scholarly journals ASSESSMENT OF SCORES IN DECISION MAKING IN METASTASES OF THE SPINE

2015 ◽  
Vol 14 (4) ◽  
pp. 312-316
Author(s):  
Marcus Vinicius de Oliveira Ferreira ◽  
Renato Hiroshi Salvioni Ueta ◽  
David Del Curto ◽  
Eduardo Barros Puertas
Keyword(s):  
Decision Making ◽  
Spinal Metastasis ◽  
Interobserver Reliability ◽  
Daily Practice ◽  
Metastatic Lesion ◽  
Intraobserver Reliability ◽  
Orthopedic Surgeons ◽  
Different Order

Objective : The aim of this study is to assess the intra- and interobserver concordance of SINS, Harrington, Tokuhashi and Tomita scores among general orthopedic surgeons and spine surgeons with experience above 5 and 10 years in the evaluation of patients with spinal metastasis. Methods : Twenty cases of patients with metastatic lesion of the spine were presented to 10 examiners and the scores aforementioned have been applied. After six weeks, the cases were reintroduced in a different order and data were analyzed. Results : The intraobserver reliability showed better agreement in SINS score among examiners with less experience and Harrington and Tomita scores among those who had more than 10-year experience. The interobserver reliability of the examiners of the group with over 10-year experience showed higher precision when using these scores, especially Harrington and Tomita. The SINS score was the choice for daily practice and was able to modify the management more often. Conclusions : This study demonstrated that the use of predictive scores of instability, Harrington, and prognosis, Tomita, had a higher intra- and interobserver reliability particularly among spine surgeons with experience above 10 years.

scholarly journals Assessment of the reliability of a non-invasive elbow valgus laxity measurement device

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Kenneth Seiber ◽  
Chris Bales ◽  
Elisabeth Wörner ◽  
Thay Lee ◽  
Marc R. Safran
Keyword(s):  
Mixed Model ◽  
Interobserver Reliability ◽  
Research Question ◽  
Intraclass Correlation ◽  
Ulnar Collateral Ligament ◽  
Daily Practice ◽  
Intraobserver Reliability ◽  
Measurement Tool ◽  
Collateral Ligament ◽  
Valgus Stress

Abstract Purpose The purpose of this study was to assess the reliability of a new objective measurement tool to measure the valgus stress laxity of the ulnar collateral ligament (UCL) of the elbow, the “Elbow Tester”. The anterior oblique portion of the ulnar collateral ligament (UCL) of the elbow is the primary static restraint to valgus stress during the overhead throwing motion. The main research question was if the “Elbow Tester” that we have developed was reliable and reproducible for further use in research and daily practice. Methods Three different examiners tested both elbows of 11 volunteers for UCL laxity. Each elbow was tested 5 times using a standard 2 Nm valgus load, and 3 times using a manual maximum valgus load. One examiner tested the volunteers again 1 week later. The outcomes of elbow valgus laxity were compared between examiners. The intraobserver reliability was assessed using an intraclass correlation coefficient (ICC) and interobserver reliability was also assessed with a mixed model repeated ANOVA test. Results The device demonstrated a high level of intraobserver reliability with both the 2 Nm valgus force and manual maximum valgus force, using a minimum of three trials as determined by an ICC > 0.9 for all examiners. The interobserver reliability was moderate using the 2 Nm valgus load with an ICC value of 0.72 and significant different outcomes of elbow valgus laxity amongst examiners (p < 0.01). A high interobserver reliability (ICC value of 0.90) was observed using manual maximum valgus force and no differences between outcomes (p > 0.53). Conclusion The noninvasive valgus elbow tester demonstrates high interobserver and intraobserver reliability using manual maximum valgus force and can be used for further research and daily practice.

scholarly journals Inter- and Intraobserver Reliability Between Orthopaedic Surgeons for Reparability of the Anterior Cruciate Ligament Using MRI

