Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Kappa

  • cohen kappa
  • weighted kappa

  • Terms modified by Kappa

  • kappa analysis
  • kappa b
  • kappa b ligand
  • kappa coefficient
  • kappa index
  • kappa light chain
  • kappa number
  • kappa opioid receptor
  • kappa score
  • kappa statistic
  • kappa statistics
  • kappa value

  • Selected Abstracts

    Do radiologists agree on the quality of computed tomography enterography?

    Kari Ersland
    Summary This study aimed to assess variation between radiologists evaluating the quality of multi-detector computed tomography enterography. For 40 consecutive examinations, three experienced radiologists independently rated the following quality variables: % length of adequately filled bowel, bowel lumen diameters, bowel wall delineation, superior mesenteric vein, and bowel wall enhancement, artefacts, and total quality. We calculated the mean difference between observers with standard deviation (SD) for continuous variables and % total agreement, exact Fleiss kappa, and P -values (McNemar's test) for categorical variables. Depending on bowel segment (duodenum distal to bulb, jejunum, ileum, terminal ileum), mean difference between observers ranged from two to 33 (SD from 11 to 32) for % length of adequately filled bowel judged subjectively, 0,2 (SD 0,3) mm for smallest bowel lumen diameter and 0,4 (SD 3,7) mm for largest bowel lumen diameter. Agreement on bowel wall delineation was 80%/kappa 0.50 in duodenum, 90%/kappa 0.57 in jejunum, 75%/kappa 0.14 in ileum and 88%/kappa 0.17 in terminal ileum, where ratings differed between observers (P < 0.04). Agreement was 65%/kappa 0.18 for bowel wall enhancement judged subjectively. For contrast enhancement measured in Hounsfield Units, mean difference between observers ranged from two to 11 (SD 12,15) in normal jejunum wall and zero to one (SD 4,5) in the superior mesenteric vein depending on observer pair. Agreement was 78%/kappa 0.12 for image artefacts. Rating of total examination quality (good/optimal versus poor/very poor) differed between observers (P < 0.01); agreement was 60%/kappa 0.41. Many subjective evaluations varied between observers. We believe that measurements of bowel lumen diameters and contrast enhancement may be preferable. [source]

    Comparison of conventional Papanicolaou smears and fluid-based, thin-layer cytology with colposcopic biopsy control in central Italy: A consecutive sampling study of 461 cases

    Siavash Rahimi M.D.
    Abstract The aim of this study was to compare the cytologic diagnosis and specimen adequacy of conventional Papanicolaou (CP) and fluid-based, thin-layer [ThinPrep (TP), Cytyc, Boxborough, MA] cervical cytology in a population from central Italy. CP and TP samples were collected simultaneously using a consecutive sampling method on women presenting for cervical screening. Colposcopy was performed as clinically indicated, and biopsy results were compared with cytologic diagnoses. Among the 461 patients included in the study, 413 were negative at both CP and TP, 9 had unsatisfactory results at both tests and 39 patients presented abnormal results at CP, TP or both. Cohen's Kappa was 0.77 showing good agreement between CP and TP test results. Histological data were available for 20 (51.28%) of the 39 patients with at least one positive test. Among the 13 patients with HSIL at histology, 7 had HSIL at CP (sensitivity 53.85%) and 5 at TP (sensitivity 38.46%). For all three patients with squamous cell carcinoma (SCC) at histology, CP and TP had shown the same diagnosis (sensitivity 100%). The positive predictive values were 33.33% for CP and 25.0% for TP regarding the LSIL diagnosis and 100% for both CP and TP regarding HSIL and SCC diagnoses. Our results may be influenced by the consecutive sampling procedure. Diagn. Cytopathol. 2009. © 2008 Wiley-Liss, Inc. [source]

    Interobserver agreement in neonatal seizure identification

    EPILEPSIA, Issue 9 2009
    Aileen Malone
    Summary Objectives:, Accurate diagnosis of neonatal seizures is critically important and is often made clinically, without EEG (electroencephalography) monitoring. This observational study aimed to determine the accuracy and interobserver reliability of healthcare professionals in distinguishing clinically manifested seizures from other neonatal movements, when presented with clinical histories and digital video recordings only. Methods:, Twenty digital video recordings of paroxysmal movements in term and preterm infants were selected from a video-EEG database. The movements were categorized as seizure and nonseizure using EEG. Health care professionals (n = 137) from eight neonatal intensive care units (NICUs) were shown the video recordings with additional relevant clinical data, excluding EEG findings. The observers were asked to indicate which movements they considered to be seizure or nonseizure. A multirater Kappa statistic was used to assess agreement between observers and with the true diagnosis. Results:, Twenty video clips (11 seizure, 9 nonseizure) were evaluated by 91 doctors and 46 other professionals. The average number of correctly identified events was 10/20. Clonic seizures were correctly identified most frequently (range 36.5,95.6% of observers). Subtle seizures were poorly identified (range 20.4,49.6% of observers). The interobserver agreement (Kappa) for doctors and other health care professionals was poor at 0.21 and 0.29, respectively. Agreement with the correct diagnosis was also poor at 0.09 for doctors and ,0.02 for other healthcare professionals. Discussion:, It is often impossible to accurately differentiate between seizure-related and nonseizure movements in infants using clinical evaluation alone. In addition, doctors do not have a higher capacity for discriminating between neonatal paroxysmal events than other health care professionals. Until reliable continuous neurologic monitoring of newborn babies is available, it is likely that some babies with seizures will remain undetected and others with nonseizure movements will continue to be treated with potentially harmful anticonvulsants. [source]

    Using species distribution models to identify suitable areas for biofuel feedstock production

