Proportion Of Overall Agreement Research Articles

Ascertaining asthma status in epidemiologic studies: a comparison between administrative health data and self-report

BackgroundStudies have suggested that agreement between administrative health data and self-report for asthma status ranges from fair to good, but few studies benefited from administrative health data over a long period. We aimed to (1) evaluate agreement between asthma status ascertained in administrative health data covering a period of 30 years and from self-report, and (2) identify determinants of agreement between the two sources.MethodsWe used administrative health data (1983–2012) from the Quebec Birth Cohort on Immunity and Health, which included 81,496 individuals born in the province of Quebec, Canada, in 1974. Additional information, including self-reported asthma, was collected by telephone interview with 1643 participants in 2012. By design, half of them had childhood asthma based on health services utilization. Results were weighted according to the inverse of the sampling probabilities. Five algorithms were applied to administrative health data (having ≥ 2 physician claims over a 1-, 2-, 3-, 5-, or 30-year interval or ≥ 1 hospitalization), to enable comparisons with previous studies. We estimated the proportion of overall agreement and Kappa, between asthma status derived from algorithms and self-reports. We used logistic regression to identify factors associated with agreement.ResultsApplying the five algorithms, the prevalence of asthma ranged from 49 to 55% among the 1643 participants. At interview (mean age = 37 years), 49% and 47% of participants respectively reported ever having asthma and asthma diagnosed by a physician. Proportions of agreement between administrative health data and self-report ranged from 88 to 91%, with Kappas ranging from 0.57 (95% CI: 0.52–0.63) to 0.67 (95% CI: 0.62–0.72); the highest values were obtained with the [≥ 2 physician claims over a 30-year interval or ≥ 1 hospitalization] algorithm. Having sought health services for allergic diseases other than asthma was related to lower agreement (Odds ratio = 0.41; 95% CI: 0.25–0.65 comparing ≥ 1 health services to none).ConclusionsThese findings indicate good agreement between asthma status defined from administrative health data and self-report. Agreement was higher than previously observed, which may be due to the 30-year lookback window in administrative data. Our findings support using both administrative health data and self-report in population-based epidemiological studies.

1.5-T MR relaxometry in quantifying splenic and pancreatic iron: retrospective comparison of a commercial 3D-Dixon sequence and an established 2D multi-gradient echo sequence

ObjectivesTo compare the quantitative measurement of splenic and pancreatic iron content using a commercial 3D-Dixon sequence (qDixon) versus an established fat-saturated R2* relaxometry method (ME-GRE).MethodsWe analyzed splenic and pancreatic iron levels in 143 MR examinations (1.5 T) using the qDixon and a ME-GRE sequence (108 patients: 65 males, 43 females, mean age 61.31 years). Splenic and pancreatic R2* values were compared between both methods using Bland–Altman plots, concordance correlation coefficients (CCC), and linear regression analyses. Iron overload (R2* > 50 1/s) was defined for both organs and compared using contingency tables, overall agreement, and Gwet’s AC1 coefficient.ResultsOf all analyzable examinations, the median splenic R2* using the qDixon sequence was 25.75 1/s (range: 5.6–433) and for the ME-GRE sequence 35.35 1/s (range: 10.9–400.8) respectively. Concerning the pancreas, a median R2* of 29.93 1/s (range: 14–111.45) for the qDixon and 31.25 1/s (range: 14–97) for the ME-GRE sequence was found. Bland–Altman analysis showed a mean R2* difference of 2.12 1/s with a CCC of 0.934 for the spleen and of 0.29 1/s with a CCC of 0.714 for the pancreas. Linear regression for the spleen/pancreas resulted in a correlation coefficient of 0.94 (p < 0.001)/0.725 (p < 0.001). Concerning iron overload, the proportion of overall agreement between the two methods was 91.43% for the spleen and 93.18% for the pancreas.ConclusionsOur data show good concordance between R2* values obtained with a commercial qDixon sequence and a validated ME-GRE relaxometry method. The 3D-qDixon sequence, originally intended for liver assessment, seems to be a reliable tool for non-invasive evaluation of iron content also in the spleen and the pancreas.Key Points• A 3D chemical shift imaging sequence and 2D multi-gradient echo sequence show good conformity quantifying splenic and pancreatic R2* values.• The 3D chemical shift imaging sequence allows a reliable analysis also of splenic and pancreatic iron status.• In addition to the liver, the analysis of the spleen and pancreas is often helpful for further differential diagnostic clarification and patient guidance regarding the iron status.

