Application of computer-aided detection for NCCN-based follow-up recommendation in subsolid nodules: Effect on inter-observer agreement.

RATIONALE AND OBJECTIVES: Computer-aided detection (CAD) of pulmonary nodules reduces the impact of observer variability, improving the reliability and reproducibility of nodule assessments in clinical practice. Therefore, this study aimed to assess the impact of CAD on inter-observer agreement in the follow-up management of subsolid nodules. MATERIALS AND METHODS: A dataset comprising 60 subsolid nodule cases was constructed based on the National Cancer Center lung cancer screening data. Five observers independently assessed all low-dose computed tomography scans and assigned follow-up management strategies to each case according to the National Comprehensive Cancer Network (NCCN) guidelines, using both manual measurements and CAD assistance. The linearly weighted Cohen's kappa test was used to measure agreement between paired observers. Agreement among multiple observers was evaluated using the Fleiss kappa statistic. RESULTS: The agreement of the five observers for NCCN follow-up management categorization was moderate when measured manually, with a Fleiss kappa score of 0.437. Utilizing CAD led to a notable enhancement in agreement, achieving a substantial consensus with a Fleiss kappa value of 0.623. After using CAD, the proportion of major and substantial management discrepancies decreased from 27.5% to 15.8% and 4.8% to 1.5%, respectively (p < 0.01). In 23 lung cancer cases presenting as part-solid nodules, CAD significantly elevates the average sensitivity in detecting lung cancer cases presenting as part-solid nodules (overall sensitivity, 82.6% vs. 92.2%; p < 0.05). CONCLUSION: The application of CAD significantly improves inter-observer agreement in the follow-up management strategy for subsolid nodules. It also demonstrates the potential to reduce substantial management discrepancies and increase detection sensitivity in lung cancer cases presenting as part-solid nodules.

Effect of M-wave Amplitude on Inter-evaluator Concordance and Number of Detected Innervation Zones in the Medial Gastrocnemius Using Multichannel Electromyography / Efecto de la Amplitud de la Onda M sobre la Concordancia entre Evaluadores y el Número de Zonas de Inervación Detectadas en el Gastrocnemio Medial Mediante Electromiografía Multicanal

SUMMARY: The Innervation Zones (IZ) correspond to clusters of neuromuscular junctions. The traditional method of locating IZs through voluntary muscle contractions may not be feasible in individuals with motor disorders. Imposed contractions by electrostimulation are an alternative. However, there is limited evidence regarding the factors that affect inter-evaluator concordance and the number of localized IZs when using imposed contraction. The main objective of this research was to determine the effect of the amplitude of compound motor action potentials (CMAPs) containing the M-wave on inter-evaluator agreement. As a secondary objective, was investigate the effect on the number of detected IZs. Twenty-four healthy volunteers (age: 21.2 ± 1.5years, weight: 67.4 ± 13.2kg, height: 1.68 ± 0.80m) participated in the study. Electrostimulation was applied to the tibial nerve to induce contraction of the medial gastrocnemius. The IZ were identified based on the M-wave recorded through multichannel electromyography. A receiver operating characteristic (ROC) analysis was conducted to assess sensitivity and specificity in detecting the IZs. Inter-rater agreement was evaluated using a two-way mixed effects test to determine the intraclass correlation coefficients (ICC). A p-value less than 0.05 was considered statistically significant. The ROC analysis revealed that for both evaluators, a specificity of 95% was achieved with an amplitude ≥30 %. The area under the ROC curve was 0.980 [0.964, 0.996], indicating a strong influence of CMAP amplitude on detection of IZs. The highest level of agreement (ICC = 0.788 [0.713, 0.844]) among the evaluators was observed with CMAP amplitudes equal to or greater than 80 % of the maximum M-wave. The findings of this study demonstrate that both the number and the inter-evaluator concordance for detecting IZs using imposed contractions are strongly influenced by the amplitude of the M-wave. Higher M-wave amplitudes were associated with improved concordance and increased IZ detection, making it crucial to standardize amplitude settings for reliable outcomes.

