Intraclass Correlation Coefficient (intraclass + correlation_coefficient)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Validation of a brief symptom questionnaire (ReQuest in Practice) for patients with gastro-oesophageal reflux disease

Summary Background, A clinical need exists for a means of assessing symptom control in patients with gastro-oesophageal reflux disease. The ReQuest questionnaire has been extensively validated for symptom assessment in both erosive and non-erosive gastro-oesophageal reflux disease but was designed for research purposes. We derived a shorter version (ReQuest in Practice) that would be more convenient for clinical practice. Aim, To validate ReQuest in Practice in patients suffering from gastro-oesophageal reflux disease. Methods, Multicentre, non-interventional, crossover comparison. Patients completed ReQuest in Practice followed by ReQuest or vice versa. Before and after a planned endoscopy, patients completed the health-related quality of life questionnaire GERDyzer. Internal consistency and the Intraclass Correlation Coefficient were calculated. Construct validity was evaluated by correlation with ReQuest and GERDyzer. Results, There was high internal consistency of ReQuest in Practice (Cronbach's alpha: 0.9) and a high Intraclass Correlation Coefficient of 0.99. The measurement error of ReQuest in Practice was 4.1. High correlation between ReQuest in Practice and ReQuest (Spearman correlation coefficient: 0.9) and GERDyzer (Spearman correlation coefficient: 0.8) demonstrated construct validity. Conclusions, ReQuest in Practice was proven to be valid and reliable. Its close correlation with ReQuest makes it a promising tool to guide the clinical management of patients across the full spectrum of both erosive and non-erosive gastro-oesophageal reflux disease. [source]

International validation of ReQuest in patients with endoscopy-negative gastro-oesophageal reflux disease

K. D. Bardhan
Summary Background :,Reflux Questionnaire (ReQuest), a newly developed gastro-oesophageal reflux disease-sensitive scale, can be used to reliably evaluate the effect of treatment on gastro-oesophageal reflux disease symptoms. Aim :,International validation of this scale, in patients suffering from endoscopy-negative gastro-oesophageal reflux disease. Methods :,In this open, multicentre and multinational clinical trial 840 endoscopy-negative gastro-oesophageal reflux disease patients received pantoprazole 20 mg daily for 28 days. The long and short versions of ReQuest were completed both in the pre-treatment and treatment phases. For scale development an item reduction analysis was performed. Internal consistency, test,retest reliability and responsiveness were calculated for psychometric analysis. Construct validity was evaluated by comparison with the Gastrointestinal Symptom Rating Scale and the Psychological General Well-being questionnaire by means of correlation coefficients. Results :,Factor analyses confirmed the content validity of both long and short version of ReQuest. Psychometric calculations proved high internal consistency (Cronbach's alpha: 0.9), test,retest reliability [Intraclass Correlation Coefficient: 0.9 (long vs. long) and 0.8 (short vs. short)], and responsiveness (Responsiveness Index 320.3) of the scale, for which also good construct validity was achieved (correlation coefficient: Gastrointestinal Symptom Rating Scale ,0.6; Psychological General Well-being ,0.4). Conclusion :,ReQuest proved valid, reliable, and responsive in this multinational clinical trial to evaluate treatment response in endoscopy-negative gastro-oesophageal reflux disease patients. [source]

Validity of the Spanish version of the Chronic Liver Disease Questionnaire (CLDQ) as a standard outcome for quality of life assessment,

Montserrat Ferrer
The Chronic Liver Disease Questionnaire (CLDQ) measures the impact on quality of life of chronic liver diseases, regardless of underlying etiology. The aim of this study was to develop a Spanish version of the CLDQ, and to assess its acceptability, reliability, validity, and sensitivity to change. The forward and back-translation method by bilingual translators, with expert panel and pilot testing on patients, was used for the adaptation. The final version was self-administered, together with the Short Form-36 Health Survey (SF-36), on 149 consecutive patients with chronic liver disease. Child-Turcotte-Pugh scores were evaluated by a physician. To assess reproducibility and responsiveness the CLDQ was readministered to a subsample of stable patients and to those who had received a liver transplant. Validity was evaluated via exploratory factor analysis, the CLDQ pattern across severity groups, and correlation coefficients with "itching" and SF-36 scores. Cronbach's alpha and Intraclass Correlation Coefficient for CLDQ global score were 0.93 and 0.90, respectively, demonstrating good reliability. Validity was supported by correlations of the CLDQ with SF-36 and "itching," and CLDQ severity gradient (global score means were 5.5, 5.2, 5.0, and 4.5 in patients with no cirrhosis, cirrhosis Child-Turcotte-Pugh A, B, and C, respectively; P = 0.012). Responsiveness was shown by a high CLDQ improvement in patients who had received liver transplant (mean change = ,1.4; P < 0.001). In conclusion, the Spanish CLDQ is reliable, valid, responsive, and equivalent to the original. These findings support its use as a standard outcome for patients with chronic liver diseases within the whole severity range, from "no cirrhosis" to transplant recipients, both in Spanish and international studies. Liver Transpl 12:95,104, 2006. © 2005 AASLD. [source]

Reproducibility of tricuspid regurgitant jet velocity measurements in children and young adults with sickle cell disease undergoing screening for pulmonary hypertension,

