Agreement Analysis (agreement + analysis)

Distribution by Scientific Domains


Selected Abstracts


Monitoring adherence to beclomethasone in asthmatic children and adolescents through four different methods

ALLERGY, Issue 10 2009
N. S. Jentzsch
Background:, Suboptimal adherence to inhaled steroids is a known problem in children and adolescents, even when medications are administered under parental supervision. This study aimed to verify the adherence rate to beclomethasone dipropionate (BDP) by four currently available methods. Methods:, In this concurrent cohort study, 102 randomly selected asthmatic children and adolescents aged 3,14 years were followed for 12 months. Adherence rate was assessed every 2 months by self and/or parent report, pharmacy dispensing data, electronic device (Doser®; Meditrack Products, Hudson, MA, USA) monitor, and canister weight. Results:, Mean adherence rates to BDP by self and/or parent report, pharmacy records, Doser, and canister weight were 97.9% (95% CI 88.0,98.6), 70.0% (95% CI 67.6,72.4), 51.5% (95% CI 48.3,54.6), and 46.3% (95% CI 44.1,48.4), respectively. Agreement analysis between (Doser) and canister weight revealed a weighted kappa equal to 0.76 (95% CI 0.65,0.87). Conclusions:, Adherence was a dynamic event and rates decreased progressively for all methods over the 12-month follow-up. Canister weight and electronic monitoring measures were more accurate than self/parent reports and pharmacy records. Rates obtained by these two methods were very close and statistical analysis also showed a substantial agreement between them. As measurements by canister weight are less costly compared with currently available electronic devices, it should be considered as an alternative method to assess adherence in both clinical research and practice. [source]


A comparison between criteria for diagnosing atopic eczema in infants

BRITISH JOURNAL OF DERMATOLOGY, Issue 2 2005
H. Jøhnke
Summary Background, Epidemiological studies have shown different estimates of the frequency of atopic eczema (AE) in children. This may be explained by several factors including variations in the definition of AE, study design, age of study group, and the possibility of a changed perception of atopic diseases. The role of IgE sensitization in AE is a matter of debate. Objectives, To determine the prevalence and cumulative incidence of AE in a group of unselected infants followed prospectively from birth to 18 months of age using different diagnostic criteria; to evaluate the agreement between criteria; and to describe the association between atopic heredity and postnatal sensitization, respectively, and the development of AE according to the different diagnostic criteria. Methods, During a 1-year period a consecutive series of 1095 newborns and their parents were approached at the maternity ward at the Odense University Hospital, Denmark and a cohort of 562 newborns was established. Infants were examined and followed prospectively from birth and at 3, 6, 9, 12 and 18 months of age. AE was diagnosed using four different criteria, the Hanifin and Rajka criteria, the Schultz-Larsen criteria, the Danish Allergy Research Centre (DARC) criteria developed for this study and doctor-diagnosed visible eczema with typical morphology and atopic distribution. Additionally, the U.K. diagnostic criteria based on a questionnaire were used at 1 year of age. Agreement between the four criteria was analysed at each time point and over time, and agreement between the four criteria and the U.K. questionnaire criteria was analysed. Results, The cumulative 1-year prevalence of AE using the Hanifin and Rajka criteria was 9·8% (95% confidence interval, CI 7,13%), for the Schultz-Larsen criteria it was 7·5% (95% CI 5,10%), for the DARC criteria 8·2% (95% CI 6,11%), for visible eczema 12·2% (95% CI 9,16%) and for the U.K. criteria 7·5% (95% CI 5,10%). The pairwise agreement between criteria showed good agreement, with rates varying between 93% and 97% and kappa scores between 0·6 and 0·8. Agreement analysis of diagnoses between the four criteria demonstrated that cumulative incidences showed better agreement than point prevalence values. Conclusions, Agreement between different criteria for diagnosing AE was acceptable, but the mild cases constituted a diagnostic problem, although they were in the minority. Repeated examinations gave better agreement between diagnostic criteria than just one examination. Atopic heredity was less predictive for AE than sensitization to common food and inhalant allergens in early childhood. [source]


