scholarly journals Intra and Inter-observer Concordance of a New Classification System for Myopic Maculopathy

2020 ◽  
Author(s):  
Rong-rong Zhang ◽  
Yan Yu ◽  
Yin-fen Hou ◽  
Chang-fan Wu
Keyword(s):  
Classification System ◽  
Clinical Decision Making ◽  
Interobserver Reliability ◽  
Type A ◽  
Clinical Decision ◽  
Intraobserver Agreement ◽  
Intraobserver Reproducibility ◽  
Fundus Photographs ◽  
Myopic Maculopathy

Abstract Background: Myopic maculopathy (MM) is one of the major causes of visual impairment and irreversible blindness in eyes with PM. However, the classification of each type of lesion associated with MM has not been determined. Recently, a new MM classification system was proposed, known as the ATN grading and classification system, which was based on the fundus photographs and OCT images, including three variable components: atrophy (A), traction (T), and neovascularization (N). Hence, this study aimed to perform an independent interobserver and intraobserver agreement evaluation of the recently developed ATN grading system for MM. Methods: This was a retrospective study. Fundus photographs and the optical coherence tomography (OCT) images of 125 patients (226 eyes) with various of MM were evaluated and classified using the ATN grading of the new MM classification system by four evaluators (2 attending ophthalmologists and 2 ophthalmic residents). All cases were repeatedly evaluated by the same evaluators after an interval of 6 weeks. The Kappa coefficient (κ) and 95% confidence interval (CI) were used to determine the interobserver and intraobserver agreement.Results: The interobserver reliability was substantial when considering the maculopathy type (A, T, and N). The weighted Fleiss κ values for each MM type (A, T, and N) were 0.651 (95% CI: 0.602–0.700), 0.734 (95% CI: 0.689–0.779), and 0.702 (95% CI: 0.649–0.755), respectively. The interobserver agreement when considering the sub-types was good or excellent, except for stages A1, A2, and N1 which weighted κ value was less than 0.6, with a moderate agreement. The intraobserver reproducibility of types or sub-types was excellent, with κ>0.8. No significant differences were observed between attending ophthalmologists and residents in the interobserver reliability and intraobserver reproducibility.Conclusions: The ATN classification allows an adequate agreement among ophthalmologists with different qualifications and by the same observer on separate occasions. Future prospective studies should further evaluate whether this classification can be better implemented at clinical decision-making and disease progression assessment.

scholarly journals Intra- and interobserver concordance of a new classification system for myopic maculopathy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rong-rong Zhang ◽  
Yan Yu ◽  
Yin-fen Hou ◽  
Chang-fan Wu
Keyword(s):  
Classification System ◽  
Interobserver Agreement ◽  
Clinical Decision Making ◽  
Interobserver Reliability ◽  
Type A ◽  
Clinical Decision ◽  
Pathologic Myopia ◽  
Intraobserver Agreement ◽  
Fundus Photographs ◽  
Myopic Maculopathy

Abstract Background Myopic maculopathy (MM) is one of the major causes of visual impairment and irreversible blindness in eyes with pathologic myopia (PM). However, the classification of each type of lesion associated with MM has not been determined. Recently, a new MM classification system, known as the ATN grading and classification system, was proposed; it is based on the fundus photographs and optical coherence tomography (OCT) images and includes three variable components: atrophy (A), traction (T), and neovascularization (N). This study aimed to perform an independent evaluation of interobserver and intraobserver agreement for the recently developed ATN grading system for MM. Methods This was a retrospective study. Fundus photographs and OCT images of 125 patients (226 eyes) with various MMs were evaluated and classified using the ATN grading of the new MM classification system by four blinded and independent evaluators (2 attending ophthalmologists and 2 ophthalmic residents). All cases were randomly re-evaluated by the same observers after an interval of 6 weeks. The kappa coefficient (κ) and 95% confidence interval (CI) were used to determine the interobserver and intraobserver agreement. Results The interobserver agreement was substantial when considering the maculopathy type (A, T, and N). The weighted Fleiss κ values for each MM type (A, T, and N) were 0.651 (95% CI: 0.602–0.700), 0.734 (95% CI: 0.689–0.779), and 0.702 (95% CI: 0.649–0.755), respectively. The interobserver agreement when considering the subtypes was good or excellent, except for stages A1, A2, and N1, in which the weighted κ value was less than 0.6, with moderate agreement. The intraobserver agreement of types and subtypes was excellent, with κ > 0.8. No significant differences were observed between the attending ophthalmologists and residents for interobserver reliability or intraobserver reproducibility. Conclusions The ATN classification allows an adequate agreement among ophthalmologists with different qualifications and by the same observer on separate occasions. Future prospective studies should further evaluate whether this classification can be better implemented in clinical decision-making and disease progression assessments.