Evaluation of Peri-Operative Management in Women with Deep Endometriosis Who are Candidates for Bowel Surgery: A Survey from the Italian Society of Gynecologic Endoscopy

Study ObjectiveThere is great consensus that the implementation of the enhanced recovery after surgery (ERAS) approach is beneficial for surgical patients, but there is a paucity of data concerning its application in women with deep endometriosis (DE) who are candidates for bowel surgery. The survey described herein was aimed at gathering detailed information on perioperative management of DE patients who were undergoing sigmoid/rectal (discoid or segmental) resection within the Italian Society of Gynecologic Endoscopy (SEGI) group. DesignBaseline survey. SettingNational survey conducted within the main Italian cooperative group in minimally invasive gynecologic surgery (SEGI). PatientsThe study did not involve patients. InterventionsA 63-item questionnaire covering ERAS items for gynecologic/elective colorectal surgery was sent to SEGI centers. Only questionnaires from centers that reported performing ≥10 sigmoid/rectal resections per year were considered for this analysis. Measurements and Main ResultsThirty-three of 38 (86.8%) of the questionnaires were analyzed. The rates of concordance with the ERAS guidelines were 40.4%, 64.4%, and 62.6% for preoperative, intraoperative, and postoperative items, respectively. The proportion of overall agreement was 56.6%. Preoperative diet, fasting and bowel preparation, correction of anemia, avoidance of peritoneal drains, postoperative feeding, and early mobilization were the most controversial items. Comparative analysis revealed that the referred rates of complete disease removal and conversion to open surgery were significantly different depending on case volume (p = .044 and p = .003, respectively) and gynecologist's/surgeon's experience (p = .042 and p = .022, respectively), with higher chances of obtaining a complete laparoscopic/robotic excision of endometriosis in centers that reported ≥30 DE surgeries performed per year and/or ≥90% of bowel resections performed by a gynecologist/general surgeon specifically dedicated to DE management. In contrast, the rates of concordance with the ERAS guidelines were not significantly different according to case volume (p = .081) or gynecologist's/surgeon's experience (p = .294). ConclusionThis is the first study on DE conducted on a national scale. The current survey results revealed suboptimal compliance with the ERAS recommendations and underline the need to improve the quality of perioperative care in DE patients undergoing sigmoid/rectal resection. This study is a first step toward building a consistent, structured reporting platform for the SEGI units and facilitating wide implementation and standardization of the ERAS protocol for DE patients in Italy.

A personhood and citizenship training workshop for care home staff to potentially increase wellbeing of residents with dementia: intervention development and feasibility testing of a cluster randomised controlled trial

BackgroundIn the UK, one third of people with dementia live in residential care homes, a sector where high staff turnover negatively affects continuity of care. To examine the effect of including personhood and citizenship principles in training, interventions need to be robustly tested, with outcomes relevant to residents with dementia.MethodsPhase one intervention development: The training intervention (PERSONABLE) comprised five reflective exercises facilitated by a mental health nurse/researcher. PERSONABLE was informed by four focus groups, and one field exercise, consisting of care home staff and family members. Phase two feasibility testing: Participants were (i) care home residents with dementia and (ii) care home staff working in any role. After baseline measurements, care homes were randomly allocated to (i) staff receiving PERSONABLE training or (ii) training as usual. Feasibility outcomes were the recruitment and attrition of care homes, residents and staff members (measured ten weeks between randomisation and follow-up), the acceptability of the training intervention PERSONABLE, and acceptability of outcome measures. The care home environment was evaluated, at baseline, using the Therapeutic Environment Screening Survey for Residential Care Homes. Measurements conducted at baseline and follow-up were resident wellbeing (Dementia Care Mapping™), staff knowledge of and confidence with personhood and citizenship (Personhood in Dementia Questionnaire and a perceived ability to care visual analogue scale). Inter-rater agreement for Dementia Care Mapping™ was undertaken at follow-up in one intervention and one training as a usual care home.ResultsPhase one: The developed reflective approach to the PERSONABLE exercises appeared to give staff a holistic understanding of residents living with dementia, seeing them as autonomous people rather than reductively as persons with a condition. Phase two: Six care homes, 40 residents and 118 staff were recruited. Four residents were lost to follow-up. Twenty-nine staff in the PERSONABLE arm of the study received the training intervention. In the PERSONABLE arm, 26 staff completed both baseline and follow-up measurements compared to 21 in the training as the usual arm. The most common reason for the loss to follow-up of staff was leaving employment. For the outcome measure Dementia Care Mapping™, the proportion of overall agreement between the two observers was 18.6%. High attrition of staff occurred in those homes undergoing leadership changes.ConclusionWith the right approach, it is possible to achieve good engagement during trial recruitment and intervention delivery of care home managers, staff and residents. Organisational changes are a less controllable aspect of trials but having a visible researcher presence during data collection helps to capitalise the engagement of those staff remaining in employment. Tailored, brief and flexible training interventions encourage staff participation. Simplification of study methods helps promote and retain sufficient staff in a definitive randomised controlled trial. This study found that some components of Dementia Care Mapping™ work effectively as an outcome measure. However, inter-rater reliability was poor, and the practical implementation of the measurement would need a great deal of further refinement to accurately capture the effect of a training intervention if delivered across a large number of clusters. The Dementia Care Mapping™ measurement fidelity issue would be further complicated if using multiple different unacquainted observers.Trial registrationRegistered with the ISRCTN under the title: Does a dementia workshop, delivered to residential care home staff, improve the wellbeing of residents with dementia? Trial identifier: ISRCTN13641553. Registered: 30/05/2017 http://www.isrctn.com/ISRCTN13641553.