Las Zonas de Inervación (IZ) corresponden a grupos de uniones neuromusculares. El método tradicional para localizar IZs mediante contracciones musculares voluntarias puede no ser factible en personas con trastornos motores. Las contracciones impuestas mediante electro estimulación son una alternativa. Sin embargo, existe poca evidencia sobre los factores que afectan la concordancia entre evaluadores y el número de IZs localizadas al usar este tipo de contracciones. El objetivo de esta investigación fue determinar el efecto de la amplitud de los potenciales de acción motores compuestos (PAMCs) que contienen la onda M sobre la concordancia entre evaluadores. Como objetivo secundario, se investigó el efecto sobre el número de IZs detectadas. Veinticuatro voluntarios sanos (edad: 21.2 ± 1.5 años, peso: 67.4 ± 13.2 kg, altura: 1.68 ± 0.80 m) participaron en el estudio. Se aplicó electroestimulación al nervio tibial para inducir la contracción del gastrocnemio medial. Las IZs se identificaron según la onda M registrada mediante electromiografía multicanal. Se realizó un análisis de curva de las característica del receptor (ROC) para evaluar la sensibilidad y especificidad en la detección de las IZs. La concordancia entre evaluadores se evaluó utilizando una prueba de efectos mixtos de dos vías para determinar los coeficientes de correlación intraclase (ICC). Se consideró un valor de p menor que 0.05 como estadísticamente significativo. El análisis ROC reveló que para ambos evaluadores se logró una especificidad del 95% con una amplitud ≥30 %. El área bajo la curva ROC fue de 0.980 [0.964, 0.996], lo que indica una fuerte influencia de la amplitud del CMAP en la detección de las IZs. El nivel más alto de concordancia (ICC = 0.788 [0.713, 0.844]) entre los evaluadores se observó con amplitudes de CMAP iguales o mayores al 80 % de la onda M máxima. Los hallazgos de este estudio demuestran que tanto el número como la concordancia entre evaluadores para detectar IZs mediante contracciones impuestas están fuertemente influenciados por la amplitud de la onda M. Las amplitudes más altas de la onda M se asociaron con una concordancia mejorada y un aumento en la detección de IZs, lo que hace crucial estandarizar los ajustes de amplitud para obtener resultados confiables.

Lógica histórica da medicina e a homeopatia / The historical logic of medicine and homeopathy

Este artigo baseia-se na tese de que a teoria homeopática está originalmente orientada por um vitalismo de caráter hermenêutico, isto é, assume que a positividade dos fenômenos com que lida é sempre dependente de uma totalidade compreensiva (totalidade vital), singularizada em cada situação individual e somente acessível por meio das narrativas dos pacientes. O objetivo do estudo foi compreender as relações entre estas concepções vitalistas e o lugar dos procedimentos compreensivo- -interpretativos na propedêutica e terapêutica propostas pela teoria homeopática, as quais podem apontar alternativas para estabelecer as suas bases de validação. Trata-se de um estudo qualitativo, baseado na análise documental de textos canônicos da homeopatia, especialmente a obra de Hahnemann, e entrevistas em profundidade com homeopatas que combinam atividade clínica com pesquisa e docência na área (formadores de opinião). A metodologia foi instruída pela Hermenêutica Filosófica e pela Epistemologia Histórica, sendo o substrato discursivo (escrito e falado) trabalhado de modo não-formalista, buscando-se identificar e interpretar livremente eixos narrativos e núcleos de significado julgados relevantes. A discussão voltou-se fundamentalmente para a recuperação dos principais movimentos históricos de conformação do paradigma vitalista na homeopatia, o cotejamento desse desenvolvimento com a adoção de procedimentos semiológicos de caráter compreensivo-interpretativo e as implicações desse "vitalismo da palavra" para as concepções homeopáticas contemporâneas. O trabalho aponta para a positividade e produtividade do trabalho com a linguagem e as narrativas no âmbito de uma homeopatia entendida como uma "medicina do sujeito", e sugere aprofundamentos na direção hermenêutico- -filosófica como alternativa para o adensamento conceitual e para o aperfeiçoamento dos processos de validação do saber e da prática da homeopatia.