    GCB BIOENERGY, Issue 2 2010
    Abstract The 2007 Energy Independence and Security Act mandates a five-fold increase in US biofuel production by 2022. Given this ambitious policy target, there is a need for spatially explicit estimates of landscape suitability for growing biofuel feedstocks. We developed a suitability modeling approach for two major US biofuel crops, corn (Zea mays) and switchgrass (Panicum virgatum), based upon the use of two presence-only species distribution models (SDMs): maximum entropy (Maxent) and support vector machines (SVM). SDMs are commonly used for modeling animal and plant distributions in natural environments, but have rarely been used to develop landscape models for cultivated crops. AUC, Kappa, and correlation measures derived from test data indicate that SVM slightly outperformed Maxent in modeling US corn production, although both models produced significantly accurate results. When compared with results from a mechanistic switchgrass model recently developed by Oak Ridge National Laboratory (ORNL), SVM results showed higher correlation than Maxent results with models fit using county-scale point inputs of switchgrass production derived from expert opinion estimates. However, Maxent results for an alternative switchgrass model developed with point inputs from research trial sites showed higher correlation to the ORNL model than the corresponding results obtained from SVM. Further analysis indicates that both modeling approaches were effective in predicting county-scale increases in corn production from 2006 to 2007, a time period in which US corn production increased by 24%. We conclude that presence-only methods are a powerful first-cut tool for estimating relative land suitability across geographic regions in which candidate biofuel feedstocks can be grown, and may also provide important insight into potential land-use change patterns likely to be associated with increased biofuel demand. [source]

    Development and evaluation of two root caries controlling programmes for home-based frail people older than 75 years

    GERODONTOLOGY, Issue 2 2008
    Kim Ekstrand
    Objectives:, (i) Initially, to devise and examine the validity of a system for determining lesion activity on root surfaces, and (ii) compare the effectiveness of two preventive programmes in controlling root caries in elderly people using the devised system. Materials and methods:, (i) Four clinical variables: texture, contour, location and colour of root caries lesions were selected to evaluate lesion activity. The intraexaminer reproducibility of the scoring system was assessed on 28 elderly patients. The accuracy was assessed on 10 of these persons using an impression material (Clinpro, 3M ESPE). (ii) Of total, 215 homebound 75+ year olds were randomly assigned to one of three groups: group 1, once a month a dental hygienist brushed the teeth of the participants and applied Duraphat vanish to active root caries lesions. The participants in groups 2 and 3 received 5000 and 1450 ppm F-toothpaste, respectively, to use twice a day. This study included an interview, a baseline examination and a final follow-up examination after 8 months. Results:, (i) Intraexaminer reproducibility of the root caries scoring system was 0.86 (Kappa). The sensitivity and specificity was 0.86 and 0.81. (ii) Data from those 189 (88%) who completed the study disclosed that there were no inter-group differences at the baseline examination concerning relevant conditions. At the end of the study, the root caries status of participants in groups 1 and 2 had improved significantly when compared with group 3 (p < 0.02). No significant difference was observed between groups 1 and 2 (p = 0.14). Conclusion:, The data suggest that the root caries scoring system is reliable. Both the intervention programmes controlled root caries development; the hygienist in eight of 10 persons, the 5000 ppm F-toothpaste in seven of 10. In contrast, five of 10 participants who only brushed with 1450 ppm F-toothpaste had root caries progression. [source]

    Imaging of root canal fillings: a comparison of subjective image quality between limited cone-beam CT, storage phosphor and film radiography

    E. So
    Abstract Aim, To compare the subjective quality of limited cone-beam computed tomography (LCBCT), storage phosphor plate (SPP) and F-speed film images for the evaluation of length and homogeneity of root fillings. Methodology, Root canals of 17 extracted permanent mandibular incisor teeth were filled. With the teeth placed in their jaws, images were obtained with Accu-I-Tomo LCBCT, Digora® Optime image plate system and F-speed film using exposure parameters yielding ,clinically' acceptable density and contrast. Three radiologists and three endodontists independently rated the quality of all images in respect to homogeneity and the length of root fillings using a 3-graded scale. Evaluations were undertaken in two sessions. In the first, the coronal LCBCT images were not included. In the second, both coronal and sagittal LCBCT images were rated along with F-speed film and SPP images. Results were compared using the Friedman test (P < 0.05). Pair-wise comparisons of systems were completed using the Wilxocon signed-ranks test (P < 0.05). Kappa was used to measure interobserver agreement. Results, Digora images were rated superior, consecutively followed by F-speed films and LCBCT images, for the evaluation of both homogeneity and length of root fillings in both the evaluation sessions (P < 0.05). Kappa ranged from slight to moderate for the length evaluation of root fillings and from poor to fair for the evaluation of homogeneity of root fillings. Conclusion, Image quality of storage phosphor images was subjectively as good as conventional film images and superior to LCBCT images for the evaluation of both homogeneity and length of root fillings in single-rooted teeth. [source]

    Determination of age-related changes in the morphological structure (sagging) of the human cheek using a photonumeric scale and three-dimensional surface parameters