Real-Time Inter-Rater Reliability of the Council of Emergency Medicine Residency Directors Standardized Direct Observation Assessment Tool

ACADEMIC EMERGENCY MEDICINE, Issue 2009
Joseph LaMantia MD
Abstract Objectives:, Developed by the Council of Emergency Medicine Residency Directors (CORD), the standardized direct observation assessment tool (SDOT) is an evaluation instrument used to assess residents' clinical skills in the emergency department (ED). In a previous study examining the inter-rater agreement of the tool, faculty scored simulated resident,patient encounters. The objective of the present study was to evaluate the inter-rater agreement of the SDOT in real-time evaluations of residents in the ED. Methods:, This was a multi-center, prospective, observational study in which faculty raters were paired to simultaneously observe and independently evaluate a resident's clinical performance using the SDOT. Data collected from eight emergency medicine (EM) residency programs produced 99 unique resident,patient encounters and reported on 26 individual behaviors related to specific core competencies, global evaluation scores for each core competency, and an overall clinical competency score. Inter-rater agreement was assessed using percentage agreement analyses with three constructs: exact agreement, liberal agreement, and binary (pass/fail) agreement. Results:, Inter-rater agreement between faculty raters varied according to category of measure used. Exact agreement ranged from poor to good, depending on the measure: the overall competency score (good), the competency score for each of the six core competencies (poor to good), and the individual item scores (fair to very good). Liberal agreement and binary agreement were excellent for the overall competency score and the competency score for each of the six core competencies and very good to excellent for the individual item scores. Conclusions:, The SDOT demonstrated excellent inter-rater agreement when analyzed with liberal agreement and when dichotomized as a pass/fail measure and fair to good agreement for most measures with exact agreement. The SDOT can be useful and reliable when evaluating residents' clinical skills in the ED, particularly as it relates to marginal performance. [source]


A comparison of three methods for estimating height in the acutely ill elderly population

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2003
M. Hickson
Abstract Background Most estimates of nutritional status rely on accurate recording of not only body weight but also height. Standing height is difficult to measure accurately in older adults due to mobility problems and kyphosis. Surrogate methods have been developed to estimate height including arm-span, demi-span and knee height. There are currently little data on the accuracy of these methods in the sick elderly population or which method is the most suitable in the clinical situation. Objective To compare three commonly used clinical measurements that can estimate height and analyse their agreement with current height. Also to evaluate which method can be used most frequently. Methods We used data collected as part of a larger intervention trial, in which elderly in-patients (over 65 years), were measured for demi-span, half arm-span, knee height and standing height. Results The results showed that demi-span and half arm-span could be measured in the largest proportions of our population, 75.6 and 72.3%, respectively. The correlation coefficients were high for all three estimates of height, r = 0.86 for demi-span, r = 0.87 for arm-span, and r = 0.89 for knee height (P < 0.0001 for all three). However, agreement analysis demonstrated very poor agreement between standing height and all the methods of estimation. The mean differences were 4.33 cm for demi-span, 7.04 cm for arm-span and ,0.6 cm for knee height. [source]


The craniocervical flexion test: intra-tester reliability in asymptomatic subjects

PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2010
Gill James
Abstract Background and Purpose.,The deep neck flexor muscles (DNFs) stabilize the cervical spine and cervicogenic pain appears to adversely affect their endurance capacity. They are inaccessible to direct palpation, thereby making assessment difficult. However, the cranio-cervical flexion test (CCFT) provides an indirect method of assessing the endurance capacity of the DNFs. The purpose of the present study was to evaluate the intratester reliability of the CCFT in asymptomatic subjects.,Method.,The clinical protocol of the CCFT was measured on two occasions with 7 days between measurements. Prior to testing, participants were trained and compensation strategies were corrected. Nineteen asymptomatic participants (mean age 24.9 years; range 22,36) were recruited.,Results.,The test had excellent intratester reliability (intraclass correlation coefficient = 0.983; standard error of the mean = 8.94; smallest real difference = 24.7). A Bland and Altman's limits of agreement analysis confirmed the high reliability of the test.,Conclusion.,The CCFT results demonstrated excellent intra-tester reliability in asymptomatic subjects, thus contributing to the normative data regarding the test. Copyright © 2010 John Wiley & Sons, Ltd. [source]


