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

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0015
Author(s):  
Peter D. Fabricant ◽  
Madison R. Heath ◽  
Matthew Veerkamp ◽  
Simone Gruber ◽  
Daniel W. Green ◽  
...  
Keyword(s):  
Decision Making ◽  
Children And Adolescents ◽  
Interrater Reliability ◽  
Clinical Decision Making ◽  
Skeletal Maturity ◽  
Patellofemoral Instability ◽  
Clinical Decision ◽  
Consensus Building ◽  
Operative Planning ◽  
And Training

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

scholarly journals Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRI of Children and Adolescents With Patellofemoral Instability: Data From the JUPITER Cohort

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199111
Author(s):  
Peter D. Fabricant ◽  
Madison R. Heath ◽  
Matthew Veerkamp ◽  
Simone Gruber ◽  
Daniel W. Green ◽  
...  
Keyword(s):  
Decision Making ◽  
Children And Adolescents ◽  
Interrater Reliability ◽  
Preoperative Planning ◽  
Skeletal Maturity ◽  
Patellofemoral Instability ◽  
Consensus Building ◽  
Surgical Decision ◽  
Surgical Decision Making ◽  
New Criteria

Background: Surgical decision making and preoperative planning for children and adolescents with patellofemoral instability rely heavily on a patient’s skeletal maturity. To be clinically useful, radiologic assessments of skeletal maturity must demonstrate acceptable interrater reliability and accuracy. Purpose: The purpose of this study was to examine the interrater reliability among surgeons of varying experience levels and specialty training backgrounds when evaluating the skeletal maturity of the distal femur and proximal tibia of children and adolescents with patellofemoral instability. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Six fellowship-trained orthopaedic surgeons (3 pediatric orthopaedic, 2 sports medicine, and 1 with both) who perform a high volume of patellofemoral instability surgery examined 20 blinded knee radiographs and magnetic resonance images in random order. They assessed these images for clinically relevant growth (open physis) or clinically insignificant growth (closing/closed physis) remaining in the distal femoral and proximal tibial physes. Fleiss' kappa was calculated for each measurement. After initial ratings, raters discussed consensus methods to improve reliability and assessed the images again to determine if training and new criteria improved interrater reliability. Results: Reliability for initial assessments of distal femoral and proximal tibial physeal patency was poor (kappa range, 0.01-0.58). After consensus building, all assessments demonstrated almost-perfect interrater reliability (kappa, 0.99 for all measurements). Conclusion: Surgical decision making and preoperative planning for children and adolescents with patellofemoral instability rely heavily on radiologic assessment of skeletal maturity. This study found that initial interrater reliability of physeal patency and clinical decision making was unacceptably low. However, with the addition of new criteria, a consensus-building process, and training, these variables became highly reliable.

The assessment of bulging fontanel and splitting of sutures in premature infants: an interrater reliability study by the Hydrocephalus Clinical Research Network

2013 ◽  
Vol 11 (1) ◽  
pp. 12-14 ◽  
Author(s):  
John C. Wellons ◽  
Richard Holubkov ◽  
Samuel R. Browd ◽  
Jay Riva-Cambrin ◽  
William Whitehead ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Research ◽  
Premature Infants ◽  
Interrater Reliability ◽  
Clinical Decision Making ◽  
Clinical Signs ◽  
Clinical Decision ◽  
Research Network ◽  
Posthemorrhagic Hydrocephalus ◽  
Clinical Research Network

Object Previous studies from the Hydrocephalus Clinical Research Network (HCRN) have shown a great degree of variation in surgical decision making for infants with posthemorrhagic hydrocephalus, such as when to temporize, when to shunt, or when to convert. Since much of this clinical decision making is dictated by clinical signs of increased intracranial pressure (including bulging fontanel and splitting of sutures), the authors investigated whether there was variability in how these signs were being assessed by neurosurgeons. They wanted to answer the following question: is there acceptable interrater reliability in the neurosurgical assessment of bulging fontanel and split sutures? Methods Explicit written definitions of “bulging fontanel” and “split sutures” were agreed upon with consensus across the HCRN. At 5 HCRN centers, pairs of neurosurgeons independently assessed premature infants in the first 3 months of life for the presence of a split suture and/or bulging fontanel, according to the a priori definitions. Interrater reliability was then calculated between pairs of observers using the Cohen simple kappa coefficient. Institutional board review approval was obtained at each center and at the University of Utah Data Coordinating Center. Results A total of 38 infants were assessed by 13 different raters (10 faculty, 2 fellows, and 1 resident). The kappa for bulging fontanel was 0.65 (95% CI 0.41–0.90), and the kappa for split sutures was 0.84 (95% CI 0.66–1.0). No complications from the study were encountered. Conclusions The authors have found a high degree of interrater reliability among neurosurgeons in their assessment of bulging fontanel and split sutures. While decision making may vary, the clinical assessment of this cohort appears to be consistent among these physicians, which is crucial for prospective studies moving forward.