Evaluation of the QIAstat-Dx Respiratory SARS-CoV-2 panel, a rapid multiplex PCR method for the diagnosis of COVID-19

IntroductionRapid, simple, and accurate methods are required to diagnose coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to evaluate the performance of the QIAstat-Dx Respiratory SARS-CoV-2 Panel (QIAstat-SARS-CoV-2), a rapid multiplex PCR assay for SARS-CoV-2 detection. MethodsNasopharyngeal swabs (NPS) that were obtained from patients with COVID-19 who were diagnosed at the National Center for Global Health and Medicine were used in this study. When the NPS samples were found to be negative for SARS-CoV-2 after treatment, they were used as negative samples. We evaluated the performance of the QIAstat-SARS-CoV-2 comparing SARS-CoV-2 detection with the National Institute of Infectious Diseases in Japan-recommended real-time polymerase chain reaction (RT-PCR) method (NIID-RT-PCR). ResultsIn total, 45 NPS samples were analyzed. The proportion of overall agreement between QIAstat-SARS-CoV-2 and NIID-RT-PCR on 45 samples was 91.0% with a sensitivity of 84.0% (21/25), specificity at 100% (20/20), negative predictive value at 83.3% (20/24), and positive predictive value at 100% (21/21). There were no patients with co-infections with pathogens other than SARS-CoV-2. ConclusionsQIAstat-SARS-CoV-2 showed a high agreement in comparison with the NIID-RT-PCR for the detection of SARS-CoV-2. The QIAstat-SARS-CoV-2 also provided a rapid and accurate diagnosis for COVID-19, even when the concurrent detection of other respiratory pathogens was desired, and therefore, has the potential to direct appropriate therapy and infection control precautions.

Evaluation of perioperative management of advanced ovarian (tubal/peritoneal) cancer patients: a survey from MITO-MaNGO Groups.

ObjectiveThe European Society of Gynaecological Oncology (ESGO)-quality indicators (QIs) for advanced ovarian cancer (AOC) have been assessed only by few Italian centers, and data are not available on the proportion of centers reaching the score considered for a satisfactory surgical management. There is great consensus that the Enhanced Recovery After Surgery (ERAS) approach is beneficial, but there is paucity of data concerning its application in AOC. This survey was aimed at gathering detailed information on perioperative management of AOC patients within MITO-MaNGO Groups.MethodsA 66-item questionnaire, covering ESGO-QIs for AOC and ERAS items, was sent to MITO/MaNGO centers reporting to operate >20 AOC/year.ResultsThirty/34 questionnaires were analyzed. The median ESGO-QIs score was 31.5, with 50% of centers resulting with a score ≥32 which provides satisfactory surgical management. The rates of concordance with ERAS guidelines were 46.6%, 74.1%, and 60.7%, respectively, for pre-operative, intra-operative, and post-operative items. The proportion of overall agreement was 61.3%, and with strong recommendations was 63.1%. Pre-operative diet, fasting/bowel preparation, correction of anaemia, post-operative feeding and early mobilization were the most controversial. A significant positive correlation was found between ESGO-QIs score and adherence to ERAS recommendations.ConclusionThis survey reveals a satisfactory surgical management in only half of the centers, and an at least sufficient adherence to ERAS recommendations. Higher the ESGO-QIs score stronger the adherence to ERAS recommendations, underlining the correlations between case volume, appropriate peri-operative management and quality of surgery. The present study is a first step to build a structured platform for harmonization within MITO-MaNGO networks.