Robert I. Liem
The reproducibility of tricuspid regurgitant jet velocity (TRJV) measurements by Doppler echocardiography has not been subjected to systematic evaluation among individuals with sickle cell disease (SCD) undergoing screening for pulmonary hypertension. We examined sources of disagreement associated with peak TRJV in children and young adults with SCD. Peak TRJV was independently measured and interpreted a week apart by separate sonographers and readers, respectively, in 30 subjects (mean age, 15.8 ± 3.3 years) who provided 120 observations. We assessed intra-/inter-reader, intra-/inter-sonographer, sonographer-reader, and within subject agreement using Intraclass Correlation Coefficient (ICC) and Cohen's kappa (,). Agreement was examined graphically using Bland-Altman plots. Although sonographers could estimate and measure peak TRJV in all subjects, readers designated tricuspid regurgitation nonquantifiable in 10,17% of their final interpretations. Intra-reader agreement was highest (ICC = 0.93 [95% CI 0.86, 0.97], P = 0.0001) and within subject agreement lowest (ICC = 0.36 [95% CI 0.02, 0.64], P = 0.021) for single TRJV measurements. Similarly, intra-reader agreement was highest (, = 0.74 [95% CI 0.53, 0.95], P = 0.0001) and within subject lowest (, = 0.14 [95% CI ,0.17, 0.46], P = 0.38) when sonographers and readers categorized TRJV measurements. On Bland-Altman plots, absolute differences in observations increased with higher mean TRJV readings for intra-/inter-reader agreement. Peak TRJV measurements in individual children and young adults with SCD are affected by several sources of disagreement, underscoring the need for methodological improvements that ensure reproducibility of this screening modality for making clinical decisions in this population. Am. J. Hematol., 2010. © 2010 Wiley-Liss, Inc. [source]

Repeatability of T1-quantification in dGEMRIC for three different acquisition techniques: Two-dimensional inversion recovery, three-dimensional look locker, and three-dimensional variable flip angle

Carl Siversson MS
Abstract Purpose: To evaluate the repeatability of the dGEMRIC (delayed gadolinium enhanced MRI of cartilage) method in osteoarthritis-prone knee joints for three different T1 quantification techniques: two-dimensional inversion recovery (2D-IR), three-dimensional Look-Locker (3D-LL), and three-dimensional variable flip angle (3D-VFA). Materials and Methods: Nine subjects were examined twice, with a 2-week interval, using all three measurement techniques. Four regions of interest were defined in the central medial and lateral femoral cartilage. The repeatability was evaluated for each measurement technique. For the 3D techniques, the variation between different slices was also evaluated. Results: Repeatability expressed by root-mean-square coefficient of variation (CVRMS) showed similar results for 2D-IR and 3D-LL (5.4,8.4%). For 3D-VFA CVRMS was higher (9.3,15.2%). Intraclass correlation coefficient showed both 2D-IR and 3D-LL reliability to be moderate, while 3D-VFA reliability was low. Inter-slice CVRMS and ICC was of the same magnitude as the repeatability. No clear differences could be interpreted between the condyles. Conclusion: Both 2D-IR and 3D-LL perform well in generating repeatable dGEMRIC results, while 3D-VFA results are somewhat inferior. Furthermore, repeatability results in this study are similar to previously published results for healthy subjects. Finally, the positioning of the analyzed images is crucial to generate reliable repeatability results. J. Magn. Reson. Imaging 2010;31:1203,1209. © 2010 Wiley-Liss, Inc. [source]

Reliability and validity of the General Health Questionnaire (GHQ-12) among urological patients: A Malaysian study

Kia Fatt Quek MPHIL
Abstract This present study was undertaken to validate the English version of the General Health Questionnaire (GHQ-12) in urological patients. Validity and reliability were studied in patients with lower urinary tract symptoms (LUTS) and patients without LUTS. Reliability was evaluated using the test,retest method and internal consistency was assessed using Cronbach's alpha. Sensitivity to change was expressed as the effect size in the pre-intervention versus post-intervention score in additional patients with benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP). Internal consistency was excellent. A high degree of internal consistency was observed for each of the 12 items with Cronbach's alpha value of 0.37,0.79, while total scores was 0.79 in the population study. Test,retest correlation coefficient for the 12 items score were highly significant. Intraclass correlation coefficient was high (0.35,0.79). It showed a high degree of sensitivity and specificity to the effects of treatment. A high degree of significant level between baseline and post-treatment scores were observed across all 12 items in the treatment cohort but not in the control group. The GHQ-12 is suitable, reliable, valid and sensitive to clinical change in urological disorders. [source]

In vivo muscle architecture and size of the rectus femoris and vastus lateralis in children and adolescents with cerebral palsy

Aim, Our aim was to investigate muscle architecture and size of the rectus femoris (RF) and vastus lateralis (VL) in children and adolescents with cerebral palsy (CP) compared with age-matched typically developing participants. Method, Muscle architecture and size were measured with ultrasound imaging in 18 participants with spastic CP (9 females, 9 males; age range 7.5,19y; mean age 12y [SD 3y 2mo]) within Gross Motor Function Classification System levels I (n=4), II (n=2), III (n=9), and IV (n=3) and 12 typically developing participants (10 females, 2 males; age range 7,20y; mean age 12y 4mo [SD 3y 11mo]). Exclusion criteria were orthopedic surgery or neurosurgery within 6 months before testing or botulinum toxin injections to the quadriceps within 3 months before testing. Results, RF cross-sectional area was significantly lower (48%), RF and VL muscle thickness 30% lower, RF fascicle length 27% lower, and VL fascicle angle 3° less in participants with CP compared to the typically developing participants (p<0.05). Intraclass correlation coefficients were ,0.93 (CP) and , 0.88 (typical development), indicating excellent reliability. Interpretation, These results provide the first evidence of altered muscle architecture and size of the RF and VL in CP, similar to patterns observed with disuse and aging. These alterations may play a significant role in the decreased capacity for force generation as well as decreased shortening velocity and range of motion over which the quadriceps can act. [source]

