Interobserver and Intraobserver Reproducibility and Reliability of the Huashan Clinical Classification System for Hirayama Disease

Purpose: The Huashan clinical classification system for Hirayama disease has recently been proposed and has been found useful for diagnosis and treatment. So far, however, there has been little in-depth evaluation of its reliability. Thus, this study aimed to assess the reproducibility and reliability of the system.Methods: Patients diagnosed with Hirayama disease between 2019 and 2020 were recruited. Seven spine surgeons from four different institutions, including an experienced group of three and an inexperienced group of four, were trained as observers of the Huashan clinical classification system for Hirayama disease, and these surgeons classified the recruited patients using the system. Then, 2 months later, they repeated the classification on the same patients in a different order. The interobserver and intraobserver agreement between the results was analyzed using percentage agreement and weighted kappa (κ) statistics.Results: A total of 60 patients were included in the analysis. For all the observers, experienced observers, and inexperienced observers, the agreement percentages were, respectively, 78.5% (κ = 0.76), 80.0% (κ = 0.78), and 78.9% (κ = 0.77), indicating substantial interobserver reproducibility. For distinguishing typical (Types I and II) and atypical (Type III) Hirayama disease among the different groups of observers, the percentage agreement ranged from 95.6 to 98.9% (κ = 0.74–0.92), indicating substantial to nearly perfect reproducibility. For suggesting conservative treatment (Types I and III) or surgery (Type II), the percentage agreement ranged from 93.3 to 96.4% (κ = 0.81–0.90), indicating nearly perfect reproducibility. As for intraobserver agreement, the percentage agreement ranged from 68.3 to 81.7% (κ = 0.65–0.79), indicating substantial reliability.Conclusion: The Huashan clinical classification system for Hirayama disease was easy to learn and apply in a clinical environment, showing excellent reproducibility and reliability. Therefore, it would be promising to apply and promote this system for the precise and individualized future treatment of Hirayama disease.

Pengembangan LKS Digital Berbasis Problem Solving Terintegrasi Karakter Islami dalam Pembelajaran Tematik Kelas 3 Tema 1

Penelitian ini bertujuan untuk, (1) Mengetahui kelayakan LKS digital berbasis problem solving terintegrasi karakter islami, (2) Mengetahui kepraktisan LKS digital berbasis problem solving terintegrasi karakter islami pada peserta didik kelas 3 tema 1. Penelitian ini merupakan penelitian pengembangan dengan menggunakan model ADDIE yang meliputi lima tahap (Analysis, Design, Development, Implementation, Evaluation). Uji coba dilakukan terhadap peserta didik kelas III SD Negeri Pekutan semester ganjil tahun ajaran 2021/2022. Teknik pengumpulan data menggunakan angket, observasi, wawancara dan analisis dokumen. Teknik analisis data yang digunakan adalah analisis kualitatif dan kuantitatif. Hasil penelitian meliputi: (1) hasil validasi kelayakan LKS digital diperoleh rata-rata 3,57 dengan kriteria sangat layak. Hasil validasi mendapatkan Percentage Agreement(PA)95,28%, (2) hasil kepraktisan worksheet ditinjau dari respon peserta didik pada uji coba terbatas mendapatkan respon 66,7% dengan kriteria sangat baik, dan 33,3% dengan kriteria baik. sedangkan respon peserta didik dengan uji luas memperoleh respon sebesar 71,4% dengan kriteria sangat baik, dan 28,6% dengan kriteria baik. Adapun hasil keterlaksanaan pembelajaran pertemuan I, II, dan III diperoleh rata-rata Percentage Agreement(PA)94,59% dengan kategori sangat baik. Dengan demikian, dapat disimpulkan bahwa LKS digital berbasis problem solving terintegrasi karakter islami layak digunakan untuk tema pertumbuhan dan perkembangan makhluk hidup kelas III Sekolah Dasar.

reliability of the scapular posture and scapular dyskinesis tests in rugby union players

OBJECTIVES: To determine the reliability of static scapular posture (SP), clavicular tilt angle (CTA) and the scapular dyskinesis (SD) assessments by expert and student therapists. DESIGN: inter-rater and intra-rater reliability study. SETTING: University level male rugby union club PARTICIPANTS: Four sport rehabilitation students and one experienced physiotherapist evaluated the position of the scapular and clavicle of male university-level rugby union players (inter-rater participants: session 1: n=17, session 2: n=12 and session 3: n=16; intra–rater participants: n = 12). MAIN OUTCOME MEASURESː Participants attended 3 testing sessions, each 1 week apart. Scapular orientation and motion were assessed in five planes of movement and using the Scapular Dyskinesis Test (SDT) respectively. RESULTSː Kappa coefficient values and percentage agreement ratings for students compared to the experienced therapist were: SP=poor to fair (-0.01-0.33), (27% - 94%); SDT=slight (0.16) (41%); CTA=fair (0.21) (59%). Test-retest (intra-rater) agreement was fair to moderate (0.22 – 0.44) (69% -95%), slight (0.12) (47%), and fair (0.39) (77%) for the SP, SDT, and CTA, respectively. CONCLUSIONSː Static and dynamic evaluation of the shoulder by students and an experienced therapist has poor to moderate reliability and should not be used to make clinical decisions based on observation alone.