Echocardiographic Left Ventricular Mass Assessment: Correlation between 2D-Derived Linear Dimensions and 3-Dimensional Automated, Machine Learning-Based Methods in Unselected Patients.

A recently developed algorithm for 3D analysis based on machine learning (ML) principles detects left ventricular (LV) mass without any human interaction. We retrospectively studied the correlation between 2D-derived linear dimensions using the ASE/EACVI-recommended formula and 3D automated, ML-based methods (Philips HeartModel) regarding LV mass quantification in unselected patients undergoing echocardiography. We included 130 patients (mean age 60 ± 18 years; 45% women). There was only discrete agreement between 2D and 3D measurements of LV mass (r = 0.662, r2 = 0.348, p < 0.001). The automated algorithm yielded an overestimation of LV mass compared to the linear method (Bland–Altman positive bias of 13.1 g with 95% limits of the agreement at 4.5 to 21.6 g, p = 0.003, ICC 0.78 (95%CI 0.68−8.4). There was a significant proportional bias (Beta −0.22, t = −2.9) p = 0.005, the variance of the difference varied across the range of LV mass. When the published cut-offs for LV mass abnormality were used, the observed proportion of overall agreement was 77% (kappa = 0.32, p < 0.001). In consecutive patients undergoing echocardiography for any indications, LV mass assessment by 3D analysis using a novel ML-based algorithm showed systematic differences and wide limits of agreements compared with quantification by ASE/EACVI- recommended formula when the current cut-offs and partition values were applied.

Evaluation of liver iron overload with R2* relaxometry with versus without fat suppression: both are clinically accurate but there are differences.

To assess clinically relevant difference in hepatic iron quantification using R2* relaxometry with (FS) and without (non-FS) fat saturation for the evaluation of patients with suspected hepatic iron overload. We prospectively enrolled 134 patients who underwent 1.5-T MRI R2* relaxometry with FS and non-FS gradient echo sequences (12 echoes, initial TE = 0.99ms). Proton density fat fraction for the quantification of steatosis was assessed. Linear regression analyses and Bland-Altman plots including Lin's concordance correlation coefficient were performed for correlation of FS R2* with non-FS R2*. Patients were grouped into 4 severity classes of iron overload (EASL based), and agreement was evaluated by contingency tables and the proportion of overall agreement. A total of 41.8% of patients showed hepatic iron overload; 67.9% had concomitant steatosis; and 58.2% revealed no iron overload of whom 60.3% had steatosis. The mean R2* value for all FS data was 102.86 1/s, for non-FS 108.16 1/s. Linear regression resulted in an R-squared value of 0.99 (p < 0.001); Bland-Altman plot showed a mean R2* difference of 5.26 1/s (SD 17.82). The concordance correlation coefficient was only slightly lower for patients with steatosis compared with non-steatosis (0.988 vs. 0.993). The overall agreement between FS and non-FS R2* measurements was 94.8% using either method to classify patients according to severity of iron storage. No correlation between R2* and proton density fat fraction was found for both methods. R2* relaxometry showed an excellent overall agreement between FS and non-FS acquisition. Both variants can therefore be used in daily routine. However, clinically relevant differences might result when switching between the two methods or during patient follow-up, when fat content changes over time. We therefore recommend choosing a method and keeping it straight in the context of follow-up examinations. • Both variants of R2* relaxometry (FS and non-FS) may be used in daily routine. • Clinically relevant differences might result when switching between the two methods or during patient follow-up, when fat content changes over time. • It seems advisable choosing one method and keeping it straight in the context of follow-up examinations.

