Sensitivity and inter-observer variability for capsule endoscopy image analysis in a cohort of novice readers.

AIM: To determine the performance of novice readers (4th year medical students) for detecting capsule endoscopy findings. METHODS: Ten capsule endoscopy cases of small bowel lesions were administered to the readers. Gold standard findings were pre-defined by gastroenterologists. Ten gold standard "targets" were identified among the 10 cases. Readers were given a 30-min overview of Rapid Reader software and instructed to mark any potential areas of abnormalities. A software program was developed using SAS to analyze the thumbnailed findings. RESULTS: The overall sensitivity for detecting the gold standard findings was 80%. As a group, at least 5 out of 10 readers detected each gold standard finding per recording. All the gold standard targets were identified when the readers' results were combined. Incidental finding/false positive rate ranged between 8.2-59.8 per reader. CONCLUSION: A panel of medical students with minimal endoscopic experience can achieve high sensitivity in detecting lesions on capsule endoscopy. A group of novice readers can pre-screen recordings to thumbnail potential areas of small bowel lesions for further review. These thumbnails must be reviewed to determine the clinical relevance. Further studies are ongoing to assess other cohorts.

Do depressed older adults who attribute depression to "old age" believe it is important to seek care?

OBJECTIVE: To determine whether depressed older adults who attribute becoming depressed to "old age" rather than illness are more likely to believe it is not important to seek treatment for depression. DESIGN: Cross-sectional mailed survey. SETTING: Academically affiliated primary care physicians' network. PARTICIPANTS: Surveys were mailed to 588 patients age > or =65 years who were randomly identified from patient lists of 20 physicians. Surveys were returned by 429 patients (73%). Patients were eligible for this study if they scored > or =2 points on the 5-item Geriatric Depression Scale (n = 94) and were not missing key variables (final n = 90). MEASUREMENTS AND MAIN RESULTS: Of the 90 depressed patients, 48 (53%) believed that feeling depressed was very important to discuss with a doctor. In unadjusted analysis, older adults who did not believe it is very important to discuss feeling depressed with a doctor were more likely to attribute becoming depressed to aging (41% vs 17%; P =.012). In a logistic regression model adjusting for sociodemographic characteristics, number of impairments in basic and instrumental activities of daily living, medical comorbidity, and physical (PCS-12) and mental (MCS-12) component summary scores from the Medical Outcomes Study Short-Form-12, depressed older adults who attributed depression to aging had a 4.3 times greater odds than those who attributed depression to illness to not believe it is very important to discuss depression with a doctor (odds ratio [OR], 4.3; 95% confidence interval [CI], 1.3 to 14.5). CONCLUSIONS: Among older persons with depression, attributing feeling depressed to old age may be an important barrier to care seeking.