nearest neighbours [KNN]) and six cases (6, 10, 11, 14, 39 and 70 input variables). We calculated accuracy, percentage positive and negative agreement, sensitivity, specificity, Cohen’s kappa and Prevalence- and Bias- Adjusted Kappa (PABAK), table frequencies and positive and negative predictive values. ResultsOf 592 eligible resident records, 500 were allocated to the training set and 92 to the test set. Three scenarios (10, 11 and 70 input variables), all based on SVM algorithm, returned overall accuracy above 75 %. ConclusionsThere is some potential for AI techniques to contribute towards better frailty identification within residential care. However, potential benefits will need to be weighed against administrative burden, data quality concerns and presence of potential bias.

Content reporting of exercise interventions in rotator cuff disease trials: results from application of the Consensus on Exercise Reporting Template (CERT)

BackgroundExercise interventions are frequently recommended for patients with rotator cuff disease, but poor content reporting in clinical trials of exercise limits interpretation and replication of trials and clinicians’ ability to...

Agreement of antenatal care indicators from self-reported questionnaire and the antenatal care card of women in the 2015 Pelotas birth cohort, Rio Grande do Sul, Brazil

BackgroundStudies of healthcare service use during the pregnancy-postpartum cycle often rely on self-reported data. The reliability of self-reported information is often questioned as administrative data or medical records, such as antenatal care cards, are usually preferred. In this study, we measured the agreement of antenatal care indicators from self-reported information and antenatal care cards of pregnant women in the 2015 Pelotas Birth Cohort, Brazil.MethodsIn a sample of 3923 mothers, indicator agreement strengths were estimated from Kappa and prevalence-and-bias-adjusted Kappa (PABAK) coefficients. Maternal characteristics associated with indicator agreements were assessed with heterogeneity chi-squared tests.ResultsThe self-reported questionnaire and the antenatal care card showed a moderate to high agreement in 10 of 21 (48%) antenatal care indicators that assessed care service use, clinical examination and diseases during pregnancy. Counseling indicators performed poorly. Self-reported information presented a higher frequency data and a higher sensitivity but slightly lower specificity when compared to the antenatal card. Factors associated with higher agreement between both data sources included lower maternal age, higher level of education, primiparous status, and being a recipient of health care in the public sector.ConclusionsSelf-reported questionnaire and antenatal care cards provided substantially different information on indicator performance. Reliance on only one source of data to assess antenatal care quality may be questionable for some indicators. From a public health perspective, it is recommended that antenatal care programs use multiple data sources to estimate quality and effectiveness of health promotion and disease prevention in pregnant women and their offspring.

Association between grayscale sonographic and clinical findings in severe knee osteoarthritis.

To assess whether ultrasonographic (US) findings associate with clinical findings in severe knee osteoarthritis (OA). Association of US findings with side-of-knee pain and inter-reader agreement of knee US were also evaluated. One-hundred-two patients (in total 123 knees) with severe knee OA were recruited for this cross-sectional study. US was performed by a single observer, and on 53 knees by two independent observers to assess inter-reader reliability. Preoperative clinical data was available for 69 knees. Cutoff values were applied to dichotomize US and clinical findings. The Chi-square test, Mann-Whitney test, and prevalence- and bias-adjusted kappa (PABAK) were applied for statistical analyses. Seven of 99 associations tested were statistically significant. Associations were observed between range of flexion and lateral femoral (P = .009) and tibial (P = .001) osteophytes, mediolateral instability and damage to the lateral femoral cartilage (P = .014) and damage to the lateral meniscus (P = .031), and alignment and damage to the lateral femoral cartilage (P < .001), lateral tibial osteophytes (P = .037), and damage to the lateral meniscus (P < .001). A strong association was observed between medial-sided pain and same-sided cartilage damage and osteophytes (P < .001). That inter-reader agreement was excellent on the medial side of the knee joint (PABAK = 0.811-0.887). US findings show a rather poor association with clinical OA findings. Inter-reader agreement of knee US is excellent on the medial side.

