Reliable Rate Research Articles

Psychometric evaluation of the Decision Support Tool for Functional Independence in community-dwelling older people

BackgroundThe aging population is increasingly faced with daily life limitations, threatening their Functional Independence (FI). These limitations extend different life domains and require a broad range of community-care professionals to be addressed. The Decision Support Tool for Functional Independence (DST-FI) facilitates community-care professionals in providing uncontradictory recommendations regarding the maintenance of FI in community-dwelling older people. The current study aims to determine the validity and reliability of the DST-FI.MethodsSixty community-care professionals completed a twofold assessment. To assess construct validity, participants were asked to assign predefined recommendations to fifty cases of older people to maintain their level of FI. Hypotheses were tested regarding the expected recommendations per case. Content validity was assessed by questions on relevance, comprehensiveness, and comprehensibility of the current set of recommendations. Twelve participants repeated the assessment after two weeks to enable both within- and between rater reliability properties, expressed by an Intraclass Correlation Coefficient.ResultsSeven out of eight predefined hypotheses confirmed expectations, indicating high construct validity. As the recommendations were indicated ‘relevant’ and ‘complete’, content validity was high as well. Agreement between raters was poor to moderate while agreement within raters was moderate to excellent, resulting in moderate overall reliability.CONCLUSIONThe DST-FI suggests high validity and moderate reliability properties when used in a population of community-dwelling older people. The tool could facilitate community-care professionals in their task to preserve FI in older people. Future research should focus on psychometric properties like feasibility, acceptability, and developing and piloting strategies for implementation in community-care.

Assessment of the quality of coronavirus-related online information in Hausa language

Objectives: To examine the quality of coronavirus related online information being posted in Hausa language. Materials and Methods: On 11th September, 2021, Google search engine was used to search the terms “Cutar Coronavirus” “Murar Mashako” “Cuta mai sarkafe Numfashi. Two raters rate the retrieved websites that met inclusion criteria and the data was validated by another independent researcher. Thereafter, inter rater reliability was computed using Pearson correlation in SPSS V20 at alpha level of 0.05. Results: A very good inter rater reliability of 0.83 was found. None of the websites belongs to an educational institution. The websites have quality information on the basic information of coronavirus such as definition, origin, mode of transmission 4.82 (0.36), but poor information on prevention and treatment effects 1.68 (0.84). Conclusion: In conclusion, coronavirus related online information being posted in Hausa Language are not reliable. There is need to educate online health information seekers on how to evaluate the genuineness of the information they are receiving.

Developing a Protocol for Quantitative Analysis of Liquid Swallowing in Children.

Objective measures in videofluoroscopic swallow studies (VFSSs) can quantify swallow biomechanics. There are a wide array of validated measures studied in infants, children, and adults. There is a need for a pediatric VFSS protocol that consists of a small number of vital, time efficient, and clinically relevant measures. In this study, we aimed to establish a standard protocol for quantitative VFSS analysis in children. Protocol development began with a systematic literature review, which identified 22 quantitative and eight descriptive measures available in the literature. A pediatric VFSS database of 553 children was collected using a standardized VFSS protocol. Studies were evaluated using the 30 previously reported measures covering displacement and timing parameters as well as penetration-aspiration and residue. Measures were tested for rater reliability and internal consistency. Measures meeting acceptable values for protocol inclusion were included in the final protocol (Cronbach's alpha > .53). Interrater and intrarater reliability of 17 measures met acceptable reliability levels. During internal consistency testing, we removed six further measures based on Cronbach's alpha levels indicating that two or more measures were equivalent in measuring the same aspect of swallow biomechanics in children. A VFSS protocol of reliable, valid, and obtainable objective quantitative (n = 6) and descriptive measures (n = 3) with separate protocols for young infants (≤ 9 months) and older children was established. A standardized quantitative VFSS protocol for children has been developed to suit two age groups (≤ 9 and > 9 months old). Consistent VFSS administration and reporting support assessment over time and across disease groups. Future research should focus on how this information can be used by clinicians to produce individualized treatment plans for children with swallowing impairment.

