Validating A Smartphone-Based Biomarker Tool Lyfas in Screening Anxiety Disorders

Lyfas is a smartphone-based biomedical application that captures the cardiovascular autonomic biomarkers (CVb), surrogating for mental health attributes. SD1/SD2 biomarker assesses the sympathovagal balance and is considered to be a potential indicator of Lyfas anxiety score (LAS). A total of 1837 males and 973 females took Lyfas (hypersensitivity-checked) and Hamilton Anxiety Rating Scale (HAM-A) self-scoring tests. LAS has been statistically validated by Linear regressions, one-way ANOVA, t-stat, correlations (r), and Bland Altman agreement assessment with respect to HAM-A. Sensitivity, specificity, precision, accuracy, Fscore, and Youden’s index (j-stat) are computed. Results show that (i) Lyfas is not a very hypersensitive instrument (mean-variance is 0.6). (ii) It can predict HAM-A with 94.7% accuracy (R2) and is a statistically significant model (p <0.05). (iii) LAS and HAM-A are positively correlated by 97%, the t-stat value of 5.38 for the population indicates that the two instruments have a significant mean difference. (iv) Bland Altman test showcases the overall agreement of 12.95% due to different modes and scales of measurements. (v) on average, LAS is 87.78% accurate, 86.82% precise, and its’ 65.2% j-stat value proves that Lyfas is a novel industry-standard smartphone biomarker application that can be used to accurately screen anxiety disorders.

An independent inter- and intra-observer agreement assessment of the Eno classification of sacroiliac joint degeneration

Background Recently, a scoring system to grade sacroiliac joint (SIJ) degeneration using computed tomography (CT) scans was described. No independent evaluation has determined the inter- and intra-observer agreement using this scheme. Purpose To perform an independent inter- and intra-observer agreement assessment using the Eno classification and determining gas in the SIJ. Material and Methods We studied 64 patients aged ≥60 years who were evaluated with abdominal and pelvic computed tomography scans. Six physicians (three orthopaedic spine surgeons and three musculoskeletal radiologists) assessed axial images to grade SIJ degeneration into grade 0 (normal), grade 1 (mild degeneration), grade 2 (significant degeneration), and grade 3 (ankylosis). We also evaluated the agreement assessing the presence of gas in the SIJ. After a four-week interval, all cases were presented in a random sequence for repeat assessment. We determined the agreement using the kappa (κ) or weighted kappa coefficient (wκ). Results The inter-observer agreement was moderate (wκ = 0.50 [0.44–0.56]), without differences among surgeons (wκ = 0.53 [0.45–0.61]) and radiologists (wκ = 0.49 [0.42–0.57]). The agreement evaluating the presence of gas was also moderate (κ = 0.45 [0.35–0.54]), but radiologists obtained better agreement (κ = 0.61 [0.48–0.72]) than surgeons (κ = 0.29 [0.18–0.39]). The intra-observer agreement using the classification was substantial (wκ = 0.79 [0.76–0.82]), without differences comparing surgeons (wκ = 0.75 [0.70–0.80]) and radiologists (wκ = 0.83 [0.79–0.87]). The intra-rater agreement evaluating gas was substantial (κ = 0.77 [0.72–0.82]), without differences between surgeons (κ = 0.71 [0.63–0.78]) and radiologists (κ = 0.84 [0.78–0.90]). Conclusion Given the only moderate agreement obtained using the Eno classification, it does not seem adequate to be used in clinical practice or in research.

An Independent Inter- and Intra-Observer Agreement Assessment of Yeom Classification for Bone Cement Leakage Following Vertebroplasty/Kyphoplasty

Background: The clinical efficacy of vertebroplasty and kyphoplasty treating osteoporotic vertebral compression fractures (OVCF) has been widely recognized in recent years. However, there are also inevitable complications, first and foremost is bone cement leakage (BCL). Yeom classification is commonly used to evaluate BCL. The objective of this study is to assess its reliability and reproducibility, and to explore its clinical application value.Methods/Design: All 58 patients with BCL following vertebroplasty / kyphoplasty were involved. 6 spine surgeons were selected to be evaluators as they were unaware of the identity of the patients and the treatment they received. They classified BCL according to Yeom system, we used kappa (K) to assess the inter- and intra-observer agreement. After 12 weeks, we repeated the analysis.Results: The inter-observer reliability of Yeom classification was substantial with K value of 0.71 (1st assessment) and 0.73 (2nd assessment). The intra-observer reproducibility of Yeom classification was near perfect with K value of 0.88.Conclusion: Yeom classification system has substantial inter-observer reliability and near perfect intra-observer reproducibility in BCL following vertebroplasty / kyphoplasty, which can be widely used in clinical care as an appropriate instrument for early observation, mechanism and severity cognition, and prognosis predicting of BCL. Besides, the adding of type M (the mixed type) may improve the classification.

Development of a tool to assess health applications for healthcare providers: A Delphi Expert Panel Study (Preprint)

BACKGROUND The presence of the mobile phone and devices is generating knowledge about the use of applications to support patient care, but there are few recommendations for apps dedicated to healthcare professionals OBJECTIVE To establish a validated scale to assess healthcare mobile applications is the most efficient step for health care providers and systems. The main goal is to create and validate a tool to evaluate health apps destined to be used by health professionals. METHODS A five steps simplified methodology to assess of the scale was followed. The first step consists of building a scale for professionals based on a literature review. Next step would be an expert panel validation by a Delphi method, rating web-based questionnaires to evaluate inclusion and weight of the indicators. It was agreed to carry out, as many iterations as necessary, to reach a consensus of 75%. Finally, a pilot of the score was developed to evaluate the reliability of the scale. For the inter-rater agreement assessment during the pilot, the Cohen Kappa was used. RESULTS After the literature review, a first scale draft was developed. Two rounds of interactions of the local investigation group and the external panel of experts were needed to select final indicators. Seventeen indicators were included in the score. For the pilot test, 280 apps were evaluated and 66 meet the criteria. The interrater agreement was strong (higher than 82% with significant kappa >0.72 per app and item). CONCLUSIONS We have developed, with a reproducible methodology, a tool that allows us to evaluate health applications for clinical, surgical and general medical providers. The ISYScore-PRO scale to be reliable and reproducible. The assessment permitted to consolidate every step of the methodology. We were able to reach consensus on the dimensions and items on the scale with only two rounds. The process of validation included two robust methodologies. The ISYScore-PRO scale is reliable and reproducible.