Homeopathic medicine is a socially validated practice, progressively incorporated into the institutional health care scheme, including the public health system. However, the issue of the fundamentals of this therapeutic, of its scientific validation, remains outstanding. In the sense of responding to this demand for validation, there is a need for research methodologies. that allow for accurate investigations, suitable for the concepts of health, illness and therapeutics that are intrinsic to the homeopathic rational. This paper is based on the notion that homeopathic theory is originally guided by a vitalism of hermeneutical character, that. is, it assumes that the positivity of phenomena with which it deals, is always dependent on the comprehensive totality (vital totality), specific to each individual situation and accessible only by means of the patients´ narratives. The study's purpose was to understand the relations between these vitalist concepts and the place of comprehensive-interpretative procedures in the propedeutics and therapeutics proposed by the homeopathic medicine that may point out to alternatives to establish its validation bases. This is qualitative research, based on the documentary analysis of homeopathy canonic texts, especially the work of Hahnemann, and originally n-depth interviews with homeopaths that combine clinic activity and education in the area (opinion makers). The methodology was instructed by Philosophic. Hermeneutics and by Historic Epistemology, and the layer subjacent to the discourse (written and spoken) effected in a non-formal manner, searching for the free identification. And interpretation of the narrative axes and core meanings that were deemed significant. The discussion was basically focused on the recovery of the major historical movements related. To the development of the vitalist paradigm in homeopathy, the comparison of this development with the adoption of semiologic procedures of comprehensive- -interpretative character and the implications of this "vitalism of the word" to the contemporary homeopathic concepts. The paper points out to the positivity and productivity of the work on language and narratives in the domain of a homeopathy understood as "medicine of the subject" and suggests deeper studies in the hermeneutical-philosophical direction as an alternative for the concept densification and for the improvement of validation processes of knowledge and practice of homeopathy.

Intrapartum cardiotocography: an exploratory analysis of interpretational variation.

Our aim was to evaluate the intra- and inter-operator agreement in cardiotocography (CTG) traces analysis using the 2015 FIGO classification guidelines, and whether the educational background and the knowledge of anamnestic data can influence the interpretation of CTG traces. A retrospective interpretation of 73 intrapartum CTGs at time 0 (T0) for a first blind interpretation and at time 1 (T1) two months later with additional anamnestic pregnancy information was made by eight different operators (four obstetricians and four midwives with different years of work experience). The intra-observer agreement demonstrates that midwifes are more concordant than obstetricians with a mean of 77.05% versus a mean of 65.75%. There is moderate inter-observer agreement in classifying a CTG trace as 'normal'; on the contrary, there is no consensus on the 'suspect' and 'pathological' classification category.IMPACT STATEMENTWhat is already known on this subject? Interpretation of intrapartum CTG is affected by significant subjective variables with relevant intra- and inter-observer lack of optimal agreement, especially in case of abnormal o pathologic findings.What do the results of this study add? Clinical data seem to play a role in interpretation of suspicious and pathological traces while they do not affect the rate of agreement for normal traces. Midwives tend to be less influenced by anamnestic data in visual CTG interpretation. Instead, obstetricians tend to be more focussed on clinical data and clinical setting that, as a consequence, tend to have great impact on CTG trace interpretation.What are the implications of these findings for clinical practice and/or further research? Cooperation among obstetricians and between obstetricians and midwives should be encouraged in order to optimise CTG reading and improve maternal and neonatal outcomes. Regarding the influence of clinical parameters in classification of intrapartum CTG traces, especially in case of abnormal CTG traces, it should be conceivable to improve medical skills in CTG blind interpretation and further investigate which clinical parameters are mainly related with an augmented risk of foetal asphyxia and adverse neonatal outcomes.

Intra- and inter-observer concordance of a fascial standing flexion test in children.

INTRODUCTION: Manual clinical tests must be highly reliable and valid to help in diagnosing, monitoring, and treating patients. Recent research highlighted the role of the fascia; thus, it is important to develop inexpensive, easy-to-use, and clinically valid procedures to assess this tissue in the field of manual therapy. The purpose of this study was to determine the level of inter- and intra-examiner concordance when performing a fascial standing flexion test in children. DESIGN: The present study is a descriptive observational study. METHODS: Two examiners tested 24 healthy children between 11 and 12 years of age performing two trials with the proposed fascial test. Inter- and intra-examiner data were analyzed using unweighted kappa coefficients and percentage agreement. RESULTS: We observed zero inter-examiner reliability in the fascial standing flexion test (mean κ = -0.071, mean percentage agreement of 43.7%), and moderate intra-examiner reliability (mean κ = 0.693, mean percentage agreement of 85.4%). CONCLUSION: The reliability and validity of the fascial standing flexion test must be improved before it can be recommended for use in a clinical setting.

