Varying Levels Of Experience Research Articles

Effect of Training on Visual Identification of High Frequency Oscillations-A Delphi-Style Intervention.

ObjectiveWe examined the effect of a simple Delphi-method feedback on visual identification of high frequency oscillations (HFOs) in the ripple (80–250 Hz) band, and assessed the impact of this training intervention on the interrater reliability and generalizability of HFO evaluations.MethodsWe employed a morphology detector to identify potential HFOs at two thresholds and presented them to visual reviewers to assess the probability of each epoch containing an HFO. We recruited 19 board-certified epileptologists with various levels of experience to complete a series of HFO evaluations during three sessions. A Delphi-style intervention was used to provide feedback on the performance of each reviewer relative to their peers. A delayed-intervention paradigm was used, in which reviewers received feedback either before or after the second session. ANOVAs were used to assess the effect of the intervention on the reviewers' evaluations. Generalizability theory was used to assess the interrater reliability before and after the intervention.ResultsThe intervention, regardless of when it occurred, resulted in a significant reduction in the variability between reviewers in both groups (pGroupDI = 0.037, pGroupEI = 0.003). Prior to the delayed-intervention, the group receiving the early intervention showed a significant reduction in variability (pGroupEI = 0.041), but the delayed-intervention group did not (pGroupDI = 0.414). Following the intervention, the projected number of reviewers required to achieve strong generalizability decreased from 35 to 16.SignificanceThis study shows a robust effect of a Delphi-style intervention on the interrater variability, reliability, and generalizability of HFO evaluations. The observed decreases in HFO marking discrepancies across 14 of the 15 reviewers are encouraging: they are necessarily associated with an increase in interrater reliability, and therefore with a corresponding decrease in the number of reviewers required to achieve strong generalizability. Indeed, the reliability of all reviewers following the intervention was similar to that of experienced reviewers prior to intervention. Therefore, a Delphi-style intervention could be implemented either to sufficiently train any reviewer, or to further refine the interrater reliability of experienced reviewers. In either case, a Delphi-style intervention would help facilitate the standardization of HFO evaluations and its implementation in clinical care.

Infection prevention and control program assessment tools: A comparative study

Infection prevention and control program (IPCP) assessment tools help to identify the improvement needs. This study aimed to identify fit-for-purpose of 3 IPCP assessment tools. An exploratory mixed-method study was performed from 2018-2019 in Brazil, using a convenience sample of IPC professionals with various levels of experience to evaluate the IPCP tools: (1) the WHO Infection Prevention and Control Assessment Framework at the Facility Level (IPCAF), (2) the University of Sao Paulo IPCP tool (OGIPCP), and (3) the Infection Prevention and Control Programme Evaluation (IPCPE) tool. A quantitative survey followed by a semi-structured interview accessed the participants' perceptions about these tools. Quantitative data analysis were descriptive and qualitative data were thematical. IPCPE was considered more complete, better for effectiveness, easy to apply, and with easily interpreted indicators. IPCAF was the best regarding to purpose, easy reporting, and interpretation; however, requires professional experience. OGIPCP have the fastest application, easy to understand, and easily calculated indicators, requiring less experience. Qualitative data endorsed the quantitative results and showed IPCPE and IPCAF tools as the most accepted. The 3 assessment tools for IPCP have similar potential for use to support improvements in the IPCP. The IPCPE and IPCAF were considered advantageous on the effectiveness and fit-for-purpose compared to OGIPCP, despite the higher familiarity of participants with this tool.

Interobserver Agreement and Correlation of an Automated Algorithm for B-Line Identification and Quantification With Expert Sonologist Review in a Handheld Ultrasound Device.