Comparison of registered and published intervention fidelity assessment in cluster randomised trials of public health interventions in low- and middle-income countries: systematic review

BackgroundCluster randomised trials (CRTs) are a key instrument to evaluate public health interventions. Fidelity assessment examines study processes to gauge whether an intervention was delivered as initially planned. Evaluation of implementation fidelity (IF) is required to establish whether the measured effects of a trial are due to the intervention itself and may be particularly important for CRTs of complex interventions conducted in low- and middle-income countries (LMICs). However, current CRT reporting guidelines offer no guidance on IF assessment. The objective of this review was to study current practices concerning the assessment of IF in CRTs of public health interventions in LMICs.MethodsCRTs of public health interventions in LMICs that planned or reported IF assessment in either the trial protocol or the main trial report were included. The MEDLINE/PubMed, CINAHL and EMBASE databases were queried from January 2012 to May 2016. To ensure availability of a study protocol, CRTs reporting a registration number in the abstract were included. Relevant data were extracted from each study protocol and trial report by two researchers using a predefined screening sheet. Risk of bias for individual studies was assessed.ResultsWe identified 90 CRTs of public health interventions in LMICs with a study protocol in a publicly available trial registry published from January 2012 to May 2016. Among these 90 studies, 25 (28%) did not plan or report assessing IF; the remaining 65 studies (72%) addressed at least one IF dimension. IF assessment was planned in 40% (36/90) of trial protocols and reported in 71.1% (64/90) of trial reports. The proportion of overall agreement between the trial protocol and trial report concerning occurrence of IF assessment was 66.7% (60/90). Most studies had low to moderate risk of bias.ConclusionsIF assessment is not currently a systematic practice in CRTs of public health interventions carried out in LMICs. In the absence of IF assessment, it may be difficult to determine if CRT results are due to the intervention design, to its implementation, or to unknown or external factors that may influence results. CRT reporting guidelines should promote IF assessment.Trial RegistrationProtocol published and available at: https://doi.org/10.1186/s13643-016-0351-0

Validation of the LESS-CHRON criteria: reliability study of a tool for deprescribing in patients with multimorbidity

ObjectiveThe ‘LESS-CHRON criteria’ (List of Evidence-Based Deprescribing for Chronic Patients criteria) is a newly created tool with 27 criteria to guide deprescribing. It was developed using a Delphi methodology. Each...

Test-retest reliability of a modified International Physical Activity Questionnaire (IPAQ) to capture neighbourhood physical activity

Introduction: Few self-report tools capture neighbourhood physical activity. The aim of our study was to modify a widely-used self-report tool (International Physical Activity Questionnaire – IPAQ) to capture neighbourhood physical activity and estimate the test-retest reliability of these modifications. Material and Methods: Seventy-five adults completed the modified IPAQ twice, 7-days apart, capturing neighbourhood days·week -1 and usual minutes·day -1 of bicycling and walking for transport and leisure, moderate physical activity, and vigorous physical activity. Test-retest reliability was assessed with Intraclass Correlations (ICC), percent of overall agreement and Kappa statistics (κ). Results: Consistency in participation in neighbourhood PA ranged from k = 0.21 for moderate physical activity to k = 0.55 for vigorous physical activity, while proportion of overall agreement ranged from 64.0% for moderate physical activity to 81.3% for bicycling for transportation. ICC for reported neighbourhood PA between the two occasions ranged from ICC = 0.33 for moderate physical activity to ICC = 0.69 for bicycling for transportation for days·week -1 , ICC = 0.17 for bicycling for transportation to ICC = 0.48 for walking for leisure for minutes·day -1 , and ICC = 0.31 for vigorous physical activity to ICC = 0.52 for walking for leisure for minutes·week -1 . Conclusions: With the exception of minutes spent bicycling for transportation, our findings suggest that IPAQ items can be modified to provide reliable estimates of neighbourhood physical activity.

Reliability of an International Physical Activity Questionnaire (IPAQ) Modified to Capture Neighbourhood-specific Physical Activity ( poster )