Intrarater and interrater reliability of the modified Thomas Test.

INTRODUCTION: The modified Thomas Test (MTT) is a method of assessing flexibility of the iliopsoas, rectus femoris and tensor fascia Latae. The aim of this study is to identify the intra and inter-rater reliability of the pass/fail scoring for the Modified Thomas Test (MTT) using digital photographs. METHODS: Six raters varying between 1 and 13years of clinical experience were used to review digital photographs of 20 semi-professional rugby players performing the /MTT. Raters were asked to score each muscle of the MTT either with 0 (fail) or 1 (pass). Digital photographs were allocated in a randomized order. Each rater reviewed each photograph three times at two week intervals. RESULTS: Cronbach's alpha (Cα) revealed a mean result of high reliability for both iliopsoas (Cα = 0.95) and rectus femoris (Cα = 1.00) flexibility. TFL flexibility values ranged from 0.64 to 0.95, demonstrating some inconsistencies within some of the 6 raters. Fleiss kappa (Fк) revealed a high mean reliability result across the 3 testing sessions for both iliopsoas (Fк = 0.78) and rectus femoris (Fк = 0.80) flexibility, along with a moderate reliability mean result for TFL (Fк = 0.56). CONCLUSION: High intra and inter rater reliability was found for iliopsoas and rectus femoris flexibility with those for TFL found to be moderately reliable.

De-risking in Tier I CNS safety assessments is the primary function of study design and technical training of laboratory staff observers.

Derisking is not a pharmaceutical industry strategy to reduce time, effort, or costs in drug development. Derisking strategies originated within the National Institutes of Health as a predicate to good science. There is a growing sentiment within drug development programs to diminish the importance of behavioral measures in toxicological studies and in the Tiered Safety assessment plans of the U.S. Regulatory Agencies and the International Commission on Harmonization. The validity and reliability of the Functional Observational Batter (FOB) is critically dependent on consistency and technical quality in each risk assessment plan. US Federal and International drug approval organizations have universally adopted the concept of principles of test construction rather than delineating specific behavioral assay endpoints for inclusion of the FOB in nonclinical safety protocols. The validity and reliability of behavioral observations in standardized neurotoxicity screening is critically dependent on the FOB developed by the Study Director with the Sponsor throughout all stages of testing.. The individual risk factors selected for observation to be included in the early Tier 1 safety program should be determined by the mechanism and mode of action of the test article. The results of Tier I testing are the basis for Tier II testing designs. Critical to the compliance with Good Laboratory Practices is the documentation of training of the operational staff scheduled to conduct all aspects of the established protocol.

Interrater Reliability of an Observational Rating Scale and Video Analysis of Yoga Poses.

CONTEXT: Yoga is increasingly popular, not only as a form of recreational exercise but also as a physician-recommended intervention for health conditions. While serious adverse effects accompanying yoga practice are rare, poses that involve upper-extremity weight-bearing have a high risk of discomfort. To better understand factors contributing to adverse effects, there is a critical need for robust instruments that objectively evaluate pose performance. The purpose of this study was to assess the interrater reliability of an observational scale developed to assess the alignment of 3 yoga poses. DESIGN: Cross-sectional experimental study. METHODS: Thirty-eight individuals were given standardized instructions and performed 3 poses (Downward Dog, Plank, and Side Plank). Lateral videos were rated by 2 raters. A rating scale evaluating the alignment of 7 regions was developed by the study team with input from yoga teachers. Descriptive statistics were used to summarize the percentage of subjects showing ideal alignment and deviations. Interrater reliability was quantified using Cohen kappa coefficient (κ). RESULTS: In Downward Dog, the prevalence of ideal alignment was 20%, 28%, and 37%, at the neck, shoulder, and back, respectively; κ ranged from .44 to .69. In Plank, the prevalence of ideal alignment was 31%, 45%, and 54% at the neck, shoulder, and back, respectively; κ ranged from .47 to .95. In Side Plank, the prevalence of ideal alignment was 16, 41%, and 24%, at the neck, shoulder, and back, respectively; κ ranged from .20 to .84. CONCLUSION: The observational scale found a high prevalence of deviations, and demonstrated fair to substantial interrater agreement.