Reproducibility of black blood dynamic contrast-enhanced magnetic resonance imaging in aortic plaques of atherosclerotic rabbits

Claudia Calcagno MD
Abstract Purpose: To investigate the short-term reproducibility of black-blood dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in atherosclerotic rabbits to evaluate the potential of this technique to be a reliable readout of plaque progression and/or regression upon therapeutic intervention. Materials and Methods: Atherosclerotic rabbits were imaged at baseline and 24 hours later with DCE-MRI on a 1.5T MRI system. DCE-MRI images were analyzed by calculating the area under the signal intensity versus time curve (AUC). Intraclass correlation coefficients (ICCs) were used to evaluate interscan, intraobserver, and interobserver reproducibility. In addition, the test,retest coefficient of variation (CoV) was evaluated. Results: Statistical analyses showed excellent interscan, intraobserver, and interobserver agreement. All ICCs were greater than 0.75, P < 0.01 indicating excellent agreement between measurements. Conclusion: Experimental results show good interscan and excellent intra- and interobserver reproducibility, suggesting that DCE-MRI could be used in preclinical settings as a read-out for novel therapeutic interventions for atherosclerosis. This preliminary work encourages investigating the reproducibility of DCE-MRI also in clinical settings, where it could be used for monitoring high-risk patients and in longitudinal clinical drug trials. J. Magn. Reson. Imaging 2010;32:191,198. © 2010 Wiley-Liss, Inc. [source]

Digit ratios (2D:4D) determined by computer-assisted analysis are more reliable than those using physical measurements, photocopies, and printed scans

Heather C. Allaway
Prenatal androgens influence the second to fourth digit ratio (2D:4D) of hands with men having lower ratios than women. Numerous methods are used to assess 2D:4D including, physical measurements with calipers, and measurements made from photocopies, scanned images, digital photographs, radiographs, and scaled tubes. Although each method appears relatively reliable, agreement upon a gold standard is necessary to better explore the putative effects of prenatal androgens. Our objective was to assess the level of intra and interobserver reliability when evaluating 2D:4D using four techniques: (1) physical measurements, (2) photocopies, (3) printed scanned images, and (4) computer-assisted image analysis. Physical measurements, photocopies, and printed scanned images were measured with Vernier calipers. Scanned images were also measured with computer-based calipers. Measurements were made in 30 men and 30 women at two different time points, by three experienced observers. Intraclass correlation coefficients were used to assess the level of reliability. Intraobserver reliability was best for computer-assisted (0.957), followed by photocopies (0.939), physical measurements (0.925), and printed scans (0.842; P = 0.015). Interobserver reliability was also greatest for computer-assisted (0.892), followed by photocopies (0.858), physical measurements (0.795), and printed scans (0.761; P = 0.001). Mean 2D:4D from physical measurements were higher than all other techniques (P < 0.0001). Digit ratios determined from computer-assisted, physical measurements, and printed scans were more reliable in men than women (P = 0.009, P = 0.017, and P = 0.012, respectively). In summary, 2D:4D determined from computer-assisted analysis yielded the most accurate and consistent measurements among observers. Investigations of 2D:4D should use computer-assisted measurements over alternate methods whenever possible. Am. J. Hum. Biol., 2009. © 2009 Wiley-Liss, Inc. [source]

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

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]

Reliability of a Rating Scale to Assess Post-stroke Psychiatric Symptoms

Tadashi Kusunoki
Background: Various rating scales for post-stroke psychiatric symptoms such as cognitive impairment have long been used in drug efficacy trials in Japan. However, their reliability has not been established. The purpose of the present study was to examine the inter-rater and intra-rater reliability of a rating scale, which has been conventionally used in Japan. Methods: The most frequent symptoms, including apathy, emotional and cognitive impairment, found in post-stroke patients were assessed using a rating scale comprising 17 items and 4 global assessment scales. Semi-structured interviews of 18 patients with symptoms with various degrees of severity were videotaped. Twelve physicians who were not interviewers independently assessed the severity of symptoms in the 18 patients by replaying the videotapes. This procedure was repeated twice with an interval of two months to examine inter-rater and test-retest reliability. Results: The results revealed almost satisfactory reliability. Intraclass correlation coefficients were over 0.6 in the inter-rater analysis for most items and the concordance correlation coefficients were over 0.7 in the intra-rater analysis. The rating scale was considered to be reliable, although some items showed relatively low agreement. Conclusion: The conventional rating scale to assess post-stroke psychiatric symptoms showed satisfactory inter-rater and intra-rater reliability by the videotape method. The validity study should be further investigated. [source]

Agreement between parent and child report of quality of life in children with attention-deficit/hyperactivity disorder

A. F. Klassen
Abstract Background There is little information in the research literature of agreement between parent and child in reports of child quality of life (QOL) for a sample of children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The aim of our study was to determine whether parent and child concordance is greater for physical domains of QOL than for psychosocial domains; whether parents rate their child's QOL better or poorer than their child's ratings; and whether concordance is related to demographic, socioeconomic or clinical factors. Methods The study was a questionnaire survey of children aged 10,17 referred to the ADHD clinic and diagnosed with ADHD in the province of British Columbia (Canada) between November 2001 and October 2002 and their parent. Results Fifty-eight children diagnosed with ADHD and their parents completed our study questionnaire. The main outcome measure was the Child Health Questionnaire, which permitted comparisons on eight QOL domains and one single item. Intraclass correlation coefficients were moderate for five domains (range from 0.40 to 0.51), and good for three domains (range from 0.60 to 0.75). Children rated their QOL significantly better than their parents in four areas and poorer in one. Standardized Response Means indicated clinically important differences in mean scores for Behaviour and Self-esteem. Compared with population norms, across most domains, children with ADHD reported comparable health. Discrepancies between parent,child ratings were related to the presence of a comorbid oppositional/defiant disorder, a psychosocial stressor and increased ADHD symptoms. Conclusions Although self-report is an important means of eliciting QOL data, in children with ADHD, given the discrepancies in this study between parent and child report, measuring both perspectives seems appropriate. [source]