A Classification-System Improves the Intra- and Interobserver Reliability of Radiographic Diagnosis of “Pistol-Grip-Deformity”

2011 ◽  
Vol 21 (6) ◽  
pp. 732-739 ◽  
Author(s):  
Ingmar Ipach ◽  
Eva-Maria Arlt ◽  
Falk Mittag ◽  
Beate Kunze ◽  
Petra Wolf ◽  
...  
Keyword(s):  
Lower Limit ◽  
Classification System ◽  
Interobserver Reliability ◽  
Alpha Angle ◽  
Treatment Algorithm ◽  
Kappa Coefficient ◽  
Intraobserver Agreement ◽  
Single Plane ◽  
Upper Limit

Early detection of pistol-grip-deformity may be beneficial in optimising the outcome and the cost effectiveness of surgery. It is important to identify reliable radiographic parameters in assessing femoro-acetabular impingement (FAI) to develop a treatment algorithm. Radiographs of 47 patients ranging from “pistol grip deformity” to a normal head-neck-junction were measured for alpha angle and head ratio, and then classified by two different observers. The Bland-Altman plot was used for inter- and intraobserver agreement of alpha angle and head ratio. Inter- and intraobserver agreement for classification of “pistol grip deformity” was determined using weighted Cohen's kappa coefficient. Observer I achieved a kappa coefficient of 0.97. Observer II achieved a kappa coefficient of 0.92. An interobserver kappa coefficient between 0.87 and 0.92 was achieved by using a classification system. By testing for interobserver agreement, a bias of –0.004 with an upper limit of 0.461 and a lower limit of –0.47 was seen for the ratio and a bias of –3.7 with an upper limit of 17.2 and a lower limit of –24.6 for the alpha angle. Therefore, poor results were seen for intra- and interobserver reliability by using only a single plane for classification of “pistol grip deformity”. The strength of agreement could be improved by using a classification system (based on two planes).

Myocarditis

2018 ◽  
pp. 290-308
Author(s):  
Vanessa M Ferreira ◽  
Juliano L Fernandes ◽  
Cristina Basso ◽  
Matthias G Friedrich
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Myocardial Inflammation ◽  
Aged Patients ◽  
Non Invasive ◽  
Quantitative Mapping ◽  
Patients With Heart Failure ◽  
High Prevalence ◽  
Mapping Techniques

Myocarditis has a high prevalence, especially in young and middle-aged patients. It is the most important differential diagnosis in patients with acute cardiac disease and evidence for cellular injury (positive troponin). In clinical decision-making, it is important to rule in or rule out myocardial inflammation. While endomyocardial biopsy, which remains the gold standard to achieve an aetiopathogenetic diagnosis, can be helpful in patients with heart failure, it is less used in the majority of cases. Cardiovascular magnetic resonance (CMR) imaging has become the most efficient non-invasive diagnostic tool for patients with suspected myocarditis. Its unique value is based on the ability to identify inflammation and myocardial injury, in combination with an accurate assessment of ventricular volumes, as well as regional and global function. In many centres, myocarditis is the most frequent indication for CMR. The diagnostic criteria include markers for myocardial oedema, hyperaemia, and necrosis, while regional or global dysfunction and pericardial effusion serve as supportive criteria. Novel markers, such as quantitative mapping techniques, may allow for even better identification and classification of myocarditis.

The Acquired Midtarsus Deformity Classification System—Interobserver Reliability and Intraobserver Reproducibility

2002 ◽  
Vol 23 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Lew C. Schon ◽  
Mark E. Easley ◽  
Ilan Cohen ◽  
Peter W.-C. Lam ◽  
Athanasios Badekas ◽  
...  
Keyword(s):  
Classification System ◽  
Interobserver Reliability ◽  
Intraobserver Reproducibility

scholarly journals Direct current electrocorticography for clinical neuromonitoring of spreading depolarizations

2016 ◽  
Vol 37 (5) ◽  
pp. 1857-1870 ◽  
Author(s):  
Jed A Hartings ◽  
Chunyan Li ◽  
Jason M Hinzman ◽  
C William Shuttleworth ◽  
Griffin L Ernst ◽  
...  
Keyword(s):  
Direct Current ◽  
Clinical Decision Making ◽  
Tissue Injury ◽  
Interobserver Reliability ◽  
Electrical Potential ◽  
Training Session ◽  
Clinical Decision ◽  
Platinum Electrodes ◽  
Slow Potentials ◽  
The Impact