Agreement and Intraobserver Variability in Detection of Helicobacter pylori Infection Using Routine Histology, H. pylori Immunohistochemical Stain, and Warthin-Starry Special Stain on Gastric Tissue Biopsy Samples

Introduction/Objective Helicobacter pylori (HP) is a prevalent cause of gastritis in the US and worldwide. Accurate detection of the organism is important for appropriate treatment. Diagnosis is made using immunohistochemistry and special stains including Warthin-Starry stain (WS) which is low cost, technically easy to perform on tissue sections, and can be automated. We aimed to assess interobserver variability, reproducibility and validity of hematoxylin and eosin stain (H&E), WS and anti-Helicobacter pylori immunohistochemical staining (HP-IHC) for the histopathological identification and evaluation of HP organisms on gastric mucosa biopsies. Methods/Case Report We prospectively evaluated gastric biopsies from ten adult patients. These patients underwent upper gastrointestinal endoscopy with subsequent biopsy for various abdominal complaints. Seven of the ten biopsies (7/10) were HP infection positive, and three cases (3/10) were HP negative by H&E stain and HP-IHC (determined by GI Pathologist). The presence or absence and density of HP, were assessed on H&E, HP-IHC and WS in blinded fashion by five general surgical (GS) pathologists. The GS pathologists assessed the cases for presence and density of HP using the semi-quantitative modified Sydney classification (none, mild, moderate, and severe). Percentage agreement and interobserver variablilty using Cohen-Kappas statistics (KS) were calculated. Results (if a Case Study enter NA) The percentage agreement for presence or absence of HP in the biopsies with H&E, HP-IHC and WS stains were 91%, 98% and 99%, respectively. The interobserver agreement for evaluation of presence of HP was excellent with WS staining method (Overall KS = 0.737 95%, Confidence Interval (CI) = 0.501- 0.973) and HP-IHC (Overall KS = 0.783, 95% CI = 0.585-0.980). Agreement for H&E was moderate (Overall KS = 0.532, 95% CI= 0.392-0.672). HP density agreement was excellent using WS and HP-IHC and H&E was in the moderate range. Conclusion This study found excellent interobserver agreement using IHC and WS. While IHC is the most specific stain, WS is more sensitive in identifying the shape and morphology of HP organisms and is an efficient and low-cost alternative with excellent morphology in general surgical practice.

P034 Inter-scorer concordance impacts MSLT results

Introduction A retrospective study on the effect of inter-scorer concordance and impact of analysing polysomnography (PSG) data prior to the Multiple Sleep Latency Test (MSLT) on clinical interpretation of Narcolepsy (N) and Idiopathic Hypersomnolence (IH). Methods Data of four individuals was randomly selected from a cohort of patients that participated in MSLT studies. De-identified MSLT fragments from four nap periods (n=16) were scored in two groups: analysis of PSG conducted prior to the respective MSLT fragments, and analysis without access to prior PSG. Individual scorers were compared to a master score set, by consensus from two experienced sleep scientists. Spearman correlation and percentage agreement statistics were applied to calculate the inter-scorer concordance in sleep latency and REM latency. Mann-Whitney test was utilised to assess differences between the two groups. A positive result was assigned as: mean (n=4) sleep latency of <10min (IH), and mean (n=4) sleep latency of <8min including (n=2) SOREMs (N). Results From 16 sets of data, four false positive results were identified when PSG was not analysed prior to scoring the MSLT fragments. Additionally, statistically significant differences were present when PSG analysis was conducted prior to scoring MSLT sleep latency and REM latency data. Discussion These results support a recommendation that PSG analysis (sleep and REM latency) should be encouraged prior to MSLT studies and performed by the same sleep scientist. Furthermore, including MSLT data in intra-lab concordance activities is important, particularly in relation to medical interpretation and practice.