Psychometric properties of the Pediatric Motor Activity Log used for children with cerebral palsy

The Pediatric Motor Activity Log (PMAL) is a parent-report measure of the use, by children with hemiplegic cerebral palsy (CP), of their affected upper limb in everyday activities. The aim of this study was to examine the psychometric properties of both scales of the PMAL (,How Often' and ,How Well' scales) using Rasch measurement modelling. Sixty-one parents of children with hemiplegic CP completed the PMAL and 31 completed it again 3 weeks later. The mean age of children was 4 years 6 months (SD 1y 9mo); 35 males, 26 females. Children were at Gross Motor Function Classification System (GMFCS) levels I (83%) and II (17%), and Manual Ability Classification System levels I (35%), II (52%), and III (14%). The original scales were found to have disordered rating scale structure. Further Rasch modelling with collapsed rating scale structures resulted in both scales conforming to the expectations of the Rasch model, yielding strong evidence for construct validity and reliability. One item from the How Often scale failed to conform to Rasch expectations and was deleted in subsequent analyses. Test,retest reliability of both scales was high (the intraclass correlation coefficient for the How Often scale was 0.94, and for the How Well scale 0.93). The revised scales possess good psychometric properties, specifically a logical item hierarchy, evidence of unidimensionality, adequate rating scale structure, and good test,retest reliability. We conclude that the revised PMAL has the capacity to yield valid and reliable scores except for children at the extremes of upper limb ability. [source]

Reproducibility, validity, and responsiveness of a disease-specific symptom questionnaire for gastroesophageal reflux disease

C. J. Allen
The purpose of this study was to establish the reproducibility, validity, and responsiveness of a symptom questionnaire to assess patients with gastroesophageal reflux disease (GERD). A total of 300 patients with GERD completed questionnaires before and 6 months after laparoscopic Nissen fundoplication. Forty-six GERD patients who continued on omeprazole served as controls. Lower esophageal sphincter pressure, 24-h pH, and quality of life (SF36) were measured at baseline and follow-up. Reproducibility was calculated as an intraclass correlation coefficient (ICC) from a repeated-measures analysis of variance on symptom scores (SS) on two consecutive days. Validity was established by correlating SS with 24-h pH and SF36 scores. Responsiveness was calculated as the the ratio of the mean paired difference in score in the surgical group to the within-subject variability in control subjects. Reproducibility was very high, as revealed by an ICC of 0.92. Strong correlations between SS and SF36 scores at baseline and after surgery demonstrated high cross-sectional validity. Correlation between change in SS and change in pH, SF36 pain, general health, and physical health scores demonstrated longitudinal validity. The mean (95% confidence interval) paired differences in SS were 25.6 (23.7, 27.5) in the study and 2.0 (,3.2, 7.3) in the control groups, and the responsive index was 1.0. The estimated minimally important clinical difference was 7. We conclude that the symptom score is a reproducible, valid, and responsive instrument for assessing symptoms caused by GERD. [source]

Reliability of orthostatic responses in healthy men aged between 65 and 75 years

Tim J. Gabbett
The purpose of this study was to investigate the short-, medium- and long-term reproducibility of cardiovascular responses during 90° head-up tilt (HUT) in healthy older men. Twenty-eight healthy male subjects aged 69 (95% confidence intervals, 68,70) years participated in the study. Eight subjects underwent duplicate 90° HUT tests on consecutive days, while 20 subjects underwent four 90° HUT tests performed at baseline, and after 1 week, 1 month and 1 year. Following a 20-min supine resting period, each subject was rapidly tilted to the upright vertical position (90° HUT) and remained in that position for 15 min. Beat-by-beat recordings of mean (MAP), systolic (SBP) and diastolic (DBP) pressures were made via Finapres, while heart rate (HR) was monitored continuously from an electrocardiogram. No significant test,retest differences (P > 0.05) were observed for the changes in HR, MAP, SBP or DBP during 90° HUT. These measurements demonstrated high reproducibility (intraclass correlation coefficient, r= 0.91,0.99, P < 0.05). The supine resting and tilted HR, MAP, SBP and DBP over the 1-week, 1-month and 1-year period were not significantly different (P > 0.05) from baseline, and demonstrated high reproducibility (intraclass correlation coefficient, r= 0.82,0.98, P < 0.05). The results of this study demonstrate that in healthy older men, cardiovascular responses during orthostasis are highly reproducible, and this reproducibility is maintained over a 12-month period. These findings demonstrate that the 90° HUT test offers a reproducible method of monitoring longitudinal orthostatic responses in healthy older men. [source]

Brief screening tool for mild cognitive impairment in older Japanese: Validation of the Japanese version of the Montreal Cognitive Assessment