Background Few self-report tools exist that accurately capture neighbourhood-based physical activity (PA) including walking. Our study aimed to modify PA items from the widely-used International Physical Activity Questionnaire (IPAQ) to capture neighbourhood-based PA, and to estimate the reliability of these modified items. Methods In 2016,75 adults from four Calgary neighbourhoods (2 high-walkable n=34 and 2 low-walkable n=41) completed the same questionnaire twice, 7-days apart. Modified-IPAQ items captured days/week and usual minutes/day of transportation cycling (TC), transportation walking (TW), leisure walking (LW), moderate PA (MPA), and vigorous PA (VPA) undertaken during the last 7-days inside the neighbourhood. To estimate the reliability for these items between the two questionnaires, we undertook Spearman’s rank correlations (r). Moreover, percent of overall agreement and Kappa statistics (κ) estimated the consistency in reported participation (any or none). Dependent t-tests, also compared differences in neighbourhood PA outcomes of the high and low walkable neighbourhoods. Spearman’s rank correlations and Kappa values approaching 1 suggest excellent agreement or consistency while values closer to 0 suggest poor agreement or consistency. Results The mean age (±SD) of our sample was 54±14 years, consisted mostly of women (65.3%), those with university-level education (80.0%), non-dog owners (65.3%), and those with access to a motor vehicle (100.0%) or bicycle (81.3%). Participation in neighbourhood PA ranged from poor (κ=0.21 for MPA) to moderate (κ=0.55 for VPA), while proportion of overall agreement was excellent and ranged from 77.3% for MPA to 81.3% for TC. Reported neighbourhood PA between the two questionnaires ranged from poor (r=0.20 for MPA) to moderate (r=0.62 for TW) for days/week, poor (r=0.34 for MPA) to moderate (r=0.55 for VPA) for minutes/day, and poor (r=0.19 for MPA) to moderate (r=0.54 for TW and VPA) for minutes/week. TC and TW participation, TC days/week, duration/day, and duration/week, and TW days/week and duration/week was significantly (p Conclusions Our findings suggest that, overall, IPAQ items can be modified to provide reliable self-report estimates of neighbourhood-based physical activity in adults. The modified-IPAQ items could be used to capture neighbourhood-based physical activity in studies investigating the relations between neighbourhood built environments and walking.

Assessment of Folate Status in Obese Patients: Should We Measure Folate in Serum or in Red Blood Cells?

Recent studies revealed that obesity is associated with decreased serum but at the same time increased red blood cell (RBC) folate concentrations compared with lean subjects, thus casting doubt upon the agreement between serum and RBC folate measurements for assessing folate status. This work aimed to determine whether these two metrics lead to the same classification of folate status in obese patients. RBC and serum folate concentrations were measured with a chemiluminescent immunoassay in 263 adults with body mass index ≥30kg/m2 and without previous bariatric surgery. Among them, 68.1% were eligible for bariatric surgery. Each serum and RBC folate result was classified as deficient or not according to thresholds recommended by the kit manufacturer (model A) or by the World Health Organization (model B). The agreement between serum and RBC folate results was evaluated using the proportion of overall agreement and the prevalence-adjusted bias-adjusted kappa (PABAK) statistics. The overall percentage agreements between serum and RBC measurements were 91.6% (95% CI 87.6-94.7%) and 92.4% (95% CI 88.5-95.3%) with PABAK coefficients of 0.87 (95% CI 0.82-0.93) and 0.88 (95% CI 0.83-0.94) in the models A and B, respectively, corresponding to almost perfect agreement. The same was true in the subgroup of patients eligible for bariatric surgery. Gender, age, and BMI did not influence the quality of agreement between the two parameters. The present study showed that folate measurements in serum and in RBC display similar performances to assess folate status in obese patients.

"Delayed Villous Maturation" in Placental Reporting: Concordance among Consultant Pediatric Pathologists at a Single Specialist Center.

Delayed villous maturation (DVM) has been associated with an increased risk of adverse pregnancy outcome, including stillbirth, in the late third trimester, but there are limited published data. Moreover, it is recognized that the assessment of villous maturation is subjective and hampered by both intraobserver and interobserver variability. This audit aims to assess concordance in the reporting of DVM among pediatric pathologists at a single specialist center to improve reproducibility of this potentially important diagnosis. This is a retrospective review of singleton placentas from pregnancies at 35 weeks gestation or greater submitted for histopathologic examination between June 2013 and December 2013. Placental slides were reviewed independently by 4 pediatric pathologists, blinded to the original report, apart from gestational age; villous maturation was assessed as appropriate, accelerated, or delayed for the stated gestational age. A total of 464 placental histopathology reports were reviewed, of which 164 were greater than 35 weeks gestation; of those, 42 (26%) were originally reported as DVM. Following the audit slide review, 38 cases (23%) were assessed to show DVM by at least 1 pathologist. Consensus, with at least 3 pathologists agreeing to a diagnosis of DVM, was achieved in only 14 cases (9% of all cases reviewed; 37% of all cases called DVM). However, the proportion of overall agreement between 2 of the pathologists was 0.92. Concordance for DVM is poor among pathologists and subject to much interobserver variability. Consistency may be improved by consensus histologic review of all the placentas in which the diagnosis of DVM is being considered and stringent application of the published diagnostic criteria.