    Synopsis The usefulness of the photo standard for evaluating skin sagging in the face, especially in the cheeks, was evaluated. A six-stage photo standard was prepared using photos of women aged 17,83-years-old at three magnification rates (136,188 women in each group). Based on this photo standard, scoring was performed using a six-grade scoring system by two specialists to obtain the consensus score. Scoring was also performed in parallel by five general observers. The degree of agreement between the two scores was evaluated by calculating the Kappa value. In each group, the Kappa value was 0.452,0.563, indicating moderate agreement. Thus, the photo standard may be useful for evaluating sagging. Based on the photo standard, a score of 2, at which sagging becomes detectable appeared at the age of 40 years. In parallel, 3D analysis of replicas around the cheek was performed to morphologically analyse age-related changes in sagging. When the depth parameter was compared between the nasolabial groove and the mouth corners, a higher value was observed in the nasolabial groove until the age of 40 years, but higher values were seen in the mouth corners thereafter. This may have been because sagging in the cheeks descends to the area around the mouth, resulting in reversion in the sWv value. These findings indicated that sagging in the cheeks becomes morphologically distinct in women in their forties. Résumé L'utilité du critère photographique afin d'évaluer l'affaissement cutané du visage, et notamment des joues, a étéévaluée. Un critère photographique en six phases a été préparé au moyen de photographies de femmes âgées de 17 à 83 ans avec trois niveaux d'agrandissement différents (136,188 femmes dans chaque groupe). En se basant sur ce critère, on a procédéà une évaluation au moyen d'un système ou échelle d'évaluation comprenant six degrés par des deux spécialistes afin d'obtenir une évaluation de référence consensuelle. Parallèlement, cinq observateurs ordinaires ont également procédéà une évaluation. Le degré d'accord entre ces deux évaluations a été estimé en calculant la valeur Kappa. Dans chaque groupe, la valeur Kappa se situait entre 0,452 et 0,563, indiquant un consensus modéré. Par conséquent, le critère photographique peut être utile afin d'évaluer l'affaissement cutané. En se basant sur le critère photographique, une évaluation de degré 2, à partir duquel l'affaissement devient détectable, est apparu à l'âge de 40 ans. Parallèlement, une analyse tridimensionnelle de répliques autour des joues a été réalisée afin d'analyser morphologiquement les modifications selon l'âge de l'affaissement. Lorsque le paramètre de profondeur a été comparé entre le sillon nasolabial et les commissures des lèvres, une valeur supérieure a été observée pour le sillon nasolabial jusqu'à l'âge de 40 ans, mais des valeurs plus élevées ont été enregistrées pour les commissures des lèvres après 40 ans. Ceci peut être dû au fait que l'affaissement des joues descend vers la zone située autour de la bouche, conduisant à une réversion de la valeur sWv. Ces résultats indiquent que l'affaissement des joues devient morphologiquement apparent chez les femmes dés la quarantaine. [source]

    Use of the Zarit scale for assessing caregiver burden and collapse in caregiving at home in dementias

    Ana M. Gort
    Abstract Objectives The main objective was to analyse the Zarit scale's (ZS) ability to identify signs of caregiver collapse amongst people looking after patients suffering from dementia. We also evaluated the dimensions most affected by the ZS and risk factors associated with caregiver burden and collapse. Methods We administered the ZS and semi-structured interviews to identify signs of caregiver collapse amongst 66 people looking after patients suffering from dementia. We evaluated the risk factors associated with the patient: age, sex, type of dementia, place of residence, length of illness, behavioural disorders, incontinence, the Barthel index (IB), the Global Deterioration Scale (GDS), Folstein's Mini-Mental State Examination (MMSE) and the use of day-care centres and also risk factors associated with the caregiver: age, sex, relationship with the patient, help received with caring, the patient's illness, other family responsibilities and other work outside the home. Results There was a large degree of agreement between the findings from the interview and the ZS (Kappa,=,0.545; p,<,0.001). With regard to the risk factors evaluated in this study, there was a statistically significant relationship between behavioural disorders and both burden (p,<,0.27) and collapse (p,<,0.17) and between caregiver collapse and the caregiver and patient not living at the same home (p,<,0.27). Conclusion The ZS is not only useful for identifying caregiver burden, but also for predicting main caregiver collapse. Behavioural disorders and not living with the patient are the main causes of caregiver burden and collapse. Copyright © 2007 John Wiley & Sons, Ltd. [source]

    Assessing expressed emotion: comparing Camberwell Family Interview and Five-minute Speech Sample ratings for mothers of children with behaviour problems

    R. Calam
    Abstract Little is known of the concordance between ratings of expressed emotion (EE) derived from the Camberwell Family Interview (CFI) and Five-minute Speech Sample (FMSS) for parents of children with behaviour problems. Concordance between CFI and FMSS ratings of EE was assessed prior to intervention and compared to parent-rated behaviour after intervention, at follow-up, 12 months later. Female primary caretakers of 75 children (3,10 years) showing behavioural difficulties were interviewed using FMSS and CFI. Interviews were coded independently by criterion-standard raters. Using CFI, 57 families were classified high EE, and 18 low EE. Using FMSS, 65 families were classified high EE and 10 low EE. 55/75 pairs of ratings (73%) were the same (high, n = 51: low, n = 4) and 20 mothers (27%) were allocated different EE status (Kappa = 0.14, n.s.). The FMSS ratings at initial interview appeared more closely related to behaviour rating at follow-up than CFI. Further investigation is required to establish comparability of CFI and FMSS results for carers of children. Copyright © 2006 John Wiley & Sons, Ltd. [source]

    Agreement Between Self-Report of Disease Diagnoses and Medical Record Validation in Disabled Older Women: Factors That Modify Agreement

    Crystal F. Simpson MD
    Objectives: To determine the agreement between self-report of chronic disease and validated evidence of disease using multiple ascertainment methods and to assess effects of cognition, education, age, and comorbidity. Design: Cross-sectional analysis. Setting: Community Baltimore, Maryland. Participants: One thousand two community-dwelling disabled women aged 65 and older. Measurements: Kappa statistics were calculated to determine the relationship between self-report of 14 diseases and standardized algorithms. Analyses were stratified using Mini-Mental State Examination score, education, number of chronic diseases, and age. Results: Kappa was excellent for hip fracture (HF), Parkinson's disease (PD), diabetes mellitus (DM), cancer, stroke, and disc disease (DD); fair to good for angina pectoris, congestive heart failure, and myocardial infarction; and poor for peripheral arterial disease, spinal stenosis, osteoporosis, arthritis, and lung disease. Overall, kappa decreased with decreasing cognition and education, increasing age, and four or more diseases. Conclusion: In disabled older women, self-report of physician diagnosis of HF, PD, DM, cancer, stroke, and DD appears valid. In general, increasing comorbidity and age and decreasing cognition and education do not reduce validity for diseases where agreement was excellent overall. [source]