Yoshinori Fujiwara
Aim: The Montreal Cognitive Assessment (MoCA), developed by Dr Nasreddine (Nasreddine et al. 2005), is a brief cognitive screening tool for detecting older people with mild cognitive impairment (MCI). We examined the reliability and validity of the Japanese version of the MoCA (MoCA-J) in older Japanese subjects. Methods: Subjects were recruited from the outpatient memory clinic of Tokyo Metropolitan Geriatric Hospital or community-based medical health check-ups in 2008. The MoCA-J, the Mini-Mental State Examination (MMSE), the revised version of Hasegawa's Dementia Scale (HDS-R), Clinical Dementia Rating (CDR) scale, and routine neuropsychological batteries were conducted on 96 older subjects. Mild Alzheimer's disease (AD) was found in 30 subjects and MCI in 30, with 36 normal controls. Results: The Cronbach's alpha of MoCA-J as an index of internal consistency was 0.74. The test,retest reliability of MoCA, using intraclass correlation coefficient between the scores at baseline survey and follow-up survey 8 weeks later was 0.88 (P < 0.001). MoCA-J score was highly correlated with MMSE (r = 0.83, P < 0.001), HDS-R (r = 0.79, P < 0.001) and CDR (r = ,0.79, P < 0.001) scores. The areas under receiver,operator curves (AUC) for predicting MCI and AD groups by the MoCA-J were 0.95 (95% confidence interval [CI] = 0.90,1.00) and 0.99 (95% CI = 0.00,1.00), respectively. The corresponding values for MMSE and HDS-R were 0.85 (95% CI = 0.75,0.95) and 0.97 (95% CI = 0.00,1.00), and 0.86 (95% CI = 0.76,0.95) and 0.97 (95% CI = 0.00,1.00), respectively. Using a cut-off point of 25/26, the MoCA-J demonstrated a sensitivity of 93.0% and a specificity of 87.0% in screening MCI. Conclusion: The MoCA-J could be a useful cognitive test for screening MCI, and could be recommended in a primary clinical setting and for geriatric health screening in the community. Geriatr Gerontol Int 2010; 10: 225,232. [source]

Shortened questionnaire on quality of life for inflammatory bowel disease

M. J. Alcalá MD
Abstract Questionnaires for measuring quality of life in patients with inflammatory bowel disease usually include a large number of items and are time-consuming for both administration and interpretation. Our aim was to elaborate and validate a short quality-of-life questionnaire with the most representative items from the Spanish version of the 36-item Inflammatory Bowel Disease Questionnaire (IBDQ-36) using the Rasch analysis. The responses to 311 IBDQ-36 questionnaires from 167 patients with ulcerative colitis (UC) and 144 with Crohn's disease (CD) were analyzed. IBDQ-36 was shortened with successive Rasch analyses until all the remaining items showed acceptable separation and goodness-of-fit properties. Validation of the short questionnaire was studied in a new group of 125 patients by determining its validity and reliability. A 9-item short questionnaire was obtained (IBDQ-9). Its correlation with IBDQ-36 was excellent (r = 0.91). Correlation between IBDQ-9 and clinical indices of activity was statistically significant in UC (r = 0.70) and CD (r = 0.70). IBDQ-9 score discriminates adequately between patients in clinical remission or relapse (P < 0.01). Sensitivity to change was determined in 14 patients who improved clinically, showing significant IBDQ-9 changes between both determinations (P < 0.01), with an effect size of ,2.67 in UC and ,5.29 in CD. IBDQ-9 was also homogeneous, with a Cronbach's , of 0.95 in UC and 0.91 in CD. In 35-clinically stable patients, test-retest reliability was good, with a statistically-significant correlation between both questionnaires (r = 0.76 in UC and 0.86 in CD, P < 0.01) and an intraclass correlation coefficient of 0.82 in UC and 0.84 in CD. In conclusion, a short and valid questionnaire to measure quality of life in patients with inflammatory bowel disease was obtained using a new measurement model. Its use should facilitate comprehension of the impact of inflammatory bowel disease. [source]

The Temporal Asynchrony of Planktonic Cladocerans Population at Different Environments of the Upper Paraná River Floodplain

Erica Mayumi Takahashi
Abstract The aim of this study was to investigate the existence of synchronic fluctuation patterns in cladoceran populations of the Upper Paraná River floodplain. The following hypothesis were tested: (i) the populations of a given species present the same fluctuation pattern in abundance for different environments and (ii) synchrony is higher when we consider subsets of neighboring environments or those belonging to the same category (e.g., lagoons, rivers). Samplings were performed every three months from February 2000 to November 2002 at 11 sites. To evaluate spatial synchrony, the intraclass correlation coefficient was used. The results showed no significant correlation for the most abundant species, meaning that fluctuation patterns of planktonic cladocerans were asynchronous. Asynchrony indicated that the influence of floods and regional climatic factors was not strong enough to synchronize the populations, suggesting that local factors were more important than regional effects in determining zooplankton abundance patterns. The implications of these results are that the observations from a single environment cannot be extrapolated to other environments in a manner that would allow its use as a sentinel site. This means that a monitoring program for floodplain systems, or at least for the Paraná River floodplain, has to comprise greater spatial extents. (© 2008 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source]

Sonography of the normal greater occipital nerve and obliquus capitis inferior muscle

John Chin Suk Cho DC
Abstract Background. To use sonography to measure the cross-sectional area (CSA) of the greater occipital nerve (GON) and the adjacent obliquus capitis inferior muscle (OCI) in normal subjects. Methods. Data from 30 asymptomatic subjects between the ages of 22 and 35 were collected. CSA and circumference of the GON and CSA of OCI were measured using sonography. Interexaminer reliability analysis was performed using the intraclass correlation coefficient. Results. The CSA of the GON and OCI were 2 mm2 ± 1 mm2 and 1.86 cm2 ± 0.51 cm2, respectively. The average circumference of the GON was 4.8 mm ± 1.3 mm. The interexaminer reliability of the measurements was excellent with intraclass correlation coefficient coefficients of 0.91, 0.84, and 0.73 for the GON CSA, GON circumference, and OCI CSA, respectively. Conclusion. We report the normal values of the CSA of the GON and OCI. Knowledge of these normal values may facilitate the diagnosis of GON entrapment and provide outcome measures in therapeutic interventions. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010 [source]