Development and Reliability Testing of a Fast-Food Restaurant Observation Form.

To develop a reliable observational data collection instrument to measure characteristics of the fast-food restaurant environment likely to influence consumer behaviors, including product availability, pricing, and promotion. The study used observational data collection. Restaurants were in the Chicago Metropolitan Statistical Area. A total of 131 chain fast-food restaurant outlets were included. Interrater reliability was measured for product availability, pricing, and promotion measures on a fast-food restaurant observational data collection instrument. Analysis was done with Cohen's κ coefficient and proportion of overall agreement for categorical variables and intraclass correlation coefficient (ICC) for continuous variables. Interrater reliability, as measured by average κ coefficient, was .79 for menu characteristics, .84 for kids' menu characteristics, .92 for food availability and sizes, .85 for beverage availability and sizes, .78 for measures on the availability of nutrition information,.75 for characteristics of exterior advertisements, and .62 and .90 for exterior and interior characteristics measures, respectively. For continuous measures, average ICC was .88 for food pricing measures, .83 for beverage prices, and .65 for counts of exterior advertisements. Over 85% of measures demonstrated substantial or almost perfect agreement. Although some measures required revision or protocol clarification, results from this study suggest that the instrument may be used to reliably measure the fast-food restaurant environment.

"Delayed Villous Maturation" in Placental Reporting: Concordance amongst Consultant Paediatric Pathologists at a Single Specialist Centre

Delayed villous maturation (DVM) has been associated with an increased risk of adverse pregnancy outcome, including stillbirth, in the late third trimester, but there are limited published data. Moreover, it is recognised that the assessment of villous maturation is subjective and hampered by both intra- and interobserver variability. This audit aims to assess concordance in the reporting of DVM among paediatric pathologists at a single specialist centre in order to improve reproducibility of this potentially important diagnosis. A retrospective review of singleton placentas from pregnancies at 35 weeks gestation or above submitted for histopathological examination between June-December 2013. Placental slides were reviewed independently by all four paediatric pathologists,, blinded to the original report apart from gestational age; villous maturation was assessed as appropriate, accelerated or delayed for the stated gestational age. A total of 464 placental histopathology reports were reviewed, of which 164 were more than 35 weeks gestation; of these, 42 (26%) were originally reported as DVM. Following the audit slide review, a total of 38 cases (23%) were assessed to show DVM by at least one pathologist. Consensus, with at least three pathologists agreeing to a diagnosis of DVM, was achieved in only 14 cases (9% of all cases reviewed; 37% of all cases called DVM). However, the proportion of overall agreement between two of the pathologists was 0.92. Concordance for DVM is poor amongst pathologists and subject to much interobserver variability. Consistency may be improved with stringent application of the diagnostic criteria.

Delirium assessment in postoperative patients: Validation of the Portuguese version of the Nursing Delirium Screening Scale in critical care

Background and objectivesThe aim of this study was to validate the Portuguese version of the Nursing Delirium Screening Scale (Nu-DESC) for use in critical care settings. MethodsWe simultaneously and independently evaluated all postoperative patients admitted to a surgical Intensive Care Unit (SICU) over a 1-month period for delirium, using the Portuguese versions of both the Nu-DESC and the Intensive Care Delirium Screening Checklist (ICDSC) within 24hours of admission by both the research staff physician and one bedside nurse. We determined the diagnostic accuracy of the Nu-DESC using sensitivity, specificity and ROC curve analyses. We assessed reliability between nurses and the research staff physician for Nu-DESC by intraclass correlation coefficient (ICC). We assessed agreement and reliability between Nu-DESC and ICDSC by overall and specific proportions of agreement and by kappa statistics. ResultsBased on the ICDSC, we diagnosed delirium in 12 of the 78 patients. Reliability between nurses and the staff physician for total Nu-DESC score was high. Agreement between nurses and staff physician in the delirium diagnosis was perfect. The proportion of overall agreement between Nu-DESC and ICDSC in the delirium diagnosis was 0.88 and the kappa ranged from 0.79 to 0.93. Nu-DESC Sensitivity was 100 and specificity was 86%. ConclusionsThe Portuguese version of the Nu-DESC appears to be an accurate and reliable assessment and monitoring instrument for delirium in critical care settings.