The Consensus on Exercise Reporting Template (CERT) applied to exercise interventions in musculoskeletal trials demonstrated good rater agreement and incomplete reporting

ObjectiveTo determine inter-rater agreement and utility of the Consensus on Exercise Reporting Template (CERT) for evaluating reporting of musculoskeletal exercise trials. Study Design and SettingTwo independent reviewers applied the CERT to a random sample of 20 exercise trials published 2010 to 2015 identified from searches of PEDro, CENTRAL, and PubMed. Reviewers recorded whether each item criterion was met and detailed missing data, and appraisal time percent agreement and the Prevalence and Bias Adjusted Kappa (PABAK) statistic were used to measure inter-rater agreement. ResultsThe trials included a range of musculoskeletal conditions (back/neck pain, hip/knee osteoarthritis, tendinopathies). For percent agreement, inter-rater agreement was high (13 items ≥80%) and for PABAK substantial (nine items: 0.61–0.80) and excellent (three items: 0.81–1.0). Agreement was lower for starting level decision rule (percent agreement: 55%, PABAK 0.30); tailoring of exercise (%A: 65%, PABAK 0.40 [95% CI: 0.00 to 0.80]); exercise equipment (percent agreement: 70%, PABAK 0.30); and motivation strategies (percent agreement: 70%, PABAK 0.40). Sixty percent of descriptions were missing information for ≥50% of CERT items. Mean appraisal time was 30 minutes, and the majority of interventions required access to other published papers. ConclusionsThe CERT has good inter-rater agreement and can comprehensively evaluate reporting of exercise interventions. Most trials do not adequately report intervention details, and information can be difficult to obtain. Incomplete reporting of effective exercise programs may be remedied by using the CERT when constructing, submitting, reviewing, and publishing articles.

Evaluating the use of parental reports to estimate health care resource utilization in children with suspected genetic disorders.

A key step in evaluating the cost-effectiveness of diagnostic genome-wide sequencing (GWS) services is to measure the cost of prior and subsequent diagnosis-related health care resource utilization by patients. The majority of patients using diagnostic GWS services are children, and parental surveys are often used to complement utilization data abstracted from medical records. The objective of this study was to evaluate the validity of parental reports for children with very high levels of resource utilization. Primary caregivers of children enrolled in the CAUSES Research Clinic, a diagnostic GWS programme at B.C. Children's Hospital, completed an online survey. Parent-reported health care encounters for the 6-month period prior to survey completion were compared to utilization data abstracted from electronic medical records (EMR). The association between demographic characteristics and the probability of survey completion was tested using logistic regression. Agreement between parent-reported and EMR data was evaluated using Cohen's kappa, prevalence- and bias-adjusted kappa (PABAK), and the intraclass correlation coefficient (ICC). There were no major differences in demographic characteristics or resource utilization levels between families that completed the survey and those who did not. Agreement between parental reports and EMR data was high for hospitalizations (κ=0.71; PABAK=0.89; ICC=0.77) but lower for outpatient physician visits (κ=0.21; PABAK=0.48; ICC=0.27). Parental surveys are a valuable tool for estimating health care resource utilization during a 6-month recall period for children with suspected genetic disorders but are best used to complement utilization data collected from other sources.

Evaluation of the new restandardized 25-hydroxyvitamin D assay on the iSYS platform

Background25-hydroxyvitamin D [25(OH)D] is the most reliable biomarker of vitamin D status, but until now 25(OH)D assays have suffered from inter-laboratory and inter-assay discrepancies. In the setting of the international Vitamin D Standardization Program, Immunodiagnostic Systems (IDS) recently reformulated and restandardized the 25(OH)D immunoassay available on the automated iSYS platform. In the present study, we evaluated this new generation of the 25(OH)D immunoassay (IS-2500). MethodsRepeatability and within-laboratory imprecision were verified according to the Clinical and Laboratory Standards Institute EP15-A3. Results from the sera of 63 patients were compared with those obtained with the previous iSYS method (IS-2700S) using Passing-Bablok and Bland-Altman analysis. The prevalence and bias-adjusted kappa (PABAK) coefficient was calculated to assess the agreement of vitamin D status provided by the two iSYS immunoassays. Fourteen Vitamin D External Quality Assessment Scheme (DEQAS) samples were used to evaluate inaccuracy. ResultsUsing the EP15-A3 protocol, repeatability and within-laboratory imprecision obtained with the new iSYS method were lower than 6% and 8%, respectively. These results are consistent with the manufacturer's claims. In more adverse conditions (50 measurements over 15days with multiple calibrations), the within-laboratory imprecision was 14.8% (39nmol/L) and 7.7% (155nmol/L). 25(OH)D concentrations measured with the new assay showed a strong correlation with those provided by the previous version (r=0.969, p<0.0001). The Passing-Bablok regression equation was as follows: new assay=1.079 x (previous assay) - 3.6nmol/L. The PABAK coefficient of 0.810 reflected almost perfect agreement between the two immunoassays to classify patients according to their vitamin D status (85.7% of agreement). Using DEQAS samples, the mean inaccuracy bias was lower than 5% when the new iSYS method was compared with LC-MS/MS methods and the NIST reference measurement procedure. ConclusionThe new generation of the iSYS immunoassay evaluated in this study meets requirements for routinely measuring 25(OH)D levels in clinical laboratories.