    Physicochemical characterization of carrageenans,A critical reinvestigation

    Gisela Berth
    Abstract Kappa-, iota-, and lambda-carrageenan (food grade) were analyzed by static light scattering (MALS in batch mode) in 0.1M NaNO3 at 25 and 60°C, earlier heated up to 90°C or not. At 25°C, there was a strong tendency for a concentration-dependent aggregation in the order lambda < kappa < iota. At 60°C, all samples were molecularly dispersed. The strongly temperature-dependent refractive index increments (equilibrium dialysis) differ. Data interpretation in terms of the wormlike chain model using the Skolnik-Odijk-Fixman approach led to an intrinsic persistence length around 3 to 4 nm and expansion factors as high as 1.5 and above in a thermodynamically good solvent for all three types. Triple-detector HPSEC (DRI, MALS, viscometry) on the three commercial samples plus a degraded (by acidic hydrolysis) kappa-carrageenan in the same solvent/eluant at 60°C yielded a uniform and slightly curved [,]- M relationship for 5 × 103 , M/(g mol) , 3 × 106 and a nearly identical molar mass dependence of the radius of gyration. HPSEC at 25°C on kappa-carrageenan confirmed formation of soluble aggregates. Special emphasis was put on analytical and methodological aspects. The reliability of the experimental data was demonstrated by analogous measurements on dextran calibration standards. © 2008 Wiley Periodicals, Inc. J Appl Polym Sci, 2008 [source]

    Light-chain-restricted plasmacellular infiltrates in necrobiosis lipoidica , a clue to an underlying monoclonal gammopathy

    Adina M. Cioc
    Background:, Necrobiosis lipoidica (NL) is a member of the palisading granulomatous dermatitides that is associated, in most cases, with diabetes mellitus. However, there are an increasing number of cases of NL associated with other forms of systemic disease. We describe a novel case of NL associated with a light-chain-restricted plasmacellular infiltrate; subsequent investigations established an underlying monoclonal gammopathy. Methods:, Skin biopsy material was obtained and was processed in the usual fashion for hematoxylin and eosin (H&E) examination. Immunohistochemical staining was performed by utilizing kappa and lambda monoclonal antibodies (Dako Corporation, Carpentiera, CA, USA). Kappa and lambda in situ hybridization was also performed (Ventana Medical Systems, Tucson, AZ, USA). Results:, A 55-year-old woman with a 5-year history of bilateral thigh subcutaneous nodules underwent a skin biopsy, showing typical changes of NL; there was a concomitant prominent perivascular plasmacellular infiltrate. Kappa light chain restriction was observed amid the plasmacellular infiltrate. Bone marrow biopsy and immunophenotyping studies revealed a clonal plasmacytosis with kappa light chain restriction. Conclusions:, Granulomatous inflammation, including NL, may be a cutaneous paraneoplastic expression of low-grade B-cell lymphoproliferative disease in the context of an underlying plasma cell dyscrasia. [source]

    Primary Cutaneous Immunocytoma Presenting with Diffuse Subclinical Involvement and Demonstrating Kappa and Lambda Light Chain Restrictions

    C. Lorenzo
    A 37 year-old man with primary cutaneous immunocytoma with lambda light chain restriction involving the left shoulder was treated with Rituxan with clinical resolution. Four years later, he presented with a six-month history of diffuse asymptomatic erythema. Physical examination revealed three grouped papules on the right upper arm and an irregular sclerotic patch with slight erythema superiorly on the left shoulder at the site of the initial tumor. There was no diffuse erythema. Biopsies were obtained from a papule on the right upper arm, the sclerotic patch on the left shoulder, and clinically uninvolved skin on the right anterior thigh. All three specimens showed a variably dense, predominantly periadnexal and perivascular dermal infiltrate of plasma cells and lymphocytes. The specimen from the right arm demonstrated kappa light chain restriction. The specimen from the right thigh showed lambda light chain restriction. Physical examination six weeks later demonstrated mottled erythema on the anterior thighs. Two biopsies were obtained from the right thigh. One showed immunocytoma. The other was unremarkable. The patient's primary cutaneous immunocytoma demonstrated two unusual findings: (1) histologic presence of tumor in clinically uninvolved and minimally involved skin; and (2) the presence of two distinct monoclonal populations. [source]

    Sensitivity of superficial cultures in lower extremity wounds,

    Chayan Chakraborti MD
    Abstract BACKGROUND: Superficial wound cultures are routinely used to guide therapy, despite a lack of clear supporting evidence. PURPOSE: To conduct a systematic review of the correlation between superficial wound cultures and the etiology of skin and soft tissue infections. DATA SOURCES: Medline, EMBASE, CINAHL, Scopus. STUDY SELECTION: Articles published between January 1960 and August 2009 involving superficial wound cultures and deeper comparison cultures. DATA EXTRACTION: Two reviewers independently searched for abstracted information pertaining to the microbiology of lower extremity wounds sufficient to calculate the sensitivity and specificity of superficial wound cultures versus comparison cultures. DATA SYNTHESIS: Data pooled using a random-effects meta-analysis model. RESULTS: Of 9032 unique citations, 8 studies met all inclusion criteria. Inter-rater reliability was substantial (Kappa = 0.78). Pooled test sensitivity for superficial wound swabs was 49% (95% confidence interval [CI], 37-61%], and specificity was 62% (95% CI, 51-74%). The pooled positive and negative likelihood ratios (LRs) were 1.1 (95% CI, 0.71-1.5) and 0.67 (95% CI, 0.52-0.82). The median number of isolates for surface cultures (2.7, interquartile range [IQR] 1.8-3.2) was not significantly different than that for comparison cultures, (2.2, IQR 1.7-2.9) (P = 0.75). CONCLUSION: Few studies show a strong relationship between superficial wound swabs and deep tissue cultures, and the current data demonstrate poor overall sensitivity and specificity. The positive and negative LRs were found to provide minimal utility in influencing pretest probabilities. Results of this analysis show that wound cultures should not be used in lieu of local antibiograms to guide initial antibiotic therapies. Journal of Hospital Medicine 2010;5:415,420. © 2010 Society of Hospital Medicine. [source]