Spreading depolarizations cause cortical electrical potential changes over a wide spectral range that includes slow potentials approaching the direct current (or 0 Hz) level. The negative direct current shift (<0.05 Hz) is an important identifier of cortical depolarization and its duration is a measure of potential tissue injury associated with longer lasting depolarizations. To determine the feasibility of monitoring the full signal bandwidth of spreading depolarizations in patients, we performed subdural electrocorticography using platinum electrode strips and direct current-coupled amplifiers in 27 patients with acute brain injury at two neurosurgical centers. While large baseline direct current offsets developed, loss of data due to amplifier saturation was minimal and rates of baseline drift throughout recordings were generally low. Transient negative direct current shifts of spreading depolarizations were easily recognized and in 306/551 (56%) cases had stereotyped, measurable characteristics. Following a standardized training session, novice scorers achieved a high degree of accuracy and interobserver reliability in identifying depolarizations, suggesting that direct current-coupled recordings can facilitate bedside diagnosis for future trials or clinical decision-making. We conclude that intracranial monitoring of slow potentials can be achieved with platinum electrodes and that unfiltered, direct current-coupled recordings are advantageous for identifying and assessing the impact of spreading depolarizations.

scholarly journals Driver somatic mutations identify distinct disease entities within myeloid neoplasms with myelodysplasia

Blood ◽  
2014 ◽  
Vol 124 (9) ◽  
pp. 1513-1521 ◽  
Author(s):  
Luca Malcovati ◽  
Elli Papaemmanuil ◽  
Ilaria Ambaglio ◽  
Chiara Elena ◽  
Anna Gallì ◽  
...  
Keyword(s):  
Somatic Mutations ◽  
Clinical Decision Making ◽  
Myeloproliferative Neoplasms ◽  
Clinical Decision ◽  
Driver Mutations ◽  
Myeloid Neoplasms ◽  
Key Points ◽  
Distinct Disease ◽  
Disease Entities

Key Points Different driver mutations have distinct effects on phenotype of myelodysplastic syndromes (MDS) and myelodysplastic/myeloproliferative neoplasms (MDS/MPN). Accounting for driver mutations may allow a classification of these disorders that is considerably relevant for clinical decision-making.

scholarly journals Evaluation of Letournel and Judet Classification of Acetabular Fracture with Plain Radiographs and Three-Dimensional Computerized Tomographic Scan

2000 ◽  
Vol 8 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Boonyarak Visutipol ◽  
Pornchai Chobtangsin ◽  
Bunyat Ketmalasiri ◽  
Narongchai Pattarabanjird ◽  
Namchai Varodompun
Keyword(s):  
Ct Scan ◽  
Acetabular Fracture ◽  
Interobserver Reliability ◽  
Three Dimensional ◽  
Fracture Line ◽  
3D Ct ◽  
Plain Radiographs ◽  
Intraobserver Reproducibility ◽  
3D Ct Scan

Letournal and Judet classification of acetabular fracture is widely used. The classification is based on the identification of fracture lines on plain radiographs. Three-dimensional CT scan was claimed to give a better view of the fracture line. Our study showed that intraobserver reproducibility and interobserver reliability were almost the same when classification was done by using plain radiographs and 3D-CT scan. And 3D-CT scan did not increase either the interobserver reliability or the intraobserver reproducibility in classifying the fracture.

Interrater and Intrarater Reliability of the Kuntz et al New Deformity Classification System

Neurosurgery ◽  
2012 ◽  
Vol 71 (1) ◽  
pp. 47-57 ◽  
Author(s):  
Martin Thaler ◽  
Ricarda Lechner ◽  
Michaela Gstöttner ◽  
Matthias Luegmair ◽  
Michael Liebensteiner ◽  
...  
Keyword(s):  
Classification System ◽  
Interobserver Agreement ◽  
Intraobserver Agreement ◽  
Spinal Alignment ◽  
Intrarater Reliability ◽  
Surgical Interventions ◽  
Apical Vertebral Rotation ◽  
Age Dependent ◽  
The Mean

Abstract BACKGROUND: Kuntz et al recently introduced a new system for classifying spinal deformities. This classification of spinal deformity was developed from age-dependent deviations from the neutral upright spinal alignment. OBJECTIVE: To determine the interobserver and intraobserver reliabilities of the new Kuntz et al system for classifying scoliosis. METHODS: Fifty consecutive patients were evaluated. Three observers independently assigned a major structural curve, minor structural curve, curve type, apical vertebral rotation, spinal balance, and pelvic alignment to each curve following the guidelines described by Kuntz et al. Assignment of the curves was repeated 4 weeks later, with the curves presented in a different blinded order. The Kendall W and Holsti agreement coefficients were used to determine the interobserver and intraobserver agreement. RESULTS: The intraobserver value of agreement for all parameters was 0.85 (range, 0.28-1.0), and the mean Kendall W coefficient was 0.89 (range, 0.5-0.97), demonstrating perfect reliability. The interobserver agreement averaged 0.7 (range, 0.251-1.0). The mean Kendall W coefficient was 0.67 (range, 0.19-1.0), demonstrating substantial reliability. The average time for classification of 1 curve was approximately 8.4 minutes. CONCLUSION: The new Kuntz et al deformity classification system is comparable to the Lenke et al system in terms of reliability. However, the Kuntz et al classification system provides no recommendations for surgical interventions. It is more complex and time-consuming and therefore may be of limited value in daily clinical practice.

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