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096460
Author(s):  
Forrest L. Anderson ◽  
Margaret L. Wright ◽  
Matthew J. Anderson ◽  
Frank J. Alexander ◽  
George Popa ◽  
...  
Keyword(s):  
Decision Making ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Interobserver Reliability ◽  
Cruciate Ligament ◽  
Intraobserver Reliability ◽  
Acl Repair ◽  
Orthopaedic Surgeons ◽  
Mri Scans ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) reconstruction is the standard of care for patients after an ACL tear, as poor historical outcomes were observed after primary ACL repair. Certain subgroups of patients, however, have been shown to have outcomes equivalent to reconstruction after undergoing ACL repair and therefore may benefit from the potential advantages offered by avoiding reconstruction. It is important to accurately and consistently identify and indicate these candidates for ACL repair. Purpose/Hypothesis: The purpose of this study was to determine the inter- and intraobserver reliability of magnetic resonance imaging (MRI) evaluation for the reparability of ACL tears and to identify imaging factors that may lead to surgeon uncertainty or disagreement in decision making. Our hypothesis was that the orthopaedic surgeons surveyed would not be able to reliably agree on the reparability of an ACL using MRI scans alone. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: We administered 2 surveys to 6 fellowship-trained orthopaedic sports medicine surgeons. Each surgeon reviewed preoperative MRI scans for 20 patients and answered a series of questions, ultimately determining whether they would choose an ACL reconstruction or repair for the patient based on the imaging alone. The same survey was repeated 6 weeks later. Kappa values for inter- and intraobserver reliability of their decision making were then calculated. Results: The average kappa for interobserver reliability in the 2 surveys was 0.22, and the average kappa for intraobserver reliability was 0.34. Interobserver reliability among the surgeons in this group was poor to moderate; intraobserver reliability was slightly better. The choice for ACL repair was significantly correlated with proximal tear locations ( r = 0.854; P < .001), good-quality ACL tissue remnant ( r = 0.929; P < .001), and how many surgeons believed that the tear only involved a single bundle ( r = 0.590; P = .006). Conclusion: The surgeons surveyed in this study did not consistently agree on candidates for ACL repair using MRI alone.

scholarly journals Reliability of the Penny and Beit CURE Radiologic Classifications of Pediatric Patients with Chronic Hematogenous Osteomyelitis in the Philippine General Hospital

2021 ◽  
Vol 55 (3) ◽  
Author(s):  
Karla Teresa S. Araneta ◽  
Juanito S. Javier
Keyword(s):  
General Hospital ◽  
Pediatric Patients ◽  
Interobserver Reliability ◽  
Intraobserver Reliability ◽  
Classification Systems ◽  
Intraobserver Agreement ◽  
Orthopedic Surgeons ◽  
Hematogenous Osteomyelitis

Objective. This study aimed to evaluate the inter- and intraobserver reliability of the Penny and Beit CURE radiologic classifications of pediatric patients with Chronic Hematogenous Osteomyelitis (CHOM) in the Philippine General Hospital (PGH). Methods. Thirty-four pre-operative radiographs of PGH pediatric patients with CHOM were classified by seven orthopedic surgeons using both Penny and Beit CURE Classification systems. Two sets of radiographs were sent to the surgeons twice, four weeks apart, to classify. The Fleiss and Cohen κ statistics were used to determine inter- and intraobserver reliabilities, respectively. Results. The Penny Classification had a slight to fair interobserver reliability (Fleiss κ = 0.17 and 0.24) and a fair intraobserver reliability (Cohen κ =0.35) with a 49.58% average intraobserver agreement. The interobserver reliability when including all Beit CURE classification subtypes was fair (κ = 0.28 and 0.31). This improved to moderate (κ = 0.41 and 0.54) when using only the four main types of the Beit CURE classification with a 77.31% intraobserver agreement. Conclusion. The Beit CURE classification for pediatric CHOM had higher inter- and intraobserver agreement rates than the Penny classification. Further improvement in reliability can be made by combining B2 and B3 subtypes under the Beit CURE classification.

scholarly journals Interobserver and Intraobserver Reliability of the Enneking Classification in Plain Radiographic Staging of Benign Bone Tumors of the Extremities in Patients Seen at the Philippine General Hospital

2021 ◽  
Vol 55 (3) ◽  
Author(s):  
Bernardino II Alpuerto ◽  
Edward Wang
Keyword(s):  
Bone Tumors ◽  
Interobserver Reliability ◽  
Intraobserver Reliability ◽  
Benign Tumors ◽  
Kappa Statistics ◽  
Tumor Registry ◽  
Repeat Testing ◽  
Plain Radiographs ◽  
Benign Bone Tumors ◽  
Orthopedic Surgeons