    The modified CAMDEX informant interview is a valid and reliable tool for use in the diagnosis of dementia in adults with Down's syndrome

    S. L. Ball
    Abstract Background Dementia because of Alzheimer's disease (AD) commonly affects older adults with Down's syndrome (DS). Methods are needed, with established concurrent and predictive validity, to facilitate the diagnostic assessment of dementia, when it is complicated by pre-existing intellectual disabilities (ID). We report on the reliability and validity of a modified version of the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) informant interview, for use when assessing people with DS suspected as having dementia. Methods As part of a previous epidemiological study of older people with DS, the CAMDEX informant interview was used to determine the prevalence of dementia. The 74 people with DS included at that time (Time 1) had also completed the Cambridge Cognitive Examination (CAMCOG), the neuropsychological assessment from the CAMDEX schedule. Fifty-six were assessed again 6 years later (Time 2). Based on the CAMDEX informant interview, nine of the 74 at Time 1, and 11 of the 56 at Time 2, were found to meet clinical criteria for AD. Forty-one scored above floor on the CAMCOG at Time 1 and were included in the analysis of cognitive decline. Concurrent validity was established by comparing diagnosis at Time 2 with independent evidence of objective decline on cognitive tasks since Time 1. Predictive validity was established by examining how accurately diagnosis at Time 1 predicted both cognitive decline and future diagnosis. Inter-rater reliability was determined by comparing the level of agreement between two raters. Results CAMDEX-based diagnosis of AD was shown to be consistent with objectively observed cognitive decline (good concurrent validity) and to be a good predictor of future diagnosis. Although numbers are small, some support is also provided for the accuracy with which diagnosis predicts cognitive decline. Inter-rater reliability was good with Kappa > 0.8 for 91% of items and >,0.6 for all items. Conclusions The use of the modified CAMDEX informant interview enables the structured collection of diagnostic information, so that a valid and a reliable diagnosis of dementia can be made in those with pre-existing ID, using established diagnostic criteria. [source]

    In vivo detection of hemorrhage in human atherosclerotic plaques with magnetic resonance imaging,

    Vincent C. Cappendijk MD
    Abstract Purpose To investigate the performance of high-resolution T1-weighted (T1w) turbo field echo (TFE) magnetic resonance imaging (MRI) for the identification of the high-risk component intraplaque hemorrhage, which is described in the literature as a troublesome component to detect. Materials and Methods An MRI scan was performed preoperatively on 11 patients who underwent carotid endarterectomy because of symptomatic carotid disease with a stenosis larger than 70%. A commonly used double inversion recovery (DIR) T1w turbo spin echo (TSE) served as the T1w control for the T1w TFE pulse sequence. The MR images were matched slice by slice with histology, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the MR images were calculated. Additionally, two readers, who were blinded for the histological results, independently assessed the MR slices concerning the presence of intraplaque hemorrhage. Results More than 80% of the histological proven intraplaque hemorrhage could be detected using the TFE sequence with a high interobserver agreement (Kappa = 0.73). The TFE sequence proved to be superior to the TSE sequence concerning SNR and CNR, but also in the qualitative detection of intraplaque hemorrhage. The false positive TFE results contained fibrous tissue and were all located outside the main plaque area. Conclusion The present study shows that in vivo high-resolution T1w TFE MRI can identify the high-risk component intraplaque hemorrhage with a high detection rate in patients with symptomatic carotid disease. Larger clinical trials are warranted to investigate whether this technique can identify patients at risk for an ischemic attack. J. Magn. Reson. Imaging 2004;20:105,110. © 2004 Wiley-Liss, Inc. [source]

    A Taxonomy of Passive Behaviors in People with Alzheimer's Disease

    Kathleen Byrne Colling
    Purpose: To construct a taxonomy of passive behaviors for understanding people with Alzheimer's disease. Passive behaviors are those associated with decreased motor movements, decreasing interactions with the environment, and feelings of apathy and listlessness. Little is known about behaviors associated with passivity, and these behaviors have not been categorized. Organizing Construct: Taxonomy construction. Passive behaviors in people with Alzheimer's disease were conceptualized as disturbing behaviors, patterns of personality change, and negative symptoms. Methods: The taxonomy was developed using critical reviews of 15 empirical studies published 1985 through 1998. Procedures included listing behaviors; clustering behaviors into inductively derived groupings; conducting an expert panel-review, making revisions, and conduting a second review; establishing global and category-by-category reliability using Cohen's Kappa. Findings: The nonhierarchic, natural taxonomy indicated five categories of behaviors associated with passivity in Alzheimer's disease: diminutions of cognition, psychomotor activity, emotions, interactions with people, and interactions with the environment. Analysis indicated substantial agreement beyond chance and showed statistically significant agreement among the six nurse-expert raters. Areas of synchrony between the taxonomy and the Need-Driven Dementia Compromised Behavior Model were identified. Conclusions: This taxonomy of passive behaviors in patients with Alzheimer's disease showed empirical rigor and compatibility with a middle-range theory and can be viewed as a sensitizing analytic scheme to guide future practice, research, and theory development. [source]