Pengembangan Ensiklopedia Digital Berbasis Keterampilan Proses dan Karakter pada Kelas V Tema Lingkungan Sahabat Kita

Development of a Digital Encyclopedia Based on Process Skills and Characters in Class V with the Theme of Our Friends Environment. Elementary School Teacher Education Study Program. Faculty of Teacher Training and Education, University of Muhammadiyah Purworejo. 2021. The background of this research is that there are still problems faced by students, namely regarding aspects of process skills that have not been implemented properly and characters that still need improvement. Learning during the pandemic is now all digital, so learning needs to be developed with interesting digital teaching materials, therefore a digital encyclopedia based on process and character skills is developed. The development of this research is aimed at (1) developing a digital encyclopedia, (2) knowing the feasibility of a digital encyclopedia, (3) knowing the practicality of digital encyclopedias at Kenteng State Elementary School, Purworejo District, class V for the 2020/2021 academic year. The research conducted is Research & Development (R&D). This model consists of 5 stages of development, namely ADDIE. The trial design is a limited trial in class V SD Negeri Kenteng. The data collection carried out were observation, interviews, questionnaires and documentation. The research instrument used validation sheets, student response sheets and learning implementation sheets. Data analysis using Percentage Agreement. The results of the research are: (1) the resulting Digital Encyclopedia Based on Process Skills and Character (2) the feasibility results of the Digital Encyclopedia Based on Process Skills and Character from three validators by two expert lecturers and an elementary school teacher obtaining an overall score of 3.7 with a very suitable category for use for learning. The reliable test obtained a percentage agreement of 93.25% with a very reliable category. (3) The response of students to the digital encyclopedia in a wider trial was obtained by a percentage of 91.1% in the very good category and (4) the implementation of the percentage of 98.46% in the very good category. Therefore, the Digital Encyclopedia Based on Process Skills and Character Class V Themes of Our Friends in Elementary Schools, which was developed in this study, was categorized as good and suitable for use in learning in elementary schools.

Reliability and validity of the Unified Classification System for postoperative periprosthetic femoral fractures around cemented polished taper-slip stems

Aims This aim of this study was to assess the reliability and validity of the Unified Classification System (UCS) for postoperative periprosthetic femoral fractures (PFFs) around cemented polished taper-slip (PTS) stems. Methods Radiographs of 71 patients with a PFF admitted consecutively at two centres between 25 February 2012 and 19 May 2020 were collated by an independent investigator. Six observers (three hip consultants and three trainees) were familiarized with the UCS. Each PFF was classified on two separate occasions, with a mean time between assessments of 22.7 days (16 to 29). Interobserver reliability for more than two observers was assessed using percentage agreement and Fleiss’ kappa statistic. Intraobserver reliability between two observers was calculated with Cohen kappa statistic. Validity was tested on surgically managed UCS type B PFFs where stem stability was documented in operation notes (n = 50). Validity was assessed using percentage agreement and Cohen kappa statistic between radiological assessment and intraoperative findings. Kappa statistics were interpreted using Landis and Koch criteria. All six observers were blinded to operation notes and postoperative radiographs. Results Interobserver reliability percentage agreement was 58.5% and the overall kappa value was 0.442 (moderate agreement). Lowest kappa values were seen for type B fractures (0.095 to 0.360). The mean intraobserver reliability kappa value was 0.672 (0.447 to 0.867), indicating substantial agreement. Validity percentage agreement was 65.7% and the mean kappa value was 0.300 (0.160 to 0.4400) indicating only fair agreement. Conclusion This study demonstrates that the UCS is unsatisfactory for the classification of PFFs around PTS stems, and that it has considerably lower reliability and validity than previously described for other stem types. Radiological PTS stem loosening in the presence of PFF is poorly defined and formal intraoperative testing of stem stability is recommended. Cite this article: Bone Joint J 2021;103-B(8):1339–1344.

High-Throughput Transcription-mediated amplification (TMA), a real and consolidated alternative for the diagnosis of SARS-COV2. Review.

The exceptional situation in which we have found ourselves since the first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified, which rapidly evolved into a global pandemic, translated into the need to incorporate the largest number of diagnostic tests to detect possible cases and contain the spread of the virus. The FDA authorized different trials using emergency procedures. One of the molecular assays adapted to the diagnosis of COVID19 is the transcription-mediated amplification (TMA) assay. We intend to answer the questions that are asked from a laboratory when a new technique is introduced. How does it work? Are your results comparable to gold standard techniques in terms of agreement and limit of detection? After the systematic review of the literature, an almost perfect concordance between the TMA and the RT-PCR was observed, taking into account the values of Cohen's kappa coefficient, positive percentage agreement, negative percentage agreement and global percentage agreement close to 100%. Regarding the concordance between the results obtained by TMA and the antigenic test, it presents a lower concordance, although it is true that the latter test is only optimal for the detection of SARS-CoV2 in a specific profile of patients. The literature shows that the TMA test has been used to study possible cases of reinfection. After analyzing the results, we concluded in the proven consolidation of TMA for the diagnosis and follow-up of SARS-COV2.