B-lines are ultrasound artifacts that can be used to detect a variety of pathologic lung conditions. Computer-aided methods to detect and quantify B-lines may standardize quantification and improve diagnosis by novice users. We sought to test the performance of an automated algorithm for the detection and quantification of B-lines in a handheld ultrasound device (HHUD). Ultrasound images were prospectively collected on adult emergency department patients with dyspnea. Images from the first 124 patients were used for algorithm development. Clips from 80 unique subjects for testing were randomly selected in a predefined proportion of B-lines (0 B-lines, 1-2 B-lines, 3 or more B-lines) and blindly reviewed by five experts using both a manual and reviewer-adjusted process. Intraclass correlation coefficient (ICC) and weighted kappa were used to measure agreement, while an a priori threshold of an ICC (3,k) of 0.75 and precision of 0.3 were used to define adequate performance. ICC between the algorithm and manual count was 0.84 (95% confidence interval [CI] 0.75-0.90), with a precision of 0.15. ICC between the reviewer-adjusted count and the algorithm count was 0.94 (95% CI 0.90-0.96), and the ICC between the manual and reviewer-adjusted counts was 0.94 (95% CI 0.90-0.96). Weighted kappa was 0.72 (95% CI 0.49-0.95), 0.88 (95% CI 0.74-1), and 0.85 (95% CI 0.89-0.96), respectively. This study demonstrates a high correlation between point-of-care ultrasound experts and an automated algorithm to identify and quantify B-lines using an HHUD. Future research may incorporate this HHUD in clinical studies in multiple settings and users of varying experience levels.

Pre-study for facilitating the discovery of microfluidic properties in blood vessels using retinal fundus images

ABSTRACT COVID-19 disease may cause alterations of microfluidic properties of blood circulation in the retinal tissue. For the pre-study of microfluidic blood physiology and transport, retinal fundus images are applied for clinical screening of abnormal vessels forms. However, fundus images captured by operators with various levels of experience have diversity in quality. Low-quality fundus images increase uncertainty in clinical observation and lead to the risk of misdiagnosis. Due to the optical beam of fundus image acquisition and vessel structure of the retina, natural image restoration methods cannot be applied straight to address this problem. The semi-automatic blind deblurring is a useful technique to restore the underlying sharp image given some assumed or known information about the cause of degradation. In this work, we propose a new hybrid algorithm for image restoration that does not require a priori knowledge of the noise distribution. The degraded image is first de-convoluted in Fourier space by parametric Wiener filtering; then, it is smoothed by using the anisotropic diffusion. The filtering model was tested on 177 fundus images. Experiment filtering results show the efficiency of our algorithm with a superlative performance (p-value < 0.05) when compared with state of the art methods.

MRI as First Line Imaging for Suspected Acute Appendicitis during Pregnancy: Diagnostic Accuracy and level of Inter-Radiologist Agreement

ObjectiveEvaluation of acute appendicitis (AA) in pregnancy is supported with diagnostic imaging. Typically, ultrasound (US) is performed first, and then often followed by magnetic resonance imaging (MRI) due to continued diagnostic uncertainty. The purpose of our study was to evaluate the sensitivity, specificity, and accuracy of US as compared to MRI and to evaluate the inter-radiologist agreement amongst body Radiologists with varying levels of expertise. Materials and MethodsWe performed a retrospective study of 364 consecutive pregnant patients with clinical suspicion of AA at a single center over a 6-year period. Sensitivity, Specificity, accuracy, positive and negative predictive values were calculated for US and MRI. Inter Radiologist agreement was determined using Cohen's Kappa analysis between original interpreting Radiologist and retrospective review by expert Radiologist. ResultsThirty-one of 364 patients (8.5%) underwent appendectomy based on preoperative diagnosis, with confirmation of acute appendicitis (AA) by pathology in 19. US was able to visualize the appendix in only 6 (1.65%), 5 of whom had appendicitis. 141 patients underwent MRI, and correctly diagnosed appendicitis in 9. No patient with a negative MRI diagnosis had AA. The sensitivity, and negative predictive value for diagnosing AA with MRI was 100%. The MRI inter-reader agreement for appendix visualization and overall accuracy were 87.9 and 98% with Cohen Kappa of 0.7 and 0.56 respectively. ConclusionsOur data suggests that MRI should be considered the first line imaging modality in pregnant patients suspected of having AA. Body Radiologists with varied levels of experience in MRI readouts had substantial agreement.