    Accuracy of frozen section in the diagnosis of malignant ovarian tumor

    Dittakarn Boriboonhirunsarn
    Abstract Aim:, To evaluate the diagnostic accuracy of frozen section for histopathologic diagnosis of ovarian tumors. Methods:, A total of 147 surgically removed ovarian tumors were studied. Each ovarian tumor sample was evaluated for histopathologic diagnosis using both frozen and paraffin sections. Interpretation was separate and blinded between each technique. Accuracy, diagnostic values and their 95% confidence intervals (CI) were estimated by comparing the results from both techniques, using paraffin section as a gold standard. Results:, Overall accuracy of frozen section was 89.8% (95% CI 83.4,94.0). Sensitivity was 90.4% (95% CI 78.2,96.4) for malignant, 33.3% (95% CI 6.0,75.9) for borderline, and 93.3% (95% CI 85.4,97.2) for benign tumors. The predictive value was 100% (95% CI 90.6,100) for malignant, 20% (95% CI 3.5,55.8) for borderline, and 92.2% (95% CI 84.1,96.5) for benign tumors. Most false negatives occurred in mucinous and borderline tumors. No benign tumor was misdiagnosed as malignant by frozen section. Accuracy and negative predictive value were significantly lower in epithelial rather than germ and other cell types. Excellent agreement with regard to histologic cell type was observed (Kappa 0.81). Conclusion:, Frozen section appears to be an accurate technique for the histopathologic diagnosis of ovarian tumors. Some limitations were observed among borderline and mucinous tumors; this emphasizes the great value of frozen section in the diagnosis of ovarian tumors. [source]

    Medico-legal assessment of disability in narcolepsy: an interobserver reliability study

    Summary Impairment because of narcolepsy strongly limits job performance, but there are no standard criteria to assess disability in people with narcolepsy and a scale of disease severity is still lacking. We explored: (1) the interobserver reliability among Italian Medical Commissions making disability and handicap benefit decisions for people with narcolepsy, searching for correlations between the recognized disability degree and patients' features; (2) the willingness to report patients to the driving licence authority and (3) possible sources of variance in judgement. Fifteen narcoleptic patients were examined by four Medical Commissions in simulated sessions. Raw agreement and interobserver reliability among Commissions were calculated for disability and handicap benefit decisions and for driving licence decisions. Levels of judgement differed on percentage of disability (P < 0.001), severity of handicap (P = 0.0007) and the need to inform the driving licence authority (P = 0.032). Interobserver reliability ranged from Kappa = ,0.10 to 0.35 for disability benefit decision and from Kappa = ,0.26 to 0.36 for handicap benefit decision. The raw agreement on driving licence decision ranged from 73% to 100% (Kappa not calculable). Spearman's correlation between percentages of disability and patients' features showed correlations with age, daytime naps, sleepiness, cataplexy and quality of life. This first interobserver reliability study on social benefit decisions for narcolepsy shows the difficulty of reaching an agreement in this field, mainly because of variance in interpretation of the assessment criteria. The minimum set of indicators of disease severity correlating with patients' self assessments encourages a disability classification of narcolepsy. [source]

    Clinical evaluation of pelvic floor muscle function in continent and incontinent women

    Annemie Devreese
    Abstract Aims The aim of the study was to investigate the reliability of a scoring system for the investigation of voluntary and reflex co-contractions of abdominal and pelvic floor muscles in lying, sitting, and standing positions in continent and incontinent women. Methods A visual inspection and digital (strength, tone, speed, and endurance) palpation scale was developed to measure the coordination of the lower abdominal and pelvic floor muscles. Inter-observer reliability of the scales was investigated in 40 continent and 40 incontinent women. Differences between the continent and incontinent group were analysed. Results Inter-observer reliability for the visual inspection scale showed kappa values between 0.91 and 1.00, for tone percentage of agreement ranged from 95 to 100% (superficial) and 95 to 98% (deep muscle). Weighted Kappa (Kw) varied from 0.77 to 0.95 for strength and 0.75 to 0.98 for the inward movement of superficial and deep pelvic floor muscles. Kw for coordination between the superficial and deep part of the pelvic floor muscles groups was from 0.87 to 0.88 and 0.97 to 1.00 for endurance and global speed of the pelvic floor contraction. The continent women exhibited significantly better coordination between the pelvic floor and lower abdominal muscles during coughing in all three positions. Also the superficial part of the inward movement, the feeling and the coordination of the pelvic floor muscles were significantly better in the continent group. Conclusions Visual inspection and digital tests are easy and reliable methods by which insight can be gained into the multi-muscular activity and coordination of the pelvic floor and lower abdominal muscles in continent and incontinent women. Neurourol. Urodynam. 23:190,197, 2004. © 2004 Wiley-Liss, Inc. [source]

    Rate Responsive Pacing Using Transthoracic Impedance Minute Ventilation Sensors: A Multicenter Study on Calibration Stability

    DURU, F., et al.: Rate Responsive Pacing Using Transthoracic Impedance Minute Ventilation Sensors: A Multicenter Study on Calibration Stability. Previous studies showed that transthoracic impedance. Previous studies showed that transthoracic impedance minute ventilation (IMV), as measured by a pacemaker sensor, is closely correlated to actual minute ventilation (VE·) determined by standard methods. The aim of this study was to analyze the changes in the calibration between IMV and VE· at rest and during exercise over time. Fifteen patients (age 60 ± 13 years) with Medtronic Kappa 400 pacemakers completed a baseline visit followed by two visits separated by 1 month and 1 week, respectively. In each patient, VE· (L/min) was monitored at rest in the supine and sitting positions and during graded bicycle ergometer exercise using a standard cardiopulmonary metabolic gas analysis system with simultaneous recording of IMV (,/min) using DR-180 extended telemetry monitors. Calibration at rest was defined as the ratio of IMV to VE·, calculated from 1-minute average values in the supine and sitting positions. Calibration during bicycle exercise was defined as intercept (IMV value at VE·= 10 L/min-typical VE· value at beginning of exercise), and slope of the IMV/VE· regression line. The calibration of IMV showed individual variability over time. The magnitude (absolute value) of observed fractional changes in calibration at 1 month was 0.23 ± 0.20 (rest-supine), 0.20 ± 0.15 (rest-sitting), 0.18 ± 0.19 (exercise-intercept), 0.28 ± 0.35 (exercise-slope), and 0.18 ± 0.15, 0.15 ± 0.09, 0.28 ± 0.39, and 0.27 ± 0.15, respectively, at 1 week. The magnitude of change at 1 month was not statistically different from the magnitude of change at 1 week. In conclusion, the calibration of IMV, as measured by a pacemaker sensor, versus actual VE· may demonstrate variability. However, this study also suggests that the observed changes are not cumulative over time. These results have implications for patient monitoring applications using these sensors and for development of future pacemaker rate response algorithms. [source]