Examining the Impact of Individualized Music for Patients on a Geriatric Psychiatry Unit

<h3>Introduction</h3> Clinicians are encouraged to use non-pharmacologic interventions first as part of the treatment of responsive behaviours due to mental health conditions. Music therapy is an example of such an intervention. In recent years, there has been an increased research focus on individualized music (IM) because it considers patient's personal music preferences. However, the findings of whether IM listening is more beneficial than general music listening has been inconsistent. This study is to further compare the effects of IM and elevator/baseline music (BM) listening on enjoyment behaviours of geriatric inpatients. <h3>Methods</h3> Fifteen participants were recruited from a geriatric psychiatry unit in an acute tertiary mental health facility in British Columbia, Canada. Their mean age was 74 years and their mean MMSE was 18. Each participant attended two 30-minute music listening sessions. Each session included a 15-minute baseline music playlist and a 15-minute IM playlist. The sequence of the two playlists was counterbalanced for each participant across the two sessions. The IM playlists were created by interviewing each participant with the Revised versions of the Assessment of Personalized Music Preference Questionnaire (APMPQ). The baseline (elevator) playlist was simply consisted of instrumental, non-lyrical jazz and classical music and was the same for every participant. The enjoyment behaviors during the sessions for each participant were measured by the Enjoyment Behavioral Coding Scheme (EBCS), which was developed for this project based on previous literature and was shown to have a good inter rater reliability. The EBCS was completed by the recreation therapist immediately after sessions. <h3>Results</h3> The average ratings of positive and negative items of the EBCS across two sessions of IM and BM were calculated. Paired samples t-test was used to compare the average ratings for the IM and BM sessions. For both the positive and negative behaviour categories, the t-tests of the average ratings did not show statistical significance. <h3>Conclusions</h3> Participants appeared to enjoy both the IM and baseline music sessions equally. <h3>This research was funded by</h3> NA

A multi-attribute based trusted routing for embedded devices in MANET-IoT

High level security is always an important requirement to save the sensitive information traveled across the MANET-IoT. Secure routing is one of the major concerns to prevent impersonation attacks from the network. There are many state of the art routing model available based on trusted metrics to enhance the security of the MANET-IoT. However, still there are many challenges to provide high secure environment due to the dynamic characteristics of the network. In this paper, an enhanced multi attribute based attack resistance (EMBTR) algorithm is proposed to perform the routing process securely based on nodes’ trusted values. The work proposed here uses QoS parameters such as stability rate (SR), reliability rate (RR), and elapsed time (ET) to enhance the performance of the network by combating trust related attacks. The algorithm introduced in the paper can provide a trustworthy route by isolating the misbehavior nodes from the communication path based on the trusted metrics calculated for the nodes in the network. The proposed work is compared with currently available routing algorithms such as TSRM (Trust based secure routing model), and TARF (Trust-aware routing framework for WSNs). The result shows that the proposed work can efficiently detect and remove malicious nodes from the network and provide secure routing with limited energy, and high detection rate than the currently available solutions.

Validity of the four‐square step test in persons with haemophilia

Recurrent bleeds into joints causes arthropathy leading to pain and reduced joint movement. This may cause a reduction in postural balance and increase the falls risk in patients with haemophilia (PWH). With an ageing PWH population the need to assess functional balance in clinic will be essential to monitor function and implement interventions to help maintain balance and prevent falls. To assess the utility of the Four-Square Step Test (FSST) in PWH. 80 PWH of all severity types were recruited and underwent a battery of outcome measures: FSST, Timed up & go (TUG), Short performance physical battery (SPPB), Haemophilia Activity List (HAL), ABC confidence questionnaire, and Haemophilia Joint Health score (HJHS). Demographics were collected, together with self-reported falls/trips history. All 80 participants were able to complete all test measures. Median age 44.5years. Number of participants reporting falls ranged from 23% in severe to 3% in mild. Recent trips 53% severe to 17% mild. Excellent Inter and intra-reliability, ICC of .981 (CI .953-.992), P<.001 and ICC .989 (.983-.993) P<.001, respectively. Strong correlations between FSST and TUG/ SPPB .753 and -.728, moderate correlation between FSST and ABC/HAL -.484, -.464 P<.01. FSST is a valid and safe measure to use in PWH. It correlates strongly with other functional measures, has excellent inter and intra rater reliability. FSST correlates with age rather than severity type and provides information to the clinician on the speed/ability to change direction and clear an obstacle. ABC questionnaire was able to differentiate between severities and offers insight into patient confidence to move. SPPB had a ceiling effect with 52/80 scoring 12 and may not be suitable for PWH.