Intima,media thickness of the abdominal aorta of neonate with different gestational ages

Esad Koklu MD
Abstract Purpose. To determine aortic intima,media thickness (aIMT) values in newborns with different gestational ages and to asses the effect of antenatal steroids on aIMT. Methods. Two hundred forty newborns from healthy mothers had their distal abdominal aIMT measured during abdominal sonographic examination. The neonates were divided into 4 groups (60 in each group) according to gestational age: group I (25,28 weeks), group II (29,32 weeks), group III (33,37 weeks), and group IV (38,42 weeks). Results. The interobserver and intersubject intraclass correlation coefficient was 0.93 and 0.94, respectively. Mean aIMT was 0.316 mm, 0.335 mm, 0.348 mm, and 0.385 mm, respectively, in group I, II, III, and IV, increasing significantly with gestational age at birth (p < 0.0001). There was no apparent effect of antenatal steroid use on aIMT. Multivariate regression models for mean aIMT demonstrated a significant association with aortic lumen diameter (p < 0.0001). Conclusion. Abdominal aIMT can be reproducibly measured in neonates and may be a useful tool for epidemiologic studies. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007 [source]

Doppler ultrasound assessment of posterior tibial artery size in humans

Manning J. Sabatier PhD
Abstract Purpose. The difference between structural remodeling and changes in tone of peripheral arteries in the lower extremities has not been evaluated. The purpose of this study was to (1) evaluate the day-to-day reproducibility and interobserver reliability (IOR) of posterior tibial artery (PTA) diameter measurements and (2) evaluate the effect of posture on PTA diameter at rest (Drest), during 10 minutes of proximal cuff occlusion (Dmin), and after the release of cuff occlusion (Dmax), as well as range (Dmax , Dmin) and constriction [(Dmax , Drest)/(Dmax , Dmin) × 100] in vivo. Methods. We used B-mode sonography to image the PTA during each condition. Results. Day-to-day reliability was good for Drest (intraclass correlation coefficient [ICC] 0.95; mean difference 4.2%), Dmin (ICC 0.93; mean difference 5.4%), and Dmax (ICC 0.99; mean difference 2.2%). The coefficient of repeatability for IOR was 70.5 ,m, with a mean interobserver error of 4.7 ,m. The seated position decreased Drest (2.6 ± 0.2 to 2.4 ± 0.3 mm; p = 0.002), increased Dmin (2.1 ± 0.2 to 2.4 ± 0.2 mm; p = 0.001), and decreased Dmax (3.1 ± 0.4 to 2.8 ± 0.3 mm; p < 0.001) compared with the supine position. The seated position also decreased arterial range (Dmax , Dmin) from 0.9 ± 0.2 to 0.5 ± 0.1 mm (p = 0.003) and increased basal arterial constriction from 57 ± 19% to 105 ± 27% (p = 0.007). Conclusions. The system employed for measuring PTA diameter yields unbiased and consistent estimates. Furthermore, lower extremity arterial constriction and range change with posture in a manner consistent with known changes in autonomic activity. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:223,230, 2006 [source]

Liver fat is reproducibly measured using computed tomography in the Framingham Heart Study

Elizabeth K Speliotes
Abstract Background and Aims:, Fatty liver is the hepatic manifestation of obesity, but community-based assessment of fatty liver among unselected patients is limited. We sought to determine the feasibility of and optimal protocol for quantifying fat content in the liver in the Framingham Heart Study using multidetector computed tomography (MDCT) scanning. Methods:, Participants (n = 100, 49% women, mean age 59.4 years, mean body mass index 27.8 kg/m2) were drawn from the Framingham Heart Study cohort. Two readers measured the attenuation of the liver, spleen, paraspinal muscles, and an external standard from MDCT scans using multiple slices in chest and abdominal scans. Results:, The mean measurement variation was larger within a single axial computed tomography (CT) slice than between multiple axial CT slices for the liver and spleen, whereas it was similar for the paraspinal muscles. Measurement variation in the liver, spleen, and paraspinal muscles was smaller in the abdomen than in the chest. Three versus six measures of attenuation in the liver and two versus three measures in the spleen gave reproducible measurements of tissue attenuation (intraclass correlation coefficient [ICCC] of 1 in the abdomen). Intrareader and interreader reproducibility (ICCC) of the liver-to-spleen ratio was 0.98 and 0.99, the liver-to-phantom ratio was 0.99 and 0.99, and the liver-to-muscle ratio was 0.93 and 0.86, respectively. Conclusion:, One cross-sectional slice is adequate to capture the majority of variance of fat content in the liver per individual. Abdominal scan measures as compared to chest scan measures of fat content in the liver are more precise. The measurement of fat content in the liver on MDCT scans is feasible and reproducible. [source]

Comparison of lipid-rich necrotic core size in symptomatic and asymptomatic carotid atherosclerotic plaque: Initial results

Vincent C. Cappendijk MD
Abstract Purpose To investigate the potential difference in the size of the lipid-rich necrotic core (LRNC) in carotid plaques of symptomatic patients versus asymptomatic patients. Pathological studies established that a large LRNC is an important feature of vulnerable atherosclerotic plaque. Previously, we have demonstrated a high correlation between semiquantitative analysis of the LRNC size in T1-weighted (w) turbo field echo (TFE) MR images and histology. Materials and Methods Thirty-seven patients with carotid stenosis >70% with (n = 26) or without (n = 11) symptoms were included. Three independent MR readers quantified the amount of LRNC with a T1w TFE pulse sequence. The relative amount of LRNC (LRNC score) was defined as sum of cross-sectional area percentages LRNC per carotid plaque. Results Interreader agreement for the three MR readers was good, with an intraclass correlation coefficient (ICC, 95% confidence interval [CI]) of 0.72 (0.57,0.83). All three MR readers on average found a larger LRNC in the symptomatic group of patients, although this was not statistically significant. The mean LRNC score was 116 ± 129 and 59 ± 62 for symptomatic and asymptomatic patients, respectively (P = 0.13). Symptomatic patients showed wide ranges in LRNC scores (0,424), while the range was much lower in the asymptomatic group (0,170). Conclusion Single-sequence T1w TFE may be a promising technique to study atherosclerotic plaque at risk of stroke. Larger studies are warranted to confirm these promising results. J. Magn. Reson. Imaging 2008;27:1356,1361. © 2008 Wiley-Liss, Inc. [source]