    Identifying cumulative trauma disorders of the upper extremity in workers' compensation databases

    Dianne Zakaria MSc (PT), PhD (Candidate)
    Abstract Background Impeding the use of workers' compensation databases for surveillance of cumulative trauma disorder of the upper extremity (CTDUE) is the lack of valid and reliable extraction strategies. Methods Using the Z795-96 Coding of Work Injury or Disease Information standard, analgorithm was developed to classify claims as definite, possible, or non-CTDUE. Reliability was assessed with standardized claim reviews. Results Moderate to substantial agreement (Kappa,=,0.48, 95% CI 0.42,0.54, n,=,328; weighted Kappa,=,0.75, 95% CI 0.70,0.80, n,=,328) was demonstrated. The algorithm produced relatively homogeneous groups of definite and non-CTDUE claims but 29.1% of the possible CTDUE claims were categorized as definite CTDUE by claim review. Part of body agreement was almost perfect (Kappa,=,0.81,1.00) when determining whether the upper extremity or specific parts of the upper extremity were involved. Conclusions The algorithm can be used to estimate the number of CTDUE and extract homogeneous groups of definite and non-CTDUE claims. Furthermore, certain upper extremity part of body codes can be used to target anatomically defined claims. Am. J. Ind. Med. 43:507,518, 2003. © 2003 Wiley-Liss, Inc. [source]

    Brief communication: The London atlas of human tooth development and eruption

    S.J. AlQahtani
    Abstract The aim of this study was to develop a comprehensive evidence-based atlas to estimate age using both tooth development and alveolar eruption for human individuals between 28 weeks in utero and 23 years. This was a cross-sectional, retrospective study of archived material with the sample aged 2 years and older having a uniform age and sex distribution. Developing teeth from 72 prenatal and 104 postnatal skeletal remains of known age-at-death were examined from collections held at the Royal College of Surgeons of England and the Natural History Museum, London, UK (M 91, F 72, unknown sex 13). Data were also collected from dental radiographs of living individuals (M 264, F 264). Median stage for tooth development and eruption for all age categories was used to construct the atlas. Tooth development was determined according to Moorrees et al. (J Dent Res 42 (1963a) 490,502; Am J Phys Anthropol 21 (1963b) 205,213) and eruption was assessed relative to the alveolar bone level. Intraexaminer reproducibility calculated using Kappa on 150 teeth was 0.90 for 15 skeletal remains of age <2 years, and 0.81 from 605 teeth (50 radiographs). Age categories were monthly in the last trimester, 2 weeks perinatally, 3-month intervals during the first year, and at every year thereafter. Results show that tooth formation is least variable in infancy and most variable after the age of 16 years for the development of the third molar. Am J Phys Anthropol, 2010. © 2010 Wiley-Liss, Inc. [source]

    Cell type accuracy of transthoracic fine needle aspiration material in primary lung cancer

    RESPIROLOGY, Issue 2 2001
    Adnan Yilmaz
    Objective: The aim of this study was to evaluate the diagnostic accuracy of transthoracic fine needle aspiration (TFNA) materials in establishing the specific cell type in primary lung cancer, and to study the influence of several factors on this accuracy. Methodology: The present study included 129 patients [(12 females, 117 males; mean age 54.6 years (range 25,75)] who underwent thoracotomy. The initial diagnosis was obtained by means of TFNA biopsy in all patients. Transthoracic fine needle aspiration was performed by 22-gauge Chiba needle with fluoroscopy guide in 93 patients and with computed tomography guide in 36 cases. Results: The overall concordance was 73.6% (Kappa = 0.52). The worst agreement was obtained for the large cell carcinoma (40%; Kappa = 0.48). The likelihood of a correct diagnosis using the TFNA specimens was 6.2-fold higher for well-differentiated tumours than for poorly differentiated tumours (P < 0.005). The stage of tumour and diameter of the lesion had no effect on cell agreement. Cell agreement was higher in central lesions than peripheral lesions, but the difference was not statistically significant (P = 0.097). This difference was more significant between patients with central and peripheral epidermoid carcinoma (P = 0.057). Conclusion: In our opinion, cell typing by TFNA may lead to incorrect results in the presence of poor differentiation, mixed tumours and peripheral epidermoid carcinomas. [source]

    Poorly performing physicians: Does the script concordance test detect bad clinical reasoning?,

    François Goulet MD
    Abstract Introduction Evaluation of poorly performing physicians is a worldwide concern for licensing bodies. The Collège des Médecins du Québec currently assesses the clinical competence of physicians previously identified with potential clinical competence difficulties through a day-long procedure called the Structured Oral Interview (SOI). Two peer physicians produce a qualitative report. In view of remediation activities and the potential for legal consequences, more information on the clinical reasoning process (CRP) and quantitative data on the quality of that process is needed. This study examines the Script Concordance Test (SCT), a tool that provides a standardized and objective measure of a specific dimension of CRP, clinical data interpretation (CDI), to determine whether it could be useful in that endeavor. Methods Over a 2-year period, 20 family physicians took, in addition to the SOI, a 1-hour paper-and-pencil SCT. Three evaluators, blind as to the purpose of the experiment, retrospectively reviewed SOI reports and were asked to estimate clinical reasoning quality. Subjects were classified into 2 groups (below and above median of the score distribution) for the 2 assessment methods. Agreement between classifications is estimated with the use of the Kappa coefficient. Results Intraclass correlation for SOI was 0.89. Cronbach alpha coefficient for the SCT was 0.90. Agreement between methods was found for 13 participants (Kappa: 0.30, P = 0.18), but 7 out of 20 participants were classified differently in both methods. All participants but 1 had SCT scores below 2 SD of panel mean, thus indicating serious deficiencies in CDI. Discussion The finding that the majority of the referred group did so poorly on CDI tasks has great interest for assessment as well as for remediation. In remediation of prescribing skills, adding SCT to SOI is useful for assessment of cognitive reasoning in poorly performing physicians. The structured oral interview should be improved with more precise reporting by those who assess the clinical reasoning process of examinees, and caution is recommended in interpreting SCT scores; they reflect only a part of the reasoning process. [source]