Co-designing new tools for collecting, analysing and presenting patient experience data in NHS services: working in partnership with patients and carers

BackgroundThe way we collect and use patient experience data is vital to optimise the quality and safety of health services. Yet, some patients and carers do not give feedback because of the limited ways data is collected, analysed and presented. In this study, we worked together with researchers, staff, patient and carer participants, and patient and public involvement and engagement (PPIE) contributors, to co-design new tools for the collection and use of patient experience data in multiple health settings. This paper outlines how the range of PPIE and research activities enabled the co-design of new tools to collect patient experience data.MethodsEight public contributors represented a range of relevant patient and carer experiences in specialist services with varied levels of PPIE experience, and eleven members of Patient and Participation Groups (PPGs) from two general practices formed our PPIE group at the start of the study. Slide sets were used to trigger co-design discussions with staff, patient and carer research participants, and PPIE contributors. Feedback from PPIE contributors alongside verbatim quotes from staff, patient and carer research participants is presented in relation to the themes from the research data.ResultsPPIE insights from four themes: capturing experience data; adopting digital or non-digital tools; ensuring privacy and confidentiality; and co-design of a suite of new tools with guidance, informed joint decisions on the shaping of the tools and how these were implemented. Our PPIE contributors took different roles during co-design and testing of the new tools, which supported co-production of the study.ConclusionsOur experiences of developing multiple components of PPIE work for this complex study demonstrates the importance of tailoring PPIE to suit different settings, and to maximise individual strengths and capacity. Our study shows the value of bringing diverse experiences together, putting patients and carers at the heart of improving NHS services, and a shared approach to managing involvement in co-design, with the effects shown through the research process, outcomes and the partnership. We reflect on how we worked together to create a supportive environment when unforeseen challenges emerged (such as, sudden bereavement).

Reconstructing the nasal septum from instrument motion during septoplasty surgery

Purpose: Surgery involves modifying anatomy to achieve a goal. Reconstructing anatomy can facilitate surgical care through surgical planning, real-time decision support, or anticipating outcomes. Tool motion is a rich source of data that can be used to quantify anatomy. Our work develops and validates a method for reconstructing the nasal septum from unstructured motion of the Cottle elevator during the elevation phase of septoplasty surgery, without need to explicitly delineate the surface of the septum. Approach: The proposed method uses iterative closest point registration to initially register a template septum to the tool motion. Subsequently, statistical shape modeling with iterative most likely oriented point registration is used to fit the reconstructed septum to Cottle tip position and orientation during flap elevation. Regularization of the shape model and transformation is incorporated. The proposed methods were validated on 10 septoplasty surgeries performed on cadavers by operators of varying experience level. Preoperative CT images of the cadaver septums were segmented as ground truth. Results: We estimated reconstruction error as the difference between the projections of the Cottle tip onto the surface of the reconstructed septum and the ground-truth septum segmented from the CT image. We found translational differences of and a rotational differences of between the reconstructed septum and the ground-truth septum [median (interquartile range)], given the optimal regularization parameters. Conclusions: Accurate reconstruction of the nasal septum can be achieved from tool tracking data during septoplasty surgery on cadavers. This enables understanding of the septal anatomy without need for traditional medical imaging. This result may be used to facilitate surgical planning, intraoperative care, or skills assessment.

Modeling ice friction for vehicle dynamics of a bobsled with application in driver evaluation and driving simulation

We provide an ice friction model for vehicle dynamics of a two-man bobsled which can be used for driver evaluation and in a driver-in-the-loop simulator. Longitudinal friction is modeled by combining experimental results with finite element simulations to yield a correlation between contact pressure and friction. To model lateral friction, we collect data from 44 bobsleigh runs using special sensors. Non-linear regression is used to fit a bob-specific one-track vehicle dynamics model to the data. It is applied in driving simulation and enables a novel method for bob driver evaluation. Bob drivers with various levels of experience are investigated. It shows that a similar performance of the top drivers results from different driving styles.

Diagnosing thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance cytology with the deep convolutional neural network