Objective. To determine the interobserver and intraobserver reliabilities of the Enneking Classification system in staging benign bone tumors. Methods. Photographs of traditional plain radiographs of 65 histologically benign tumors from the PGH Department of Orthopedics Tumor Registry were used in the study. Nine Orthopedic surgeons (three consultants, one fellow, and five senior residents) staged the tumors using the Enneking Classification based on radiographic tumor-host margins. The photographs were sent to the surgeons twice (batch 1 and 2), three months apart, for staging. The Fleiss and Cohen kappa statistics were used to determine interobserver and intraobserver reliabilities, respectively. This is a pilot study. Results. There was only fair interobserver reliability of the Enneking Classification staging with Fleiss kappa of 0.38 and 0.26 for batches 1 and 2, respectively. Also, there was only moderate intraobserver reliability (Cohen kappa 0.48) for the staging. Moreover, there was also a relatively low intraobserver percent agreement (67%) among raters. In both reliabilities, the consultants/fellow group consistently showed better interobserver and intraobserver reliabilities compared to the residents. Conclusion. The Enneking Classification in staging benign bone tumors had relatively low interobserver and intraobserver reliabilities. There was also a tendency of experienced orthopedic tumor consultants and senior residents to stage the same radiograph differently upon repeat testing.

scholarly journals THU0647-HPR SHARED DECISION MAKING AMONGST RHEUMATOLOGISTS IN TRAINING IN THE NETHERLANDS: WHERE DO WE STAND?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 568.2-568
Author(s):  
L. Kranenburg ◽  
M. Dankbaar ◽  
N. Basoski ◽  
W. Van den Broek ◽  
J. Hazes
Keyword(s):  
Decision Making ◽  
The Netherlands ◽  
Shared Decision Making ◽  
Online Survey ◽  
Daily Practice ◽  
Clear Understanding ◽  
Shared Decision ◽  
Professional Activities ◽  
Self Evaluation ◽  
The Subject

Background:The training curriculum for rheumatologists in training in the Netherlands describes competences and entrusted professional activities (EPA) to monitor the progress in learning. However, this training program does not discuss training of Shared Decision Making. As the basis for shared care and patient participation is made during these years, the question arises how rheumatologist in training think about Shared Decision Making and how they use this in daily practice.Objectives:Inventory of vision, experience and self-evaluation of skills related to Shared Decision Making amongst rheumatologists in training in the Netherlands in order to identify barriers in the implementation of Shared Decision Making in daily practice.Methods:Qualitative data was collected from on online survey amongst rheumatologists in training who were registered in January 2018 by the Dutch Society of Rheumatology.Results:Forty-two rheumatologists in training from various years of training responded (60%). Respondents think that Shared Decision Making is important. A third applies Shared Decision Making on a regular basis in daily practice. Self rating of skills for Shared Decision Making varies from sufficient to good. However, respondents are uncertain about their performance due to a lack of feedback and unclearness of the concept. They indicate that Shared Decision Making is not possible for all patients and find it difficult to assess whether the patient has a clear understanding of the options. Patient’s preferences are discussed only by 33% of the doctors on a regular basis when starting new treatment.Conclusion:Rheumatologists in training agree on the importance of Shared Decision Making, but are uncertain about their performance. Unclearness of the concept is described as a known barrier in literature1,2and is frequently mentioned by respondents. Rheumatologist in training indicate that not all patients are fit for Shared Decision Making. Regarding the limited training on the subject this could also be a misjudgment of patients preferences and lack of experience how to deal with different patient types. There is a clear plea for more training and feedback on the subject. Training should be integrated in the curriculum focusing on how to assess patients preferences and how to apply Shared Decision Making also for patients who indicate to leave decisions up to their doctor.References:[1]van Veenendaal, H.et al.Accelerating implementation of shared decision-making in the Netherlands: An exploratory investigation.Patient Educ Couns101, 2097-2104 (2018).[2]Legare, F., Ratte, S., Gravel, K. & Graham, I. D. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions.Patient Educ Couns73, 526-535 (2008).Disclosure of Interests:Laura Kranenburg Grant/research support from: Pfizer and UCB for the development of the Reuma App, a tool to support selfmanagement for patients. This is not used for the research related to the submitted abstract., Mary Dankbaar: None declared, Natalja Basoski: None declared, Walter Van den Broek: None declared, Johanna Hazes: None declared

Hindrances to achieve professional confidence: The nurse’s participation in ethical decision-making

2017 ◽  
Vol 26 (3) ◽  
pp. 715-727 ◽  
Author(s):  
Anne Storaker ◽  
Dagfinn Nåden ◽  
Berit Sæteren
Keyword(s):  
Decision Making ◽  
Data Storage ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Research Question ◽  
Daily Practice ◽  
Clinical Work ◽  
Ethical Guidelines ◽  
Science Data ◽  
Written Information