    Parents underestimate their child`s overweight

    ACTA PAEDIATRICA, Issue 9 2010
    Nina Vuorela
    Abstract Aim:, The aim of this study was to evaluate parents' ability to perceive the weight status of their children. Methods:, This cross-sectional study was performed on 5 (n = 310) and 11-year-old (n = 296) children. The height, weight and waist circumference were measured. Body mass index (BMI, kg/m²) was calculated. The International Obesity Task Force criteria and the British cut-off points were used to classify BMI and waist circumference. Parents filled out a questionnaire concerning their perception of the weight class of their child. The parents and the 11-year-old children estimated their own weight class. For analysis, the measured and perceived weight classes were divided into two categories; normal weight (including underweight) and overweight or obese. To measure the agreement cross-tabulation with Cohen's Kappa was used. Explanatory variables associated with misclassification of overweight children as normal weight were examined by logistic regression modelling. Results:, The prevalence of overweight (including obese) was 17.4% and 21.6% in 5- and 11-year-old children in this study. Only a few parents misclassified their normal weight children as overweight. By contrast, a majority of parents to the 5-year-old children and about half of the parents to the 11-year-old children misclassified them as normal weight. Using waist circumference for body size classification did not improve parents' performance. Mothers performed best when estimating own weight class. Conclusion:, A majority of parents fail to recognize overweight or obesity in their 5- and 11-year-old children. The underestimation of overweight may impair the motivation of the parents to adopt weight control. [source]

    Interrater reliability of diagnosing complex regional pain syndrome type I

    R. S. G. M. Perez
    Background: Diagnosis of complex regional pain syndrome type I (CRPS I) is based on clinical observation of symptoms. As little information is available on the reliability of CRPS I diagnosis, we evaluated the agreement between therapists with regard to the presence and severity of CRPS I and its symptoms. Methods: The interrater reliability was evaluated in 37 presumed CRPS I patients by three observers; one consultant anesthesiologist and two resident anesthesiologists. Patients were assessed on the basis of Veldman's CRPS criteria. Results: The interrater reliability for diagnosing CRPS I was good for the majority of observer combinations. The percentage of agreement for the absence or presence of CRPS I was good (88%,100%). Cohen's Kappa's ranged from 0.60 to 0.86. The agreement for the mean symptom score ranged from 70.2% to 88.6%; Kappa's were lower and showed more variation. Interrater reliability for assessment of the severity of CRPS I and its symptoms was poor. Factors influencing the interrater reliability were symptom type, individual observers and sample population. Conclusion: Diagnosing CRPS I can be performed on the basis of clinical observation. Further assessment of severity of CRPS I and its symptoms should be performed with reliable and valid measurement instruments. [source]

    Meta-analyses of agreement between diagnoses made from clinical evaluations and standardized diagnostic interviews

    David C. Rettew
    Abstract Standardized diagnostic interviews (SDIs) have become de facto gold standards for clinical research. However, because clinical practitioners seldom use SDIs, it is essential to determine how well SDIs agree with clinical diagnoses. In meta-analyses of 38 articles published from 1995 to 2006 (N = 15,967 probands), mean kappas (z -transformed) between diagnoses from clinical evaluations versus SDIs were 0.27 for a broad category of all disorders, 0.29 for externalizing disorders, and 0.28 for internalizing disorders. Kappas for specific disorders ranged from 0.19 for generalized anxiety disorder to 0.86 for anorexia nervosa (median = 0.48). For diagnostic clusters (e.g. psychotic disorders), kappas ranged from 0.14 for affective disorders (including bipolar) to 0.70 for eating disorders (median = 0.43). Kappas were significantly higher for outpatients than inpatients and for children than adults. However, these effects were not significant in meta-regressions. Conclusions: Diagnostic agreement between SDIs and clinical evaluations varied widely by disorder and was low to moderate for most disorders. Thus, findings from SDIs may not fully apply to diagnoses based on clinical evaluations of the sort used in the published studies. Rather than implying that SDIs or clinical evaluations are inferior, characteristics of both may limit agreement and generalizability from SDI findings to clinical practice. Copyright © 2009 John Wiley & Sons, Ltd. [source]

    Inference for Kappas for Longitudinal Study Data: Applications to Sexual Health Research

    BIOMETRICS, Issue 3 2008
    Yan Ma
    Summary Analysis of instrument reliability and rater agreement is used in a wide range of behavioral, medical, psychosocial, and health-care-related research to assess psychometric properties of instruments, consensus in disease diagnoses, fidelity of psychosocial intervention, and accuracy of proxy outcomes. For categorical outcomes, Cohen's kappa is the most widely used index of agreement and reliability. In many modern-day applications, data are often clustered, making inference difficult to perform using existing methods. In addition, as longitudinal study designs become increasingly popular, missing data have become a serious issue, and the lack of methods to systematically address this problem has hampered the progress of research in the aforementioned fields. In this article, we develop a novel approach based on a new class of kappa estimates to tackle the complexities involved in addressing missing data and other related issues arising from a general multirater and longitudinal data setting. The approach is illustrated with real data in sexual health research. [source]

    Sheep have the last word: kappa and delta opioid receptors initiate haemorrhagic hypotension

    ACTA PHYSIOLOGICA, Issue 1 2007
    William R. MillingtonArticle first published online: 3 AUG 200
    No abstract is available for this article. [source]