To compare the diagnostic performances of physicians and a deep convolutional neural network (CNN) predicting malignancy with ultrasonography images of thyroid nodules with atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) results on fine-needle aspiration (FNA). This study included 202 patients with 202 nodules ≥ 1 cm AUS/FLUS on FNA, and underwent surgery in one of 3 different institutions. Diagnostic performances were compared between 8 physicians (4 radiologists, 4 endocrinologists) with varying experience levels and CNN, and AUS/FLUS subgroups were analyzed. Interobserver variability was assessed among the 8 physicians. Of the 202 nodules, 158 were AUS, and 44 were FLUS; 86 were benign, and 116 were malignant. The area under the curves (AUCs) of the 8 physicians and CNN were 0.680–0.722 and 0.666, without significant differences (P > 0.05). In the subgroup analysis, the AUCs for the 8 physicians and CNN were 0.657–0.768 and 0.652 for AUS, 0.469–0.674 and 0.622 for FLUS. Interobserver agreements were moderate (k = 0.543), substantial (k = 0.652), and moderate (k = 0.455) among the 8 physicians, 4 radiologists, and 4 endocrinologists. For thyroid nodules with AUS/FLUS cytology, the diagnostic performance of CNN to differentiate malignancy with US images was comparable to that of physicians with variable experience levels.

Novice and experienced music teacher resilience: A comparative case study

In many schools, both urban and rural, children living in poverty face daily stressors including lack of parental support, lack of resources, unsafe living conditions, and poor nutrition. As teachers are first responders in facing these difficult situations, resilience enables teachers to overcome challenges and succeed professionally. Teachers who have been found to be more resilient tend to feel more successful and stay in their positions longer. Teachers at varying experience levels have different approaches to maintaining their resilience in response to daily stressors. The purpose of this comparative case study was to compare the resilience factors of an early career and a late career music teacher within high-poverty, trauma-sensitive contexts. Participants exhibited varying levels of resilience by adapting their expectations to their school context and maintaining a positive attitude.

Interprofessional Learning in an Online Programme: A SWOT Analysis

The unprecedented COVID-19 pandemic has forced educators individually, and educational institutions collectively, to rethink their teaching and assessment modes. Several universities have seen a sudden shift from traditional face to face teaching and learning to online approaches. The aim of this case study is to share the authors’ experience in the design, coordination, delivery and evaluation of a fully online post-registration programme. Now in its twelfth year, this is an interdisciplinary course and caters for qualified health professionals from various sectors and with various levels of experience seeking a baccalaureate qualification. The paper uses the SWOT analysis technique to highlight the programme’s strengths and weaknesses, and to reflect on its opportunities for, and threats to, further development. In so doing, it discusses some considerations underpinning the shift from a face to face to an online, mainly asynchronous, mode of delivery for this post-registration academic top-up programme. The paper explains the challenges encountered and the lessons learnt through feedback from the students, stakeholders, and external examiners. The good practices that were developed as a result, including strategies to foster a community of learners, may be of interest to, and applied by, educators in other settings.

A Cost Comparison of Holmium Laser Enucleation of the Prostate with and without Moses™.

Holmium laser enucleation of the prostate (HoLEP) is a size-independent treatment option for the treatment of benign prostatic hyperplasia. HoLEP has been shown to have excellent improvements in prostate symptom scores and maximum flow rates that have been durable for 2 decades. However, the steep learning curve associated with HoLEP has prevented its widespread adoption. New advancements in lasers, specifically the Moses™ pulse-modulation technology, have resulted in improvements in hemostasis and achieving same-day discharges and catheter removals. We aimed to perform a cost-comparison to analyze if Moses-augmented HoLEP (m-HoLEP) resulted in cost-savings. A retrospective review was performed of a single expert surgeon's experience from May 2018 to November 2020, comparing m-HoLEP with HoLEP. Perioperative and postoperative variables were abstracted from the medical record. Univariate and multivariate analyses were performed using SAS® 9.4. Two-sided significance was set at p <0.05. A total of 312 men underwent HoLEP during the study period (192 in m-HoLEP group and 120 in HoLEP group). The m-HoLEP group had more same-day discharges (p <0.001) and emergency department visits (6.3% vs 1.7%, p=0.0071). m-HoLEP resulted in hospital cost savings of $840 for the initial surgical episode (p=0.0297). When factoring in emergency department visits/readmissions, the cost savings decreased to $747 per case (p=0.0574). m-HoLEP was associated with same-day discharge and hospital cost savings of $840 for the initial surgical episode. Further study in other institutions with surgeons of varying experience levels will need to be performed to see if these findings can be replicated.