Radiographic Determination of the Distal Ulnar Diaphyseal Angle

Characterizing the distal ulnar diaphyseal angle (DUDA) may be important for anatomic recreation of the distal ulna during ulnar shortening osteotomy procedures using conventional straight plates. This study characterized the DUDA and determined side-to-side, age, and sex effects on DUDA magnitudes and locations. Retrospective analyses of bilateral wrist radiographs were performed on 60 patients. The DUDA was defined as the angle of intersection between a line passing through the center of the distal ulnar metadiaphyseal region, in line with the landmarked long axis of the ulna, on a lateral radiograph. This inflection point was measured from the most distal aspect of the ulnar head and recorded as the DUDA tip-to-apex distance (TAD). Rater reliability was determined using the intraclass correlation coefficient. We found DUDAs in 94% of radiographs. The mean DUDA angle was 5.6° ± 2.6° and the mean TAD was 45.3 ± 9.5 mm. The Pearson correlation coefficients for side-to-side comparisons were 0.47 for the DUDA angle and 0.69 for the TAD. For male and female patients, the mean DUDAs were 5.4° ± 2.3° and 5.9° ± 2.9°, respectively, and the mean TADs were 47.8 ± 9.7 mm and 41.7 ± 7.9 mm, respectively. The DUDA angle and TAD had negligible associations with age (r=-0.15 and-0.08, respectively). At 0.74 (95% CI, 0.58-0.85), interrater reliability was good. At 0.93 (95% CI, 0.88-0.96), intrarater reliability was excellent. We demonstrated DUDAs, representing valgus deviations from the center axis and anteroposterior views of the ulna. Contralateral lateral wrist radiographs are moderate to strongly reliable in determining a DUDA. Rater reliability was good to excellent. Re-creation of the DUDA may benefit procedures such as ulnar shortening osteotomy, fractures, or malunion by contributing to knowledge of distal radioulnar joint biomechanics.

Validity and Intra Rater Reliability of a New Device for Tongue Force Measurement

Validity and Intra Rater Reliability of a New Device for Tongue Force Measurement

Adaptation and Validation of the Bangla Version of Children's Yale- Brown Obsessive Compulsive Scale

Background: Obsessive Compulsive Disorder (OCD) is one of the common psychiatric disorders among children and adolescent. Prevalence of child and adolescent OCD is 2% in Bangladesh. Gold standard Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) is a clinician-rated and most widely used scale in measurement of OCD symptom severity and thereby treatment response in children and adolescent age group. A validated scale for children and adolescent patient with OCD is needed for measuring symptom severity as well as treatment outcome in Bangladesh. Aim of the study: The aim of this study was to develop a culturally adapted and psychometrically validated Bangla version Children's Yale Brown Obsessive Compulsive Scale for use in Bangla speaking child and adolescent patients with obsessive compulsive disorder in Bangladesh. Methods: This validation study was conducted in the period of July 2016 to September 2017 in the department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka. In this study researcher applied Bangla version of Children's Yale Brown Obsessive- Compulsive Scale in 47 child and adolescent with OCD and assessed the validity (Content validity, Face validity, Convergent validity and Factor analysis) and reliability (Internal consistency, Inter-rater reliability, Test-retest reliability). Results: Age of the respondents were ranging from 8-17 years. Content validity and face validity was maintained by following standard procedures. Good convergent validity was found with culturally adapted Developmental and Well Being Assessment (DWABA) Bangla by using spearman's rho. Factor analysis revealed 2 components in the construct. Communalities were above accepted level. In assessing internal consistency, Cronbach's Alpha (a) value was 0.91, which reflects good reliability. Inter rater reliability was excellent for CY-BOCS total and each individual 10 items as the range of intraclass correlation was 0.96 to 0.98 which represented very .........