Background: Research suggests that nurses generally do not participate in ethical decision-making in accordance with ethical guidelines for nurses. In addition to completing their training, nurses need to reflect on and use ethically grounded arguments and defined ethical values such as patient’s dignity in their clinical work. Objectives: The purpose of this article is to gain a deeper understanding of how nurses deal with ethical decision-making in daily practice. The chosen research question is “How do nurses participate in ethical decision-making for the patient?” Design and method: We use Gadamer’s philosophical hermeneutics as well as Kvale and Brinkmann’s three levels of understanding in interpreting the data material. Nine registered nurses were interviewed. Ethical considerations: The Ombudsman of Norwegian Social Science Data and the head of the hospital approved the investigation. The participants received both oral and written information about the study and they gave their consent. We informed the participants that the participation was voluntary and that they were free to withdraw at any point in the course of the study. The requirement of anonymity and proper data storage was in accordance with the World Medical Association Declaration of Helsinki (1964). The participants were assured that privacy, and confidentiality would be duly protected. Results: Four key themes emerged: (1) confusion in relation to professional and operational expectations of role, (2) ideal somnolence, (3) inadequate argumentation skills, and (4) compound pressure. Conclusion: Ethical ideals appear to be latent in the mindset of the participants; however, the main finding of this investigation is that nurses need to activate the ideals and apply them into practice. Furthermore, management needs to initiate professional reasoning and interdisciplinary discussions leading to common goals for patients.

Association Between 45° Flexion Anteroposterior Elbow Radiographs and Diagnostic Accuracy of Capitellum Osteochondritis Dissecans

2021 ◽  
pp. 036354652110271
Author(s):  
Michael G. Saper ◽  
Viviana Bompadre ◽  
Gregory A. Schmale ◽  
Sarah Menashe ◽  
Monique Burton ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Osteochondritis Dissecans ◽  
Predictive Value ◽  
Interobserver Reliability ◽  
Intraobserver Reliability ◽  
Control Group ◽  
Level Of Evidence ◽  
Level Of Confidence ◽  
High Level ◽  
Sensitivity Specificity

Background: An anteroposterior (AP) radiograph of the elbow in 45° of flexion has been suggested to increase the diagnostic accuracy of capitellum osteochondritis dissecans (OCD). Purpose: To assess the diagnostic performance, inter- and intraobserver reliability, and confidence level for identifying capitellum OCD using plain radiographs (AP, lateral, and 45° flexion AP). Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: This was a retrospective study of pediatric and adolescent patients with capitellum OCD and a control group. Six independent clinicians who were blinded to the official radiologists’ reports reviewed images on 2 separate occasions, 1 week apart. A 5-point Likert scale was used to assess the clinicians’ level of confidence. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for individual and combinations of radiographic views. Inter- and intraobserver reliability was determined using Cohen kappa (κ) coefficients. Results: A total of 28 elbows (mean age, 12.5 ± 2 years) were included. There were no differences in age ( P = .18), sex ( P = .62), or laterality ( P > .999) between groups. There were marked variations in the diagnostic accuracy between views: sensitivity (AP, 85.1; lateral, 73.2; 45° flexion AP, 91.7), specificity (AP, 89.3; lateral, 91.7; 45° flexion AP, 91.1), PPV (AP, 88.8; lateral, 89.8; 45° flexion AP, 91.1), NPV (AP, 85.7; lateral, 77.4; 45° flexion AP, 91.6), and accuracy (AP, 87.2; lateral, 82.4; 45° flexion AP, 91.4). Standard radiographs (AP and lateral views) failed to diagnose capitellum OCD in 4.8% of cases. The sensitivity of the 3 combined views was 100%. Confidence intervals in the clinicians’ diagnostic assessments were similar for each view (AP, 4.0; lateral, 4.0; and 45° flexion AP, 4.1). Interobserver reliability was substantial for AP and lateral views (κ = 0.65 and κ = 0.60, respectively) but highest for the 45° flexion AP radiographs (κ = 0.72). Intraobserver reliability for the 45° flexion AP view was moderate to almost perfect (κ = 0.45 to 0.93). Conclusion: The 45° flexion AP view can detect capitellum OCD with excellent accuracy, a high level of confidence, and substantial interobserver agreement. When added to standard AP and lateral radiographs, the 45° flexion AP view aids in the identification of capitellum OCD.

scholarly journals Composer—Visual Cohort Analysis of Patient Outcomes

2019 ◽  
Vol 10 (02) ◽  
pp. 278-285 ◽  
Author(s):  
Jen Rogers ◽  
Nicholas Spina ◽  
Ashley Neese ◽  
Rachel Hess ◽  
Darrel Brodke ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Outcomes ◽  
Visual Analysis ◽  
Treatment Options ◽  
Cohort Analysis ◽  
Analysis Tool ◽  
Electronic Health Record Data ◽  
Patient Cohort ◽  
Orthopedic Surgeons ◽  
Patient Reported

