Reliability Of Clinical Judgment Research Articles

Mild cognitive impairment: a concept in evolution

The construct of mild cognitive impairment (MCI) has evolved over the past 10 years since the publication of the new MCI definition at the Key Symposium in 2003, but the core criteria have remained unchanged. The construct has been extensively used worldwide, both in clinical and in research settings, to define the grey area between intact cognitive functioning and clinical dementia. A rich set of data regarding occurrence, risk factors and progression of MCI has been generated. Discrepancies between studies can be mostly explained by differences in the operationalization of the criteria, differences in the setting where the criteria have been applied, selection of subjects and length of follow-up in longitudinal studies. Major controversial issues that remain to be further explored are algorithmic versus clinical classification, reliability of clinical judgment, temporal changes in cognitive performances and predictivity of putative biomarkers. Some suggestions to further develop the MCI construct include the tailoring of the clinical criteria to specific populations and to specific contexts. The addition of biomarkers to the clinical phenotypes is promising but requires deeper investigation. Translation of findings from the specialty clinic to the population setting, although challenging, will enhance uniformity of outcomes. More longitudinal population-based studies on cognitive ageing and MCI need to be performed to clarify all these issues.

Factors Affecting the Reliability of Clinical Judgments About the Function of Children's School-Refusal Behavior

Conducted two studies to examine the interrater reliability, test-retest stability, and the effect of various clinician variables, such as years of clinical experience, theoretical orientation, and prior experience with children, on clinical judgments about the reinforcement functions of children's school-refusal behavior. Results indicated that the judgments by individual clinicians were of questionable reliability. Judgments aggregated across 3 clinicians yielded acceptable interrater and test-retest reliability in Study 1, but a greater number of clinicians were necessary to achieve acceptable reliability in Study 2. Years of clinical experience and training were the only clinician variables related to the reliability of judgments about reinforcement functions. Several recommendations for the clinical assessment of the function of children's school-refusal behavior are discussed.

Serum Concentrations of Orosomucoid: Improved Decision-Making for Tapering Prednisolone Therapy in Patients with Active Inflammatory Bowel Disease?

Background: The reliability of clinical judgment for the tapering of glucocorticoids in patients with active inflammatory bowel disease has been questioned. Methods: The current study compared decision-making strategies on the basis of a combination of disease indices and serum concentrations of orosomucoid (strategy A) and disease indices only (strategy B) for the tapering of prednisolone. Twenty-nine patients with clinically active ulcerative colitis and 59 patients with Crohn's disease and increased concentrations of S-orosomucoid participated. The initial dose of prednisolone was 40 or 75 mg, which was tapered off over a minimum of 6 or 8 weeks. Results: The tapering schedule was completed in 11 of 44 (25%) patients treated in accordance with strategy A, whereas 28 of 44 patients (64%) had prednisolone completely tapered, in accordance with strategy B. At follow-up 4 of 11 patients (36%) and 17 of 28 patients (61%) treated in accordance with strategies A and B, respectively, had clinical relapse (0.10 > P > 0.05). By means of multiple regression analysis a high serum concentration of orosomucoid and previous disease activity were identified as predictors of relapse. Conclusion: A therapeutic end-point of normalization of an increased level of S-orosomucoid in addition to clinical remission may be difficult to use, as serum concentrations may be continuously increased in spite of clinical remission. However, this goal may still be relevant, as a trend towards higher risk of relapse was found in patients with increased orosomucoid concentrations after completing therapy.

Valgus Stress Test Study

To the Editor: We would like to address some inadequacies in “Intertester Reliability of Clinical Judgments of Medial Knee Ligament Integrity” (Phys Ther 69:268–275, 1989), by McClure et al, a study of the valgus stress test for medial knee ligament stability. The authors began by making what we feel are some erroneous assumptions and by extrapolating from accessory motion testing jargon to a common clinical test. The authors also inexplicably gave the test a new name, embracing the manual therapy jargon that two of the authors have repeatedly disdained. The most serious flaw in this study involved the inclusion of a three-category scale where three categories of response are not expected. The authors cited the most common, referenced method of interpreting the valgus stress test.1,2… [ ARTICLE][1] [1]: /lookup/volpage/69/268?iss=4

Reliability of clinical judgements of pupil dilation.

Reliability of clinical judgements of pupil dilation.

Validity and reliability in clinical judgments of C-V-S protocols as a function of amount of information and diagnostic category.

45 Ph.D. clinicians, with at least 4 yr. post-doctoral clinical experience, made a diagnostic judgment from the C-V-S Intelligence Scale protocols of 10 Ss in normal, retardate, organic, process, and reactive schizophrenic categories ( n = 50), with judges grouped on the basis of number of subtests (1, 2, or all 3) and type of subtest information (various combinations of C, V, and S) used. Correct diagnoses (validity) using 1, 2, or 3 subtests significantly exceeded chance. Contrary to the hypothesized relationship, diagnostic accuracy did not increase when the number of subtests to be judged was increased. Inter-judge agreement (reliability) increased significantly as a function of increasing information. Methodological factors in studies assessing validity and reliability of clinical judgment were cited.

The reliability of clinical judgments of asocial tendency.

The reliability of clinical judgments of asocial tendency.

Reliability of clinical judgment as a function of clinical experience

Reliability of clinical judgment as a function of clinical experience