P-OGC50 An Objective Evaluation of Youtube Videos on Oesophageal Cancer using the PEMAT Score

Abstract Background Studies in patient literature particularly regarding online video literature in all fields are few. Scoring systems for video materials such as the validated PEMAT(Patient Education Material Assessment Tool) have been used before to look at video patient literature. The aim of this study is to use the PEMAT tool to evaluate the quality of Youtube patient literature on oesophageal cancer and look at the inter rater reliability between lay and medical scorers. Methods A Youtube search was performed in April 2021 using the search terms “oesophageal cancer”, “esophageal cancer” “gullet cancer”. Characteristic data collected included language, ratings (thumbs up), type of video, country of origin and presence of advertising as well as intended audience. A PEMAT tool which is validated instrument to rate patient video material was used. A score of 70% is acceptable in the actionability and understandability domains. Cohen’s kappa coefficient was used to test inter-rater reliability between two lay person raters; and two medical raters. Results Seven sites were rated as understandable by the medical raters average and 13 were rated understandable by the lay raters average. Only two videos achieved best case scenario where both medical raters rated as understandable, rather than the average of both. Twelve videos were rated by both lay raters as understandable. Actionability rated poorer with only two videos rated as actionable on average by the medical raters and seven rated actionable by the lay raters on average. Conclusions Youtube videos on Oesophageal cancer score poorly in terms of actionability and understandability.

Inter and Intra Rater Reliability of Different Measurement Techniques of Weight Bearing Ankle Dorsiflexion Range of Motion

Background: Measurement of range of motion is a crucial parameter in the physiotherapeutic evaluation and follow up. Ankle dorsiflexion is important for functional activities like running, jogging, waking, stair climbing. Restricted ankle dorsiflexion is seen in various lower limb injuries. Therefore, assessment of dorsiflexion is important to assess function. Goniometer, tape measure, mobile goniometer, inclinometer is used to measure ankle dorsiflexion range of motion in weight bearing and non-weight bearing positions. Weight bearing dorsiflexion has reported higher intra and inter-rater reliability as compared to non-weight bearing ankle dorsiflexion. All these measures may be taken by the same and by different therapists in the management of one patient. Therefore, it is necessary to determine if the measurements used are reliable both within and between the therapists. Material and Methods: 50 healthy subjects were recruited and their role was explained in the study. Written consent was taken from all the subjects. Weight bearing lunge was done in which the subject was asked to stand with the heel in contact with the ground and the great toe 10 cm away from the wall and the knee touching the wall. Inclinometer, standard goniometer, mobile goniometer and tape measure were administered to check for ankle dorsifexion range of motion. Results: ICC for inter rater reliability was almost perfect for tape measure and goniometer (0.968 and 0.837 respectively) and it was substantial for inclinometer and mobile goniometer (0.746 and 0.796 respectively). ICC for intra rater reliability was almost perfect for tape measure, inclinometer and goniometer (0.965,0.894 and 0.837 respectively) and it was substantial for mobile goniometer (0.802). Conclusion: The inter-rater reliability of tape measure, goniometer is almost perfect and for mobile goniometer, inclinometer is substantial. The intra rater reliability of tape measure, inclinometer, goniometer is almost perfect and mobile goniometer is substantial. KEY WORDS: Dorsiflexion, Mobile goniometer, Tape measure, Goniometer, Inclinometer, Reliability.

Reliability of HOME FAST BRAZIL-Self-Reported Version for Community-Dwelling Older Adults.

Objective: Verify the intra- and inter-rater reliability of the HOME FAST BRAZIL—Self-reported version and correlate household environmental risks with the history of falls by community-dwelling older adults.Method: Cross sectional study with 50 community-dwelling older adults who were screened by the cut-off point of the Mini Mental State Exam and replied to the HOME FAST BRAZIL—Self-reported version using two evaluators, on three occasions. The reliability analysis was determined by the Intra-class Correlation Coefficient (ICC), considering ICC > 0.70 as adequate. To test the correlations, the Spearman test was used.Results: The mean age of the participants was 73.2 ± 5.8 years. The inter- rater reliability of HOME FAST BRAZIL—Self-reported version was ICC 0.83 (IC95%, 0.70–0.90) and the Intra- reliability ICC 0.85 (IC95%, 0.74–0.91). A risk of falls was verified in 88% of the sample and four environmental risks presented significant correlations with the history of falls.Conclusions: The HOME FAST BRAZIL—Self-reported version presented adequate reliability for the evaluation of household environmental risks for community-dwelling older adults. Risks such as inadequate armchairs/ sofas, the absence of anti-slip mats in the shower recess, the presence of pets and inadequate beds require attention in the evaluation of household risks, due to their correlation with the occurrence of falls.

Measurement Properties of Canadian Agility and Movement Skill Assessment for Children Aged 9-12 Years Using Rasch Analysis.