Fidelity assessment of nurse-led non-pharmacological package of care for knee pain in the package development phase of a feasibility randomised controlled trial based in secondary care: a mixed methods study

ObjectivesTo evaluate fidelity of delivery of a nurse-led non-pharmacological complex intervention for knee pain.SettingSecondary care. Single-centre study.Study designMixed methods study.ParticipantsEighteen adults with chronic knee pain.Inclusion criteriaAge >40 years, knee pain present for longer than 3 months, knee pain for most days of the previous month, at least moderate pain in two of the five domains of Western Ontario and McMaster Universities Osteoarthritis Index pain scale.InterventionsNurse-led non-pharmacological intervention comprising assessment, education, exercise, use of hot/cold treatments, footwear modification, walking aids and weight-loss advice (if required).Outcome(s)Primary: fidelity of delivery of intervention, secondary: nurses’ experience of delivering intervention.MethodsEach intervention session with every participant was video recorded and formed part of fidelity assessment. Fidelity checklists were completed by the research nurse after each session and by an independent researcher, after viewing the video-recordings blinded to nurse ratings. Fidelity scores (%), percentage agreement and 95% Confidence Intervals (CI) were calculated. Two semi-structured interviews were conducted with the research nurse.ResultsFourteen participants completed all visits. 62 treatment sessions took place. Nurse self-report and assessor video rating scores for all 62 treatment sessions were included in fidelity assessment. Overall fidelity was higher on nurse self-report (97.7%) than on objective video-rating (84.2%). Percentage agreement between nurse self-report and video-rating was 73.3% (95% CI 71.3 to 75.3). Fidelity was lowest for advice on footwear and walking aids. The nurse reported difficulty advising on thermal treatments, footwear and walking aids, and did not feel confident negotiating achievable and realistic goals with participants.ConclusionsA trained research nurse can deliver most components of a non-pharmacological intervention for knee pain to a high degree of fidelity. Future research should assess intervention fidelity in a routine clinical setting, and examine its clinical and cost-effectiveness.Trial registration numberNCT03670706.

Revisiting the Examination of Sharp/Dull Discrimination as Clinical Measure of Spinothalamic Tract Integrity

Objective: Revisiting the sharp/dull discrimination as clinical measure of spinothalamic tract function considering the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Three clinically relevant factors were evaluated as to their impact on reliability: (1) the localization of dermatomes in relation to the sensory level, (2) the examination tool, and (3) the threshold of correct answers for grading of a preserved sharp/dull discrimination.Design: Prospective monocentric psychometric study.Setting: Spinal Cord Injury Center, Heidelberg University Hospital, Germany.Participants: Convenient sample of 21 individuals with subacute spinal cord injury (age: 31–82 years) and 20 individuals without spinal cord injury (age: 24–63 years).Assessment: All participants underwent three assessments for sharp/dull discrimination, applying five commonly used examination tools in seven dermatomes, performed by three trained examiners under conditions in accordance with ISNCSCI.Main Outcome Measures: Assessment of interrater reliability by determining both the Fleiss kappa (κ) coefficient and the percentage agreement between raters. Data were dichotomized regarding the ISNCSCI threshold.Results: Interrater reliability in individuals with SCI was overall substantial (κ = 0.68; CI 0.679–0.681) and moderate (κ = 0.54; CI 0.539–0.543) in dermatomes below the sensory level. All applied tools led to at least moderate reliability below the sensory level (lowest κ = 0.44; CI 0.432–0.440), with the officially endorsed safety pin achieving the highest (substantial) reliability (κ = 0.64; CI 0.638–0.646). Percentage agreement differed between non-SCI (97.3%) and formally intact above level dermatomes in SCI (89.2%).Conclusions: Sharp/dull discrimination as a common clinical examination technique for spinothalamic tract function is a reliable assessment. Independent from the used examination tools, reliability was substantial, with the medium-sized safety pin delivering the most favorable results. Notwithstanding this, all other tools could be considered if a safety pin is not available. Regarding interrater reliability and guessing probability, a threshold of 80% correct responses for preserved sharp/dull discrimination appears to be most suitable, which is in line with current clinical approaches and ISNCSCI. The causal attribution of the identified differences in sharp/dull discrimination between clinically intact dermatomes of individuals with SCI and unaffected dermatomes of individuals without SCI requires future work.Clinical Trial Registration Number (German Clinical Trials Register): DRKS00015334 (https://www.drks.de).