Exploring safety knowledge sharing among experienced and novice workers

Introduction: This paper investigates how members of a culinary and hospitality arts program generate, share, and learn safety knowledge via social and identity mechanisms. Method: We conducted semi-structured interviews with 20 participants of varying roles and experience (i.e., students, culinary instructors, and restaurant chefs) in the culinary and hospitality arts program at a large polytechnic in western Canada. Results: The emergent themes from these interviews indicated that the circulation of safety knowledge relied on the interaction among individuals with various levels of experience, such that those who were more experienced in the culinary arts were able to share safety knowledge with novices, who had less experience. Comparing safety knowledge gleaned from within the school against that gleaned from within the industry highlighted differences between the construction of safety in the two contexts. Notably, many aspects of safety knowledge are not learned in school and those that are may not apply in the industry context. We found that safety knowledge was shared through informal means such as storytelling, a process that allowed members to come to a deep, collective understanding of what safety meant, which they often labeled “common sense.” Conclusion: We found that safety knowledge was a currency through which participants achieved legitimacy, generated through continual practical accomplishment of the work in interaction with others. Practical Applications: Our findings provide novel insights into how safety knowledge is shared, and we discuss the implications of these findings for classroom, work-based learning, and other forms of curricula.

Detection and PI-RADS classification of focal lesions in prostate MRI: Performance comparison between a deep learning-based algorithm (DLA) and radiologists with various levels of experience

PurposeTo compare the performance of lesion detection and Prostate Imaging-Reporting and Data System (PI-RADS) classification between a deep learning-based algorithm (DLA), clinical reports and radiologists with different levels of experience in prostate MRI. MethodsThis retrospective study included 121 patients who underwent prebiopsy MRI and prostate biopsy. More than five radiologists (Reader groups 1, 2: residents; Readers 3, 4: less-experienced radiologists; Reader 5: expert) independently reviewed biparametric MRI (bpMRI). The DLA results were obtained using bpMRI. The reference standard was based on pathologic reports. The diagnostic performance of the PI-RADS classification of DLA, clinical reports, and radiologists was analyzed using AUROC. Dichotomous analysis (PI-RADS cutoff value ≥ 3 or 4) was performed, and the sensitivities and specificities were compared using McNemar’s test. ResultsClinically significant cancer [CSC, Gleason score ≥ 7] was confirmed in 43 patients (35.5%). The AUROC of the DLA (0.828) for diagnosing CSC was significantly higher than that of Reader 1 (AUROC, 0.706; p = 0.011), significantly lower than that of Reader 5 (AUROC, 0.914; p = 0.013), and similar to clinical reports and other readers (p = 0.060–0.661). The sensitivity of DLA (76.7%) was comparable to those of all readers and the clinical reports at a PI-RADS cutoff value ≥ 4. The specificity of the DLA (85.9%) was significantly higher than those of clinical reports and Readers 2–3 and comparable to all others at a PI-RADS cutoff value ≥ 4. ConclusionsThe DLA showed moderate diagnostic performance at a level between those of residents and an expert in detecting and classifying according to PI-RADS. The performance of DLA was similar to that of clinical reports from various radiologists in clinical practice.

Inter-observer reliability using the General Movement Assessment is influenced by rater experience

ObjectiveTo describe the inter-observer reliability of the General Movement Assessment (GMA) among a sample of infants at high-risk of cerebral palsy (CP) among raters with various levels of experience. MethodsVideo assessments of 150 high-risk infants at 10–15 weeks corrected age were rated by three Prechtl GMA-certified observers with varied experience using the assessment. Videos were scored based on temporal organization of fidgety movements (FMs), presence of abnormal FMs, or absence of FMs. Inter-observer agreements were analyzed with Gwet's AC1 statistic. ResultsWe found fair to moderate agreement when subcategories of normal FMs (continuous and intermittent) were included (AC1 = 0.32–0.57) and moderate to near perfect agreement when normal categories of FMs were combined (AC1 = 0.60–0.95). Reliability was higher among observers with more experience using the GMA (AC1 = 0.57–0.98) than the observer with less experience (AC1 = 0.32–0.61). ConclusionsCaution may be warranted when the GMA is used to differentiate “continuous and intermittent” FMs temporal organization. The GMA is highly reliable among experienced raters when comparing normal FMs to other FMs categorizations.

Construct and Validation of a Three-Dimensional Physical Model for Training in Transnasal Office Procedures.