Multicontrast black-blood MRI of carotid arteries: Comparison between 1.5 and 3 tesla magnetic field strengths

Vasily L. Yarnykh PhD
Abstract Purpose To compare black-blood multicontrast carotid imaging at 3T and 1.5T and assess compatibility between morphological measurements of carotid arteries at 1.5T and 3T. Materials and Methods Five healthy subjects and two atherosclerosis patients were scanned in 1.5T and 3T scanners with a similar protocol providing transverse T1 -, T2 -, and proton density (PD)-weighted black-blood images using a fast spin-echo sequence with single- (T1 -weighted) or multislice (PD-/T2 -weighted) double inversion recovery (DIR) preparation. Wall and lumen signal-to-noise ratio (SNR) and wall/lumen contrast-to-noise ratio (CNR) were compared in 44 artery cross-sections by paired t -test. Interscanner variability of the lumen area (LA), wall area (WA), and mean wall thickness (MWT) was assessed using Bland-Altman analysis. Results Wall SNR and lumen/wall CNR significantly increased (P < 0.0001) at 3T with a 1.5-fold gain for T1 -weighted images and a 1.7/1.8-fold gain for PD-/T2 -weighted images. Lumen SNR did not differ for single-slice DIR T1 -weighted images (P = 0.2), but was larger at 3T for multislice DIR PD-/T2 -weighted images (P = 0.01/0.03). The LA, WA, and MWT demonstrated good agreement with no significant bias (P 0.5), a coefficient of variation (CV) of <10%, and intraclass correlation coefficient (ICC) of >0.95. Conclusion This study demonstrated significant improvement in SNR, CNR, and image quality for high- resolution black-blood imaging of carotid arteries at 3T. Morphologic measurements are compatible between 1.5T and 3T. J. Magn. Reson. Imaging 2006. © 2006 Wiley-Liss, Inc. [source]

Measurement error in computed tomography pelvimetry

N Anderson
SUMMARY Computed tomography pelvimetry is still used in clinical practice. We wished to quantify observer error in order to assess the level of confidence with which pelvic measurements can be described as adequate or inadequate. Anteroposterior inlet, anteroposterior outlet, transverse inlet and interspinous distances were measured from 11 CT pelvimetry examinations by five observers at one institution. Three CT pelvimetries were measured by five observers at a second institution. Intraobserver and interobserver variation was assessed using analysis of variance. Reliability of measurements was assessed using intraclass correlation coefficient. Combined error was calculated to determine 95% confidence limits for published minimum recommended pelvic measurements. The standard error of measurement, combining all sources, for measurement of the bony dimensions of the pelvis were: for anteroposterior inlet, 2.0 mm; anteroposterior outlet, 6.9 mm; transverse inlet, 1.3 mm; and interspinous distance, 2.1 mm. The 95% confidence interval around the recommended anteroposterior outlet of 100 mm was 88.5,111.3 mm. Observer variation in measurement of anteroposterior outlet is so large as to make the measurement of doubtful clinical utility. [source]

Technical and non-technical skills can be reliably assessed during paramedic simulation training

Background: Medical teams depend on technical skills (TS) as well as non-technical skills (NTS) for successful management of critical events. Simulated scenarios are an opportunity for presentation of similar crisis situations. The aim of this study was to test whether TS and NTS are assessable with satisfactory interrater reliability (IRR) during a regular paramedic training. Methods: Thirty paramedics were rated by two independent observers using video-recording and previously validated checklists while managing two simulated emergency scenarios as a team of two. The observed items of the team's TS included type, order, and time of adequate medical care. The NTS were restricted to six team-oriented dimensions. The IRR was quantified by calculating the intraclass correlation coefficient (ICC). The z -transformed values of the TS and NTS were correlated by Pearson's correlation. Internal consistency was controlled using Cronbach's ,. Results: The average measures ICC for the IRR was between 0.97 [95% confidence interval (CI) 0.91,0.99] and 0.98 (95% CI 0.94,0.99) for the TS sum-score, and was 0.94 (95% CI 0.87,0.97) for the NTS sum-score; the Cronbach's , of this NTS sum-score was 0.86. There is a positive correlation between the normalised TS and NTS sum-scores (r=0.53; P<0.05). Conclusion: Assessment of TS and NTS is feasible and reliable during paramedic training in emergency scenarios. TS can be reliably assessed by one trained observer; for NTS, two trained raters provide a suitable condition for excellent observations. There is a significant positive correlation between TS and NTS. [source]

Validation of a dental image analyzer tool to measure alveolar bone loss in periodontitis patients