Differences in Attitudes toward Patients among Medical Specialties

1989 ◽  
Vol 18 (3) ◽  
pp. 223-233 ◽  
Author(s):  
Gerald Roskin ◽  
Susan K. Marell
Keyword(s):  
Internal Medicine ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Treatment Approach ◽  
Clinical Decision ◽  
Medical Specialties ◽  
Attitudinal Dimension ◽  
The Impact ◽  
Moral Weakness ◽  
And Training

In a prior study a questionnaire was developed which reliably measured a variety of physicians' attitudes toward patients [1]. In the present study we have used this questionnaire to compare the attitudes of physicians specializing in Internal Medicine, Surgery, Pediatrics and Psychiatry with one another and with a group of medical students. One way analyses of variance yielded highly significant differences ( p < .001) among these groups on the “Nurturant-Empathic” attitudinal dimension, as well as on the “Psychodynamic” and “Moral Weakness” Etiology Scales. Significance and ramifications of these findings are discussed in terms of the impact of these attitudes on treatment approach, clinical decision-making, and quality and comprehensiveness of patient care. Further, these findings suggest that a variety of education and training approaches could be advantageously utilized to integrate and upgrade the care of patients by the different medical specialties.

scholarly journals Implementation of evidence-based practice: The experience of nurses and midwives

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256600
Author(s):  
Asrat Hailu Dagne ◽  
Mekonnen Haile Beshah
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Public Hospitals ◽  
Evidence Based ◽  
Limited Support ◽  
Research Findings ◽  
Nurses And Midwives ◽  
And Training

Background Implementation of evidence-based practice in clinical practice is crucial. Nurses and midwives play a vital role in using updated evidence. However, limited support and barriers to implementing evidence-based practice hamper the use of up-to-date evidence in clinical decision-making practice. Therefore, this study aimed to explore the implementation of evidence-based practice of nurses and midwives working in public hospitals. Methods A qualitative descriptive study was conducted to explore the experience of implementing evidence-based practice among nurses and midwives working in public hospitals. A total of 86 participants, of which, 25 in-depth interviews, 5 FGDs having 47 participants and 14 participants were involved during observations, were considered in Amhara Region public hospitals from November 17, 2019 to April 25, 2020. The observational data, interview and FGD transcripts were imported into NVivo 12 plus to manage and analyze the data using the Computer-Assisted Data Analysis Software Program (CAQDAS). The data were analyzed through thematic content analysis. Results Nurses and midwives perceived that implementation of evidence-based practice is the use of research findings, guidelines, hospital protocols, books, and expert experience in clinical decision-making practice. However, there was limited support for the implementation of evidence-based practice by nurses and midwives. The lack of knowledge and skill to use evidence like research findings, time mismanagement, the lack of motivation, the lack of resources and training were the perceived barriers to the implementation of evidence-based practice. Stick to the traditional practice due to lack of incentive and unclear job description between diploma and BSc nurses and midwives were the perceived causes of the lack of motivation. Conclusions The experience of evidence-based practice of nurses and midwives indicated that there was limited support for the implementation of evidence-based practice. However, research findings were rarely used in clinical decision-making practice The Knowledge, attitude towards implementing evidence-based practice, lack of resources and training, time mismanagement and lack of motivation were the barriers to the implementation of evidence-based practice. Therefore, the promotion of adopting the implementation of evidence-based practice and training on the identified barriers are mandatory.