Reliability of visual inspection and palpation to assess relative flexibility of the shoulder.

INTRODUCTION: Movement compensations during internal rotation of the shoulder can provoke pain. Reliably observing and measuring compensations in the shoulder using visual and palpatory methods can result in more efficacious treatments of shoulder pathology. Despite this, the reliability of these measures and the relationship between them is unknown. METHODS: Bilateral shoulders of 33 Doctor of Physical Therapy (DPT) students were measured. Two third-year DPT student examiners used visual inspection and physical palpation to identify the first signs of internal rotation (IR) passive stiffness. Measurements were taken and recorded by a third examiner using the GetMyROM (Version 1.1) iPhone application. RESULTS: Good intra-rater reliability for both examiners was identified for physical palpation (ICC = 0.896, 95% CI = 0.830, 0.936, ICC = 0.901, 95% CI = 0.839, 0.939) and visual inspection (ICC = 0.813, 95% CI = 0.699, 0.884, ICC = 0.782, 95% CI = 0.667, 0.880). Moderate interrater reliability was found between the examiners for physical palpation (ICC = 0.681, 95% CI = 0.479, 0.797) while poor interrater reliability was found between examiners for visual inspection (ICC = 0.481, 95% CI = 0.234, 0.648). The correlation between physical palpation and visual inspection indicated moderate reliability for both examiners (r = 0.815, p = 0.01, r = 0.832, p = 0.01). CONCLUSION: The findings of this research study indicate that both physical palpation and visual inspection are reliable methods for measuring relative flexibility of shoulder IR when performed by the same examiner. However, the reliability for both methods decreases when performed by different examiners. Additionally, a strong correlation was found between both measures.

A national study on the inter-observer variability in the delineation of organs at risk in the brain.

BACKGROUND: The Danish Neuro Oncology Group (DNOG) has established national consensus guidelines for the delineation of organs at risk (OAR) structures based on published literature. This study was conducted to finalise these guidelines and evaluate the inter-observer variability of the delineated OAR structures by expert observers. MATERIAL AND METHODS: The DNOG delineation guidelines were formed by participants from all Danish centres that treat brain tumours with radiotherapy. In a two-day workshop, guidelines were discussed and finalised based on a pilot study. Following this, the ten participants contoured the following OARs on T1-weighted gadolinium enhanced MRI from 13 patients with brain tumours: optic tracts, optic nerves, chiasm, spinal cord, brainstem, pituitary gland and hippocampus. The metrics used for comparison were the Dice similarity coefficient (Dice), mean surface distance (MSD) and others. RESULTS: A total of 968 contours were delineated across the 13 patients. On average eight (range six to nine) individual contour sets were made per patient. Good agreement was found across all structures with a median MSD below 1 mm for most structures, with the chiasm performing the best with a median MSD of 0.45 mm. The Dice was as expected highly volume dependent, the brainstem (the largest structure) had the highest Dice value with a median of 0.89 whereas smaller volumes such as the chiasm had a Dice of 0.71. CONCLUSION: Except for the caudal definition of the spinal cord, the variances observed in the contours of OARs in the brain were generally low and consistent. Surface mapping revealed sub-regions of higher variance for some organs. The data set is being prepared as a validation data set for auto-segmentation algorithms for use within the Danish Comprehensive Cancer Centre - Radiotherapy and potential collaborators.

Repeatability and reproducibility of the pressure biofeedback unit.

INTRODUCTION: Although the pressure biofeedback unit (PBU) is used for muscular assessment and training, there is little evidence of its reproducibility and repeatability. OBJECTIVE: This study aims to assess intra- and inter-rater reproducibility and repeatability of the PBU in the assessment of the transverse abdominal (TrA), internal oblique (IO), low back multifidi, and deep neck flexors (DNF). METHODS: Fifty individuals had three muscular groups tested: TrA/IO, lower back multifidi, and DNF. For repeatability, one rater did three consecutive measures; for intra-rater reproducibility the same rater did two measures with seven-day intervals, and for inter-rater reproducibility, three raters, on the same day, did the measures. Data were analyzed with: Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC). (α = 0,05). RESULTS: Repeatability: TrA/IO (ICC = 0.847), Multifidi (ICC = 0.860), DNF (ICC = 0.831). Inter-rater reproducibility: TrA/IO (ICC = 0.876), Multifidi (ICC = 0.508), DNF (ICC = 0.442). Intra-rater reproducibility: TrA/IO (ICC = 0.747), Multifidi (ICC = 0.293), DNF (ICC = 0.685). Except for Multifidi, all the SEM values were less than 10 mmHg and the MDC values were less than 15 mmHg. CONCLUSIONS: The PBU can be used with reliability by different evaluators, although the evaluation of multifidi is not indicated.