W. J. Teeuw
Background and Objective:, Radiographs are an essential adjunct to the clinical examination for periodontal diagnoses. Over the past few years, digital radiographs have become available for use in clinical practice. Therefore, the present study investigated whether measuring alveolar bone loss, using digital radiographs with a newly constructed dental image analyzer tool was comparable to the conventional method, using intra-oral radiographs on film, a light box and a Schei ruler. Material and Methods:, Alveolar bone loss of the mesial and distal sites of 60 randomly selected teeth from 12 patients with periodontitis was measured using the conventional method, and then using the dental image analyzer tool, by five dentists. The conventional method scored bone loss in categories of 10% increments relative to the total root length, whereas the software dental image analyzer tool calculated bone loss in 0.1% increments relative to the total root length after crucial landmarks were identified. Results:, Both methods showed a high interobserver reliability for bone loss measurements in nonmolar and molar sites (intraclass correlation coefficient , 0.88). Also, a high reliability between both methods was demonstrated (intraclass correlation coefficient nonmolar sites, 0.98; intraclass correlation coefficient molar sites, 0.95). In addition, the new dental image analyzer tool showed a high sensitivity (1.00) and a high specificity (0.91) in selecting teeth with , 50% or < 50% alveolar bone loss in comparison with the conventional method. Conclusion:, This study provides evidence that, if digital radiographs are available, the dental image analyzer tool can reliably replace the conventional method for measuring alveolar bone loss in periodontitis patients. [source]

Validation of a client-based clinical metrology instrument for the evaluation of canine elbow osteoarthritis

C. A. Hercock
Objective: To validate a disease-specific client-based clinical metrology instrument (questionnaire) for dogs with chronic osteoarthritis of the elbow joint. Materialsand Methods: This was a prospective cohort study involving 26 dogs with chronic osteoarthritis of the elbow with 24 associated clients. Validity (face and criterion), reliability and responsiveness of the metrology instrument (named "Liverpool Osteoarthritis in Dogs [elbow]") were tested in a sequence of studies. Face validity involved use of international peer review. Reliability was assessed using a test-retest scenario with a two week interval; peak vertical force as measured by a force platform was used as an external standard measure. Responsiveness was tested with a two week, single-blinded placebo-controlled intervention using a licensed non-steroidal anti-inflammatory drug. Results: The reliability of Liverpool Osteoarthritis in Dogs (elbow) in the test-retest scenario was good; intraclass correlation coefficient is 0·89, 95 per cent confidence interval 0·75 to 0·95, compared with intraclass correlation coefficient 0·92, 95 per cent confidence interval 0·74 to 0·98, for peak vertical force. Responsiveness testing indicated that the "net" effect size (allowing for placebo effect) for Liverpool Osteoarthritis in Dogs (elbow) was 0·13 compared with (,)0·18 for the force platform. Criterion validity for Liverpool Osteoarthritis in Dogs (elbow) against peak vertical force was poor; Spearman's rank correlation is ,0·24 (P=0·30). Clinical Significance: Liverpool Osteoarthritis in Dogs (elbow) was considered reliable with satisfactory responsiveness. The poor criterion validity suggests a mismatch between force platform peak vertical force and client perceptions of lameness. This instrument requires further validation in larger studies with alternative client groups and alternative therapeutic interventions, but this initial validation suggests that Liverpool Osteoarthritis in Dogs (elbow) is worthy of continued investigation. [source]

A family of measures to evaluate scale reliability in a longitudinal setting

Annouschka Laenen
Summary., The concept of reliability denotes one of the most important psychometric properties of a measurement scale. Reliability refers to the capacity of the scale to discriminate between subjects in a given population. In classical test theory, it is often estimated by using the intraclass correlation coefficient based on two replicate measurements. However, the modelling framework that is used in this theory is often too narrow when applied in practical situations. Generalizability theory has extended reliability theory to a much broader framework but is confronted with some limitations when applied in a longitudinal setting. We explore how the definition of reliability can be generalized to a setting where subjects are measured repeatedly over time. On the basis of four defining properties for the concept of reliability, we propose a family of reliability measures which circumscribes the area in which reliability measures should be sought. It is shown how different members assess different aspects of the problem and that the reliability of the instrument can depend on the way that it is used. The methodology is motivated by and illustrated on data from a clinical study on schizophrenia. On the basis of this study, we estimate and compare the reliabilities of two different rating scales to evaluate the severity of the disorder. [source]

Development and validation of a disease-specific quality of life questionnaire for gastro-oesophageal reflux disease: the GERD-QOL questionnaire

Aliment Pharmacol Ther,31, 452,460 Summary Background, A simple and meaningful health-related quality of life (HRQoL) questionnaire for gastro-oesophageal reflux disease (GERD) patients is lacking. Aim, To develop and validate a disease-specific HRQoL instrument (GERD-QOL) for GERD patients. Methods, An 18-item questionnaire was generated to measure the impact of GERD on sleep, exercise, diet, need for medication, sex life, work, social activity and psychological well-being. GERD patients were invited to complete the GERD-QOL, a visual analogue scale (VAS) and a validated Chinese generic QoL (SF-36) questionnaire before and after esomeprazole treatment. Factor analysis was performed for item selection and psychometric properties were measured. An English version was developed by a forward-backward translation process. Results, A final 16-item GERD-QOL questionnaire was developed. The items were grouped into four subscales (Daily activity, Treatment effect, Diet, and Psychological well-being) after factor analysis. GERD-QOL had good item-internal consistency (Cronbach's alpha: 0.64,0.88), high test-retest reliability (intraclass correlation coefficient: 0.73,0.94, P < 0.001). Its subscale scores were correlated with SF-36 and VAS, which demonstrated high construct validity (P < 0.001). Discriminant validity was verified by correlating GERD-QOL scores with symptom severity (P < 0.001). Responsiveness after esomeprazole treatment was significant (paired- t -test P < 0.001). An English version of GERD-QOL was developed. Conclusion, The instrument, GERD-QOL, is valid and reliable. [source]