Fetal tricuspid valve Doppler at 11,13 weeks and 6 days: reference values and reproducibility

PRENATAL DIAGNOSIS, Issue 8 2010
Milena Almeida Prado Ninno
Abstract Objective To determine normal blood flow velocities across the fetal tricuspid valve (TV) at 11,13 weeks and 6 days of gestation and to examine the reproducibility of these measurements. Methods A prospective study involving 166 normal singleton pregnancies examined at 11,13 weeks and 6 days was carried out. Descriptive analysis of E- and A-waves' maximum velocities, E/A ratio, duration of the cardiac cycle (C) and diastole (D) and D/C ratio were calculated. Intraobserver and interobserver agreement analysis was performed in a subgroup of 12 cases. Results Average ( ± SD) flow velocities were: E-wave, 25.0 ( ± 4.6) cm/s; A-wave, 42.9 ( ± 5.9) cm/s; E/A, 0.58 ( ± 0.07); cardiac cycle, 390 ( ± 21.1) ms; diastole, 147 ( ± 18) ms and D/C, 0.38 ( ± 0.04). Significant correlation was observed between all parameters (except A-wave) and gestational age but not with nuchal translucency (NT). Intraclass correlation coefficients (interobserver, intraobsever examiner 1 and intraobserver examiner 2) were: E-wave, 0.53, 0.53 and 0.64; A-wave, 0.45, 0.46 and 0.49; cardiac cycle, 0.70, 0.79 and 0.84 and diastole, 0.63, 0.85 and 0.82, respectively. Conclusions The present study establishes normal Doppler parameters for blood flow across the TV at 11,13 weeks and 6 days and demonstrates that these parameters do not correlate with NT measurement and have good/moderate reproducibility. Copyright © 2010 John Wiley & Sons, Ltd. [source]


Association between thrombin activatable fibrinolysis inhibitor genotype and levels in plasma: comparison of different assays

BRITISH JOURNAL OF HAEMATOLOGY, Issue 5 2004
A. H. C. Guimarães
Summary Thrombin activatable fibrinolysis inhibitor (TAFI) antigen levels exhibit a large interindividual variability in which genetic control seems to play a major role. However, recent reports have questioned the association between TAFI concentration and genotype, suggesting that variable antibody reactivity towards TAFI isoforms, particularly the Thr325Ile polymorphism (1040C/T), may lead to artefacts in TAFI antigen levels. In order to compare assay outcome we determined plasma TAFI levels in 92 healthy individuals, using an enzyme-linked immunosorbent assay (ELISA) (commercial antibodies), an electroimmunoassay (in-house antibodies) and a commercial chromogenic assay (Actichrome® TAFI). Each individual was genotyped for the ,438A/G and 1040C/T polymorphisms in the TAFI gene. TAFI levels were significantly associated with genotype in both antigen and chromogenic assays. All assays displayed significant correlations with each other. Linear regression and Bland,Altman agreement analysis in the genotype subgroups showed that neither the genotype nor the concentration affected the relationship between the Actichrome® TAFI and the electroimmunoassay. In contrast, the ELISA/Actichrome® TAFI and the ELISA/electroimmunoassay relationships were concentration- and genotype-dependent. Our results demonstrate that artefacts may arise when measuring TAFI antigen levels by ELISA. Nevertheless, the electroimmunoassay and the Actichrome® TAFI assay support a genotype-related variation of TAFI concentration. [source]