Validation of the PDMS-2 scale in the Spanish population. Evaluation of physiotherapy intervention and parental involvement in the treatment of children with neurodevelopmental disorders. / Validación de la PDMS-2 en población española. Evaluación de la intervención de fisioterapia y la participación de los padres en el tratamiento de niños con trastornos del neurodesarrollo.

AIM: Cross-culturally adapt the PDMS-2 scale from Spanish-Mexican to Spanish-Spanish and evaluate its validity. To determine the efficacy of physiotherapy treatment (number of physiotherapy sessions and activities proposed by the physiotherapist and performed by the parents) in children with neurodevelopmental disorders between the ages of 0 and 3 years. SUBJECTS AND METHODS: A first prospective descriptive study of validation of the PDMS-2 scale including 74 subjects with neurodevelopmental disorder with aged from 0 and 3 years old. A second randomized clinical trial to evaluate the physiotherapy (Bobath concept) intervention in the experimental group (EG) (n = 37) who received unique 30-minute weekly sessions for 8 weeks against the control group (CG) (n = 37) that did not receive physiotherapy using the PDMS-2 scale for evaluation. RESULTS: An adequate inter-rater reliablity was found (ICC = 0.76). The scale showed also a very good internal consistency (alpha = 0,99). Significant differences between both groups at 8 weeks. EG obtained better scores in the postest after administrating the physiotherapy treatment (p < 0.001) Moderate and significant correlation coefficients were found between the number of physiotherapy sessions and Total Motor Quotient (TMQ) (r = 0.38; p < 0.05) and the home actitvities with TMQ (r = 0.46; p = 0.005). CONCLUSIONS: The Peabody PDMS-2 scale is a valid and reliable instrument to measure gross and fine motor development in children with neurodevelopmental disorder aged from 0 and 3 years old. Physiotherapy is useful for helping children with delayed neurodevelopment improve. The number of physiotherapy sessions and the activities proposed by the physiotherapist and performed at home by the parents show a direct and positive relationship with the results obtained in motor development.

TITLE: Validación de la PDMS-2 en población española. Evaluación de la intervención de fisioterapia y la participación de los padres en el tratamiento de niños con trastornos del neurodesarrollo.Objetivo. Adaptar transculturalmente la escala del desarrollo motor de Peabody, segunda edición (PDMS-2), del español mexicano al español de España y evaluar su validez. Determinar la eficacia del tratamiento fisioterápico (número de sesiones de fisioterapia y actividades propuestas por el fisioterapeuta y realizadas por los padres) en niños con trastornos del neurodesarrollo de 0 a 3 años. Sujetos y métodos. Un primer estudio descriptivo prospectivo de validación de la PDMS-2, que incluyó a 74 sujetos con trastorno del neurodesarrollo con edades comprendidas entre 0 y 3 años. Un segundo ensayo clínico aleatorio para evaluar la intervención de fisioterapia (concepto Bobath) en el grupo experimental (n = 37), que recibió sesiones únicas de 30 minutos semanales durante ocho semanas frente al grupo de control (n = 37), que no recibió fisioterapia y utilizó la PDMS-2 para su evaluación. Resultados. Se encontró una adecuada confiabilidad interagente (coeficiente de correlación intraclase = 0,76). La escala mostró también una muy buena consistencia interna (alfa = 0,99). Hubo diferencias significativas entre ambos grupos a las ocho semanas. El grupo experimental obtuvo mejores puntuaciones en el postest después de administrar el tratamiento de fisioterapia (p menor de 0,001). Se encontraron coeficientes de correlación moderados y significativos entre el número de sesiones de fisioterapia y el cociente motor total (r = 0,38; p menor de 0,05) y las actividades realizadas en casa con el cociente motor total (r = 0,46; p = 0,005). Conclusiones. La PDMS-2 es un instrumento válido y fiable para medir el desarrollo motor grueso y fino en niños con trastorno del neurodesarrollo de 0 a 3 años. La fisioterapia es útil en la mejoría en niños con retraso del neurodesarrollo. El número de sesiones de fisioterapia y las actividades propuestas por el fisioterapeuta y realizadas en casa por los padres muestran una relación directa y positiva con los resultados obtenidos en el desarrollo motor.