Ergonomic issues in ewe cheese production: reliability of the Strain Index and OCRA Checklist risk assessments

Occupational ergonomists often use a variety of methods to identify jobs that are considered at high risk for the development of work-related musculoskeletal illnesses. The Strain Index (SI) and the Occupational Repetitive Actions (OCRA) Checklist are two popular upper limb risk assessment tools used in many industries, including the agro-food industry. Both methods are based on similar biomechanical, physiological and epidemiologic principles, but their approach to quantification and estimation of risk factor magnitude is quite different. The purpose of this study was to assess the inter-method reliability of SI and OCRA Checklist. Methods: Twenty-one jobs were video recorded in a Sardinian cheese manufacturing facility. Eight raters were recruited to assess job exposures to physical risk factors using the SI and OCRA Checklist. Inter-method reliability was characterized using proportion of overall agreement, Cohen’s kappa, and Spearman and Pearson correlations. Results: Strain Index and the OCRA Checklist assessments produced generally reliable results, classifying the risk of 35 of 42 (83%) job exposures similarly. Conclusions: The OCRA Checklist and SI risk assessments are reliable upper limb measures of physical work exposures. Both measures appear useful for assessing risk of upper limb disorders of work tasks in the agro-food industry. However, the SI is specific to disorders of the distal upper limb and perhaps most useful for assessing risk in work primarily involving the wrist and fingers. Whereas the OCRA Checklist, which includes an assessment of the shoulder, may be more appropriate for evaluating jobs that also require extended periods of reaching and shoulder activity.

Quality of life assessment in dementia patients referred to an acute care setting – Experiences with the ADRQL-instrument

Introduction and aims.– Although it is strongly recommended that ECP receive a CGA before any oncological treatment decision, there is no consensus about the best formof evaluation. The present analysis was conducted to compare the Balducci’s CGA1 (MGA) and the MPI2 as predictor of 12months mortality in ECP. Patients andmethods.– In the context of a prospective trial reported elsewhere, 160 patients aged 69years or more with inoperable/metastatic cancer received MGA1 (Balducci, Cancer Control 2001), from which the MPI3 was calculated. Cohen’s kappa coefficient and proportion of overall agreement for MGA and MPI categories were constructed. The area under the ROC curves (AUC) was assessed to compare MGA and MPI performance using logistic regression models, sexand age-adjusted. Results.– Between April 2008 and April 2010, 160 patients, 88 females (55%),meanage79.4 years, range69–93, entered the study. The overall mortality rate was 46.9% (75 patients) at 12months. At MGA, 30 patients (18.7%)were classified as fit, 35 (21.9%) as vulnerable and 95 (59.4%) as frail. One hundred and two patients (63.8%) had a low MPI, 46 (28.7%) a moderate MPI and 12 (7.5%) a severe MPI. The agreement between MGA and MPI was low, with a weighted Cohen’s K of 0.17 (95% CI =0.11–0.23, P<0.0001). The AUC for MPI was statistically greater thanAUC forMGA (0.73, 95% CI =0.65–0.81 vs 0.65, 95% CI =0.56–0.73, respectively; P=0.019). Conclusions.– The present study showed that theMPI performs better than MGA and could be used to correctly classifying 12months mortality in ECP.

Development and Reliability Testing of a Food Store Observation Form

To develop a reliable food store observational data collection instrument to be used for measuring product availability, pricing, and promotion. Observational data collection. A total of 120 food stores (26 supermarkets, 34 grocery stores, 54 gas/convenience stores, and 6 mass merchandise stores) in the Chicago metropolitan statistical area. Inter-rater reliability for product availability, pricing, and promotion measures on a food store observational data collection instrument. Cohen's kappa coefficient and proportion of overall agreement for dichotomous variables and intra-class correlation coefficient for continuous variables. Inter-rater reliability, as measured by average kappa coefficient, was 0.84 for food and beverage product availability measures, 0.80 for interior store characteristics, and 0.70 for exterior store characteristics. For continuous measures, average intra-class correlation coefficient was 0.82 for product pricing measures; 0.90 for counts of fresh, frozen, and canned fruit and vegetable options; and 0.85 for counts of advertisements on the store exterior and property. The vast majority of measures demonstrated substantial or almost perfect agreement. Although some items may require revision, results suggest that the instrument may be used to reliably measure the food store environment.