Nursing Information Systems

2015 ◽  
pp. 959-977
Author(s):  
Ana Paula Macedo ◽  
Fernando Petronilho ◽  
João Cainé
Keyword(s):  
Decision Making ◽  
Information Systems ◽  
Nursing Practice ◽  
Clinical Decision Making ◽  
Health Information Systems ◽  
Clinical Decision ◽  
Central Resource ◽  
The Impact ◽  
And Training

We have witnessed a change in the Health Information Systems (HIS) in what concerns structure, contents, and support for optimization of the resources, the best efficiency in cost control, and a better management of the quality of services rendered to the citizens. From the standpoint of reformulating the HIS, we can see an evolution in the production of information centered almost exclusively in the need of a documental proof on the care rendered by nurses to the citizens to produce information that can constitute a central resource for their clinical decision making. The authors describe the evolution of the Nursing Information Systems (NIS), reflect upon the impact of reformulation and implementation of the NIS in Portugal in the development of the nursing practice, and reflect upon the impact of the NIS reformulation in the quality of care as well as in education and training in the nursing area.

scholarly journals Measuring and Quantifying Collateral Information in Psychiatry: Feasibility study of the McLean Collateral Information and Clinical Actionability scale (M-CICAS) (Preprint)

2020 ◽  
Author(s):  
Praise Owoyemi ◽  
Sarah Salcone ◽  
Christopher King ◽  
Heejung Julie Kim ◽  
Kerry James Ressler ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Records ◽  
Interrater Reliability ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Collateral Information ◽  
Psychiatric Setting ◽  
Study Staff ◽  
Minimal Research ◽  
Made In

BACKGROUND The review of collateral information is an essential component of patient care. Though this is standard practice, minimal research has been devoted to quantifying collateral information collection and to understanding how collateral information translates to clinical decision-making. To address this, we developed and piloted a novel measure (the McLean collateral information and clinical actionability scale (M-CICAS)) to evaluate the types and number of collateral sources viewed and resulting actions made in a psychiatric setting. OBJECTIVE Study aims included: 1) feasibility testing of the M-CICAS measure, 2) validating this measure against clinician notes via medical records, and 3) evaluating whether reviewing a higher volume of collateral sources is associated with more clinical actions taken. METHODS For the M-CICAS measure, we developed a three-part instrument, focusing on measuring collateral sources reviewed, clinical actions taken, and shared decision-making between clinician and patient. We recruited clinicians providing psychotherapy services at McLean hospital (N = 7) to complete the M-CICAS measure after individual clinical sessions. We also independently completed the M-CICAS using only the clinician’s corresponding note from that session, in order to validate the reported measure against the electronic health record which served as the objective point of comparison. Based on this, we estimated inter-rater reliability, reporting validity and whether significant variance in clinical actions taken could be attributed to inter-clinician differences. RESULTS Study staff had high interrater reliability on the M-CICAS for the sources reviewed (r=0.98, P<.001) and actions taken (r=0.97, P <.001). Clinician and study staff ratings were moderately correlated and statistically significant on the M-CICAS summary scores for the sources viewed (r’s=0.24 and 0.25, P=.02202 and P=.0188, respectively). Univariate regression modelling demonstrated a significant association between collateral sources and clinical actions taken when clinicians completed the M-CICAS (B=.27, t=2.47, P =.015). Multilevel fixed slopes random intercepts model confirmed a significant association even when accounting for clinician differences (B=.23, t=2.13, P =.037). CONCLUSIONS This pilot study establishes feasibility and preliminary validity for the M-CICAS measure in assessing collateral sources and clinical decision-making in psychiatry. This study also indicated that reviewing more collateral sources may lead to an increased number of clinical actions following a session.

Nursing Information Systems

2013 ◽  
pp. 474-491
Author(s):  
Ana Paula Macedo ◽  
Fernando Petronilho ◽  
João Cainé
Keyword(s):  
Decision Making ◽  
Information Systems ◽  
Nursing Practice ◽  
Clinical Decision Making ◽  
Health Information Systems ◽  
Clinical Decision ◽  
Central Resource ◽  
The Impact ◽  
And Training

We have witnessed a change in the Health Information Systems (HIS) in what concerns structure, contents, and support for optimization of the resources, the best efficiency in cost control, and a better management of the quality of services rendered to the citizens. From the standpoint of reformulating the HIS, we can see an evolution in the production of information centered almost exclusively in the need of a documental proof on the care rendered by nurses to the citizens to produce information that can constitute a central resource for their clinical decision making. The authors describe the evolution of the Nursing Information Systems (NIS), reflect upon the impact of reformulation and implementation of the NIS in Portugal in the development of the nursing practice, and reflect upon the impact of the NIS reformulation in the quality of care as well as in education and training in the nursing area.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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