Most simulation models in rhinology are costly and are primarily meant to enhance endoscopic surgical skills. The present study aimed to construct a 3-dimensional model of the nose which is easily constructible with commonly available low cost plaster of Paris (POP) and assess its usefulness in training residents in basic transnasal procedures. A nose model was created using plaster of Paris and assessed for face and content validity by experts in rhinology while a construct validation was performed on five specified tasks by residents. All experts agreed with the resemblance of 10 of the 13 anatomical landmarks in the POP model and its utility in teaching basic transnasal procedures. There was a statistically significant difference in the time taken by I and III year residents in performing a diagnostic nasal endoscopy (p = 0.007), anterior nasal packing with polyvinyl alcohol tampon (p = 0.007), posterior nasal packing with Foley's catheter (p = 0) and nasopharyngeal swabbing (p = 0.025). This study demonstrates the construct of a low cost 3-dimensional POP model and validates its utility in training residents in routine transnasal rhinological procedures. Face and content validation showed a high degree of resemblance to human anatomy with good agreement that this model could increase resident competency. The significant difference in time taken by residents at various levels of experience in performing rhinological procedures also confirmed a reliable construct validity. The described model could be an affordable and easily constructible alternative tool to other simulation models in otorhinolaryngology residency programs especially in developing countries.

A tool to assess nontechnical skills of perfusionists in the cardiac operating room

ObjectivesThis study aimed to develop the Perfusionists' Intraoperative Non-Technical Skills tool, specifically to the perfusionists' context, and test its inter-rater reliability. MethodsAn expert panel was convened to review existing surgical nontechnical skills taxonomies and develop the Perfusionists' Intraoperative Non-Technical Skills tool. During a workshop held at a national meeting, perfusionists completed the Perfusionists’ Intraoperative Non-Technical Skills ratings after watching 4 videos displaying simulated cardiac operations. Two videos showed “good performance,” and 2 videos showed “poor performance.” Inter-rater reliability analysis was performed and intraclass correlation coefficient was reported. ResultsThe final version of the Perfusionists' Intraoperative Non-Technical Skills taxonomy contains 4 behavioral categories (decision making, situation awareness, task management and leadership, teamwork and communication) with 4 behavioral elements each. Categories and elements are rated using an 8-point Likert scale ranging from 0.5 to 4.0. A total of 60 perfusionist raters were included and the comparison between rating distribution on “poor performance” and “good performance” videos yielded a statistically significant difference between groups, with a P value less than .001. A similar difference was found in all behavioral categories and elements. Reliability analysis showed moderate inter-rater reliability across overall ratings (intraclass correlation coefficient, 0.735; 95% confidence interval, 0.674-0.796; P < .001). Similar inter-rater reliability was found when raters were stratified by experience level. ConclusionsThe Perfusionists' Intraoperative Non-Technical Skills tool presented moderate inter-rater reliability among perfusionists with varied levels of experience. This tool can be used to train and assess perfusionists in relevant nontechnical skills, with the potential to enhance safety and improve surgical outcomes.

Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRIs of Children and Adolescents with Patellofemoral Instability