The Canadian Agility and Movement Skill Assessment (CAMSA) was recently widely used to assess fundamental motor skills in children. Although the CAMSA is reported to be reliable and valid, its measurement properties are not clear. This study aimed to examine the measurement properties of the CAMSA in a sample of Chinese children using Rasch analysis. The study sample was from 1,094 children aged 9–12 years in Zunyi City, Guizhou Province. Descriptive data were analyzed using SPSS 24.0 software, and the dichotomous data were analyzed by Winsteps version 4.5.4 and Facets 3.67.1 software performing Rasch analysis. The present study investigated CAMSA measurement characteristics by Rasch analysis, including the reliability of the rating instrument, unidimensionality, item-fit statistics, and differential item functioning (DIF). Inter-rater reliability and retest reliability showed that the CAMSA had a good internal consistency. Rasch analysis indicated that the CAMSA was unidimensional, locally independent, and had a good item-fit-statistic. Additionally, the CAMSA displayed a good fit for the item separation index (12.50 > 2.0), as well as for item reliability (0.99 > 0.90). However, the item difficulty of the CAMSA did not fit well with personal ability, and a significant DIF was found across genders. In the Chinese children sample test, the CAMSA demonstrated appropriate goodness-of-fit validity and rater reliability. Thus, future research will explore item difficulty and person ability fit, as well as DIF across genders.

Contrast–enhanced ultrasound imaging of the optic nerve sheath diameter – a proof of concept study

Purpose: The present proof of concept study was performed to evaluate the consistency between measurements of the optic nerve sheath taken using contrast– enhanced sonography and high– resolution magnetic resonance imaging (MRI). The main goal was to devise a novel candidate method to measure the optic nerve sheath diameter that is easy to perform, straightforward to interpret, and highly reproducible.&#x0D; Methods: The approval of the National Medical Ethics Committee of the Republic of Slovenia was obtained; the study was registered under No. 30/03/12. Nine healthy young adults were examined with high–resolution MRI and contrast–enhanced ultrasound (CEUS). Measurements of the optic nerve sheath diameter were performed 3 mm behind the bulb, using both methods. The datasets were anonymized and the readers, blinded. Statistical analysis included evaluation of agreement using Bland–Altman plots. The assessment of inter– rater reliability was achieved by calculation of the intra class correlation coefficient.&#x0D; Results: Bland–Altman plots showed favorable overall agreement between both methods, with clinically acceptable limits of agreement. The intra class correlation coefficient calculated for both methods suggests that the CEUS method was at least as reproducible as high–resolution MRI.&#x0D; Conclusion: The described method, using CEUS to measure the optic nerve sheath diameter, facilitates the identification of the surrounding anatomy. When CEUS is employed, the measurement points can be easily and reliably set, and retro bulbar artifacts are less confounding. Based on results from a relatively small sample, this method seems to be comparable with high–resolution MRI. Evaluation of the method on a larger sample of healthy subjects and patients with increased intracranial pressure is needed.

Test-retest Reliability of EMG β-Band Intermuscular Coherence of Non-specific Chronic Low Back Pain During Flexion-extension Task

Introduction: This study aimed to investigate the reliability and agreement of the Beta-band Intermuscular Coherence (Bb-IMC) as a clinical assessment tool for Non-Specific Chronic Low Back Pain (NS-CLBP) patients and healthy subjects by studying four phases of the Flexion-Extension Task (F-ET): standing, flexion, relaxation, and extension phases. Materials and Methods: Twenty-four men with NS-CLBP and 20 healthy subjects voluntarily participated in this study. All subjects performed three trials of F-ET while the surface electromyography was recorded from the lumbar erector spinal, gluteus maximus, and hamstring muscles of both sides. Beta-band intermuscular coherence analysis was used to calculate the pool coherence and the pairwise coherence for all mentioned muscles. Afterward, the Intra-class Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC) for four phases of F-ET were used to analyze the intra- rater reliability and agreement of the measurements. Results: The investigation of ICC, SEM, and MDC showed that the reliability was moderate to a high level for pool and pairwise coherence of Bb-IMC in all mentioned muscles for four phases of the flexion-extension task in NS-CLBP patients and healthy subjects. Yet, the agreement was low because the measurement error was relatively large. Conclusion: So far, no studies have used the Bb-IMC method to study low back pain, which is carried out in our research to check the reliability of this new method. Our findings revealed that pool and pairwise coherence obtained during F-ET have moderate to a high level of reliability for using Bb-IMC and could be considered a tool for the NS-CLBP patients’ assessment. Despite the small sample size investigated, in clinical practice the using Bb-IMC measure can help to study the interaction of corticospinal in NS-CLBP and also in healthy subjects. This measure requires larger sample sizes in addition to studying other circumstances and functional movements such as lifting weight. Further, more research appears to be warranted by the observed effectiveness of a particular intervention in modulation mechanisms of corticospinal tract function by Bb-IMC in NS-CLBP.