Objective Visual cohort analysis utilizing electronic health record data has become an important tool in clinical assessment of patient outcomes. In this article, we introduce Composer, a visual analysis tool for orthopedic surgeons to compare changes in physical functions of a patient cohort following various spinal procedures. The goal of our project is to help researchers analyze outcomes of procedures and facilitate informed decision-making about treatment options between patient and clinician. Methods In collaboration with orthopedic surgeons and researchers, we defined domain-specific user requirements to inform the design. We developed the tool in an iterative process with our collaborators to develop and refine functionality. With Composer, analysts can dynamically define a patient cohort using demographic information, clinical parameters, and events in patient medical histories and then analyze patient-reported outcome scores for the cohort over time, as well as compare it to other cohorts. Using Composer's current iteration, we provide a usage scenario for use of the tool in a clinical setting. Conclusion We have developed a prototype cohort analysis tool to help clinicians assess patient treatment options by analyzing prior cases with similar characteristics. Although Composer was designed using patient data specific to orthopedic research, we believe the tool is generalizable to other healthcare domains. A long-term goal for Composer is to develop the application into a shared decision-making tool that allows translation of comparison and analysis from a clinician-facing interface into visual representations to communicate treatment options to patients.

Reimagining the Humble but Mighty Pen: Quality Measurement and Naturalistic Decision Making

2018 ◽  
Vol 12 (3) ◽  
pp. 198-201 ◽  
Author(s):  
Eric C. Schneider
Keyword(s):  
Decision Making ◽  
Best Practices ◽  
Pay For Performance ◽  
Quality Measurement ◽  
Daily Practice ◽  
Cost Of Care ◽  
Naturalistic Decision Making ◽  
Joint Decisions ◽  
The Cost

Much of the health system’s avoidable spending may be driven by doctors’ decision making. Past studies demonstrated potentially consequential and costly inconsistencies between the actual decisions that clinicians make in daily practice and optimal evidence-based decisions. This commentary examines the “best practices regimen” through the lens of the quality measurement movement.  Although quality measures have proliferated via public reporting and pay-for-performance programs, evidence for their impact on quality of care is scant; the cost of care has continued to rise; and the environment for clinical decisions may not have improved. Naturalistic decision making offers a compelling alternative conceptual frame for quality measurement. An alternative quality measurement system could build on insights from naturalistic decision making to optimize doctors’ and patients’ joint decisions, improve patients’ health outcomes, and perhaps slow the growth of health care spending in the future.

scholarly journals High Reproducibility of an Automated Measurement of Mobility for Patients with Axial Spondyloarthritis

2018 ◽  
Vol 45 (10) ◽  
pp. 1383-1388 ◽  
Author(s):  
Juan L. Garrido-Castro ◽  
Rafael Curbelo ◽  
Ramón Mazzucchelli ◽  
María E. Domínguez-González ◽  
Cristina Gonzalez-Navas ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Repeated Measures ◽  
Axial Spondyloarthritis ◽  
Activity Index ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Disease Activity Index ◽  
Intraobserver Reliability ◽  
Spinal Mobility ◽  
Video Capture

Objective.Conventional measures of spinal mobility used in the assessment of patients with axial spondyloarthritis (axSpA), such as the Bath Ankylosing Spondylitis Metrology Index and its components, are subject to interobserver variability. The University of Córdoba Ankylosing Spondylitis Metrology Index (UCOASMI) is a validated composite index based on a motion video-capture system, UCOTrack. Our objective was to assess its reproducibility in clinical practice settings.Methods.We carried out an observational study of repeated measures in 3 centers. Video-capture systems were installed and adapted to clinical rooms. Patients with axSpA and stable disease were selected by consecutive stratified sampling [disease duration, sex, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)]. Intraobserver reliability of the UCOASMI and of conventional measures was tested 3–5 days apart. For interobserver reliability, 3 patients from each center were evaluated in the other centers, within 3–7 days. The intraclass correlation coefficients (ICC) were calculated.Results.Thirty patients were included (73% men, mean age 53 yrs, mean BASDAI 3.0). Interobserver and intraobserver ICC of the UCOASMI was 0.98. Conventional measurements showed lower but adequate reproducibility as well, except for interobserver reliability of lateral flexion (0.41), cervical rotation (0.61), and Schöber test (0.07), and intraobserver reliability of tragus-to-wall distance (0.30).Conclusion.Reproducibility of the UCOASMI seems very high, and apparently more reliable than conventional measures of mobility.

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