Acknowledgements:The authors would like to acknowledge Drs. Matthew Milewski, Yi-Meng Yen, and Adam Yanke for their contributions.Background:Surgical decision-making and pre-operative planning for children and adolescents with patellofemoral instability relies heavily on skeletal maturity status. In order to be clinically useful, radiologic assessments of skeletal maturity must demonstrate acceptable interrater reliability and accuracy.Purpose:The purpose of this study was to evaluate the interrater reliability among surgeons of varying experience levels and specialty training backgrounds when evaluating skeletal maturity in the distal femur and proximal tibia of children and adolescents with patellofemoral instability.Study Design:Cross-sectional studyMethods:Six fellowship-trained orthopedic surgeons (4 pediatric orthopedic, 2 sports medicine) who perform a high volume of patellofemoral instability surgery examined 20 blinded and randomized knee radiographs and MR images. They assessed these images for clinically relevant growth (open physis) or clinically insignificant growth (closing/closed physis) remaining in the distal femoral and proximal tibial physes. Fleiss’s kappa was calculated for each measurement. After initial ratings, raters discussed consensus methods to improve reliability and assessed the images again in order to determine if training and new criteria improved interrater reliability.Results:Reliability for initial assessments of distal femoral and proximal tibial physeal status was poor (Kappa range: 0.01 – 0.58). After consensus building, all assessments demonstrated almost perfect interrater reliability (Kappa = 0.99 for all measurements).Conclusion:Surgical decision-making and pre-operative planning for children and adolescents with patellofemoral instability relies heavily on radiologic assessment of skeletal maturity. This study found that initial interrater reliability of physeal status and clinical decision making was unacceptably low. However, with the addition of new criteria, a consensus-building process, and training, these variables became highly reliable.Clinical Relevance:Lack of assessment reliability can jeopardize patient care, both when determining surgical indications as well as choosing an appropriate procedure based upon skeletal maturity. Surgeons should focus on using reliable imaging metrics in children and adolescents with patellofemoral instability, and measurements that remain unreliable after consensus building and training should be removed from clinical decision-making algorithms.What is known about the subject:Treatment of patellofemoral instability heavily relies on skeletal maturity status. Physeal assessments of the knee must be reliable and clinically relevant to ensure optimal patient care.What this study adds to existing knowledge:Physeal assessment of the knee without training can be unreliable among fellowship trained orthopedic surgeons. With consensus building and training in the use of the methods described in this manuscript, physeal assessments can demonstrate almost perfect reliability.

Development of a standardized histopathology scoring system for intervertebral disc degeneration and regeneration in rabbit models-An initiative of the ORSspine section.

BackgroundThe rabbit lumbar spine is a commonly utilized model for studying intervertebral disc degeneration and for the pre‐clinical evaluation of regenerative therapies. Histopathology is the foundation for which alterations to disc morphology and cellularity with degeneration, or following repair or treatment are assessed. Despite this, no standardized histology grading scale has yet been established for the spine field for any of the frequently utilized animal models.AimsThe purpose of this study was to establish a new standardized scoring system to assess disc degeneration and regeneration in the rabbit model.Materials and MethodsThe scoring system was formulated following a review of the literature and a survey of spine researchers. Validation of the scoring system was carried out using images provided by 4 independent laboratories, which were graded by 12 independent graders of varying experience levels. Reliability testing was performed via the computation of intra‐class correlation coefficients (ICC) for each category and the total score. The scoring system was then further refined based on the results of the ICC analysis and discussions amongst the authors.ResultsThe final general scoring system involves scoring 7 features (nucleus pulposus shape, area, cellularity and matrix condensation, annulus fibrosus/nucleus pulposus border appearance, annulus fibrosus morphology, and endplate sclerosis/thickening) on a 0 (healthy) to 2 (severe degeneration) scale. ICCs demonstrated overall moderate to good agreement across graders. An addendum to the main scoring system is also included for use in studies evaluating regenerative therapeutics, which involves scoring cell cloning and morphology within the nucleus pulposus and inner annulus fibrosus.DiscussionOverall, this new scoring system provides an avenue to improve standardization, allow a more accurate comparison between labs and more robust evaluation of pathophysiology and regenerative treatments across the field.ConclusionThis study developed a histopathology scoring system for degeneration and regeneration in the rabbit model based on reported practice in the literature, a survey of spine researchers, and validation testing.

Open-source image analysis software yields reproducible MRI measures of lumbar intervertebral disc degeneration in sheep models.

Sheep are established models for intervertebral disc degeneration (IVDD) translational research. Objectives of this retrospective, secondary analysis, observational study were to evaluate reproducibility of two magnetic resonance imaging (MRI) measures of IVDD in sheep using open-source image analysis software. Sagittal planar, T2-weighted, lumbar MRI scans from a previous, prospective study were evaluated (4 sheep @ 3 treatment periods/sheep @ 7 lumbar discs /treatment period=84 discs). A standardized protocol was developed for measuring MRI index (nucleus pulposus signal intensity × nucleus pulposus sagittal area), and nucleus pulposus signal intensity standard deviation (NPSISD). Scans were randomized and four observers with varying experience levels applied the protocol to independently perform triplicate measures. Mean coefficient of variation values for both the MRI index and NPSISD were within an acceptable range (<10). Mean values for the three readers with at least 2 months of image analysis experience did not differ (P>.05).