Development of Gazi Functional Vision Assessment Instrument

&lt;p style="text-align:justify"&gt;This study aimed to develop a valid and reliable instrument that measures the functional vision of students with low vision. Thus, an assessment tool and performance activities were developed for three vision skill groups (near vision skills, distance vision skills, and visual field) that include functional vision skills. The universe was 1485 students studying in various primary and middle schools (from 2nd to 7th grades) affiliated to the Ministry of National Education, and simple random sampling was used to select 310 students. The data were collected using the Gazi Functional Vision Assessment Instrument developed by the researchers. Many-facet Rasch model and generalizability theory were used for the rater reliability of the measurements obtained from the instrument, while discriminant analysis was used for the validity of the measurements. The analysis showed that the measurements were reliable, and the inferences based on these measurements were valid. Thus, this instrument can be used to identify and assess the functional vision status of students with low vision.&lt;/p&gt;

Intrarater and interrater reliability of the modified Thomas Test

IntroductionThe modified Thomas Test (MTT) is a method of assessing flexibility of the iliopsoas, rectus femoris and tensor fascia Latae. The aim of this study is to identify the intra and inter-rater reliability of the pass/fail scoring for the Modified Thomas Test (MTT) using digital photographs. MethodsSix raters varying between 1 and 13years of clinical experience were used to review digital photographs of 20 semi-professional rugby players performing the /MTT. Raters were asked to score each muscle of the MTT either with 0 (fail) or 1 (pass). Digital photographs were allocated in a randomized order. Each rater reviewed each photograph three times at two week intervals. ResultsCronbach's alpha (Cα) revealed a mean result of high reliability for both iliopsoas (Cα = 0.95) and rectus femoris (Cα = 1.00) flexibility. TFL flexibility values ranged from 0.64 to 0.95, demonstrating some inconsistencies within some of the 6 raters. Fleiss kappa (Fк) revealed a high mean reliability result across the 3 testing sessions for both iliopsoas (Fк = 0.78) and rectus femoris (Fк = 0.80) flexibility, along with a moderate reliability mean result for TFL (Fк = 0.56). ConclusionHigh intra and inter rater reliability was found for iliopsoas and rectus femoris flexibility with those for TFL found to be moderately reliable.

Retrograde urethrography, sonouretrography and magnetic resonance urethrography in evaluation of male urethral strictures. Should the novel methods become the new standard in radiological diagnosis of urethral stricture disease?

PurposeTo verify which of the diagnostic modalities: Voiding cystouretrography (VCUG), Sonouretrography (SUG) or Magnetic resonance uretrography (MRU) is the most accurate in the assessment of urethral strictures in males and in what cases the application of novel imaging techniques benefits most.Methods55 male patients with a diagnosis of urethral stricture, were enrolled in this prospective study. Initial diagnosis of urethral stricture was based on anamnesis, uroflowmetry and VCUG. Additional imaging procedures—SUG and MRU were performed before the surgery. Virtual models and 3D printed models of the urethra with the stricture were created based on the MRU data. Exact stricture length and location were evaluated by each radiological method and accuracy was verified intraoperatively. Agreement between SUG and MRU assessments of spongiofibrosis was evaluated. MRU images were independently interpreted by two radiologists (MRU 1, MRU 2) and rater reliability was calculated.ResultsMRU was the most accurate [(95% CI 0.786–0.882), p < 0.0005] with an average overestimation of 1.145 mm (MRU 1) and 0.727 mm (MRU 2) as compared with the operative measure. VCUG was less accurate [(95% CI 0.536–0.769), p < 0.0005] with an average underestimation of 1.509 mm as compared with operative measure. SUG was the least accurate method [(95% CI 0.510–0.776), p < 0.0005] with an average overestimation of 2.127 mm as compared with the operative measure. There was almost perfect agreement of MRU interpretations between the radiologists.ConclusionsVCUG is still considered as a ‘gold standard’ in diagnosing urethral stricture disease despite its limitations. SUG and MRU provide extra guidance in preoperative planning and should be considered as supplemental for diagnosing urethral stricture. Combination of VCUG and SUG may be an optimal set of radiological tools for diagnosing patients with urethral strictures located in the penile urethra. MRU is the most accurate method and should particularly be considered in cases of post-traumatic or multiple strictures and strictures located in the posterior urethra.