Accuracy of Self-Reported Heart Failure. The Atherosclerosis Risk in Communities (ARIC) Study

ObjectiveThe aim of this work was to estimate agreement of self-reported heart failure (HF) with physician-diagnosed HF and compare the prevalence of HF according to method of ascertainment. Methods and ResultsARIC cohort members (60–83 years of age) were asked annually whether a physician indicated that they have HF. For those self-reporting HF, physicians were asked to confirm their patients' HF status. Physician-diagnosed HF included surveillance of hospitalized HF and hospitalized and outpatient HF identified in administrative claims databases. We estimated sensitivity, specificity, positive predicted value, kappa, prevalence and bias–adjusted kappa (PABAK), and prevalence. Compared with physician-diagnosed HF, sensitivity of self-report was low (28%–38%) and specificity was high (96%–97%). Agreement was poor (kappa 0.32–0.39) and increased when adjusted for prevalence and bias (PABAK 0.73–0.83). Prevalence of HF measured by self-report (9.0%), ARIC-classified hospitalizations (11.2%), and administrative hospitalization claims (12.7%) were similar. When outpatient HF claims were included, prevalence of HF increased to 18.6%. ConclusionsFor accurate estimates HF burden, self-reports of HF are best confirmed by means of appropriate diagnostic tests or medical records. Our results highlight the need for improved awareness and understanding of HF by patients, because accurate patient awareness of the diagnosis may enhance management of this common condition.

Inter- and Intraexaminer Reliability in Identifying and Classifying Myofascial Trigger Points in Shoulder Muscles

ObjectiveTo determine inter- and intraexaminer reliability of examiners without clinical experience in identifying and classifying myofascial trigger points (MTPs) in the shoulder muscles of subjects asymptomatic and symptomatic for unilateral subacromial impact syndrome (SIS). DesignWithin-day inter- and intraexaminer reliability study. SettingPhysical therapy department of a university. ParticipantsFifty-two subjects participated in the study, 26 symptomatic and 26 asymptomatic for unilateral SIS. InterventionsTwo examiners, without experience for assessing MTPs, independent and blind to the clinical conditions of the subjects, assessed bilaterally the presence of MTPs (present or absent) in 6 shoulder muscles and classified them (latent or active) on the affected side of the symptomatic group. Each examiner performed the same assessment twice in the same day. Main Outcome MeasuresReliability was calculated through percentage agreement, prevalence- and bias-adjusted kappa (PABAK) statistics, and weighted kappa. ResultsIntraexaminer reliability in identifying MTPs for the symptomatic and asymptomatic groups was moderate to perfect (PABAK, .46–1 and .60–1, respectively). Interexaminer reliability was between moderate and almost perfect in the 2 groups (PABAK, .46–.92), except for the muscles of the symptomatic group, which were below these values. With respect to MTP classification, intraexaminer reliability was moderate to high for most muscles, but interexaminer reliability was moderate for only 1 muscle (weighted κ=.45), and between weak and reasonable for the rest (weighted κ=.06–.31). ConclusionsIntraexaminer reliability is acceptable in clinical practice to identify and classify MTPs. However, interexaminer reliability proved to be reliable only to identify MTPs, with the symptomatic side exhibiting lower values of reliability.