198 Neuropsychiatric Effects of Cannabis Toxicity in the Emergency Department: A Community-Based Study

The state law to legalize recreational use of marijuana in Michigan went into effect in December 2018. Increased availability and use of cannabis in Michigan have led to a marked increase in emergency department (ED) visits associated with the drug’s neuropsychiatric effects. Our purpose was to describe the prevalence, clinical features, and disposition of cannabis neuropsychiatric toxicity in a community-based study. This was a retrospective cohort analysis of consecutive patients diagnosed with toxicity related to cannabis use. Patients were seen at seven emergency departments (EDs) over a 24-month study period (November 2018-October 2020). Spanning 13 counties in Michigan, affiliated institutions included three rural medical centers, three university-affiliated hospitals, and a children’s tertiary care facility. Data collected included demographics, clinical features, and treatment outcomes in patients presenting to the ED with neuropsychiatric symptoms (NPS) versus those experiencing other forms of cannabis toxicity. Chi-squared and t-tests were used to compare these two groups across key demographic and outcome variables. One investigator performed a blinded critical review of a random sample of 10% of the charts to determine inter- rater reliability using kappa statistics. During the study period, 1214 patients were evaluated for cannabis toxicity. A total of 584 patients (48.1%) had a neuropsychiatric chief complaint (NPS group) and 630 (51.9%) experienced other forms of cannabis toxicity, predominantly symptoms of intoxication (51.0%) or cannabis hyperemesis syndrome (37.5%). The NPS group presented with acute anxiety (37.5%), suicidal ideation (18.4%), depression (16.1%), hallucinations (9.5%), mania (5.9%), seizures (5.5%), psychosis (4.6%), and paranoia (4.5%). NPS patients were more likely to younger (25.3 vs 29.2 years, P<0.001), have comorbidities (15.3 vs 9.2%, P=0.001) and a history of polysubstance abuse (13.2 vs 8.6%, P=0.004). These patients also had a longer ED length-of-stay (7.3 vs 4.0 hours, P<0.001) and significantly more hospital admissions (41.9% vs 6.4%, P<0.001). Reliability of data collection (k = 0.91) showed excellent agreement. Neuropsychiatric toxicity is common after acute or chronic cannabis exposures, occurring in nearly half of ED patients in this community-based study. These troublesome findings highlight the risks associated with the use of cannabis for recreational or therapeutic purposes.

Rehabilitative ultrasound imaging for the assessment of selected morphometric parameters of the flexor hallucis longus muscle in healthy individuals: An inter- and intra- rater reliability study

IntroductionUltrasound imaging (USI) is useful to evaluate structures of the foot to guide treatment, but the reliability of USI technique needs to be clarified. The goal of the study was to evaluate the intra- and inter-examiner reliability of USI image capture, and measurement of the cross-sectional area (CSA) and thickness of the flexor hallucis longus (FHL) for experienced and novice examinersMaterial and methodsFHL images were captured for 20 healthy adults. Reliability of image capture was evaluated between images repeated at 10-min interval for an experienced and a novice examiner. Reliability of image-based measurements was evaluated for one experienced and one novice rater, using all images. The intra-class correlation coefficient (ICC) and the standard error of measurement (SEM) were calculatedResultsIntra-examiner reliability of image capture for the FHL muscle examined by USI was excellent for both thickness (ICC3,1, 0.944–0.976; SEM, 6.8%–10.0%) and CSA (ICC3,1, 0.954–0.979; SEM, 10.8%–16.5%), with no effect of examiner experience. Reliability was also excellent for measurement of thickness (ICC3,1, 0.954–0.972; SEM, 1.2%–9.6%) and CSA (ICC3,1, 0.961–0.986; SEM, 9.2%–14.1%), with no effects of experience.ConclusionsReliability of image capture and image-based measurements developed by USI of CSA and thickness for the FHL muscle in healthy individuals was excellent, independent of the examiner experience.