Intra- and inter-rater reliability of an electronic health record audit used in a chiropractic teaching clinic system: an observational study.

BACKGROUND: There is a dearth of information about health education clinical file audits in the context of completeness of records and demonstrating program-wide competency achievement. We report on the reliability of an audit instrument used for electronic health record (EHR) audits in the clinics of a chiropractic college in Canada. METHODS: The instrument is a checklist built within an electronic software application designed to pull data automatically from the EHR. It consists of a combination of 61 objective (n = 20) and subjective (n = 41) elements, representing domains of standards of practice, accreditation and in-house educational standards. Trained auditors provide responses to the elements and the software yields scores indicating the quality of clinical record per file. A convenience sample of 24 files, drawn randomly from the roster of 22 clinicians, were divided into three groups of eight to be completed by one of three auditors in the span of 1 week, at the end of which they were transferred to another auditor. There were four audit cycles; audits from cycles 1 and 4 were used to assess intra-rater (test-retest) reliability and audits from cycles 1, 2 and 3 were used to assess inter-rater reliability. Percent agreement (PA) and Kappa statistics (K) were used as outcomes. Scatter plots and intraclass correlation (ICC) coefficients were used to assess standards of practice, accreditation, and overall audit scores. RESULTS: Across all 3 auditors test-retest reliability for objective items was PA 89% and K 0.75, and for subjective items PA 82% and K 0.63. In contrast, inter-rater reliability was moderate at PA 82% and K 0.59, and PA 70% and K 0.44 for objective and subjective items, respectively. Element analysis indicated a wide range of PA and K values inter-rater reliability of many elements being rated as poor. ICC coefficient calculations indicated moderate reliability for the domains of standards of practice, accreditation, and overall file scores. CONCLUSION: The file audit process has substantial test-retest reliability and moderate inter-rater reliability. Recommendations are made to improve reliability outcomes. These include modifying the audit checklist with a view of improving clarity of elements, and enhancing uniformity of auditor responses by increased training aided by preparation of an audit guidebook.

Interexaminer Agreement and Reliability of an Internationally Endorsed Screening Framework for Cervical Vascular Risks Following Manual Therapy and Exercise: The Go4Safe Project.

OBJECTIVE: Clinicians are recommended to use the clinical reasoning framework developed by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) to provide guidance regarding assessment of the cervical spine and potential for cervical artery dysfunction prior to manual therapy and exercise. However, the interexaminer agreement and reliability of this framework is unknown. This study aimed to estimate the interexaminer agreement and reliability of the IFOMPT framework among physical therapists in primary care. METHODS: Ninety-six patients who consulted a physical therapist for neck pain or headache were included in the study. Each patient was tested independently by 2 physical therapists, from a group of 17 physical therapists (10 pairs) across The Netherlands. Patients and examiners were blinded to the test results. The overall interexaminer agreement, specific agreement per risk category (high-, intermediate-, and low-risk), and interexaminer reliability (weighted κ) were calculated. RESULTS: Overall agreement was 71% (specific agreement in high-risk category = 63%; specific agreement in intermediate-risk category = 38%; specific agreement in low-risk category = 84%). Overall reliability was moderate (weighted κ = 0.39; 95% CI = 0.21-0.57) and varied considerably between pairs of physical therapists (κ = 0.14-1.00). CONCLUSION: The IFOMPT framework showed an insufficient interexaminer agreement and fair interexaminer reliability among physical therapists when screening the increased risks for vascular complications following manual therapy and exercise prior to treatment. IMPACT: The IFOMPT framework contributes to the safety of manual therapy and exercise. It is widely adopted in clinical practice and educational programs, but the measurement properties are unknown. This project describes the agreement and reliability of the IFOMPT framework.

Quantitative measurements of forward head in college-aged students: A conformational study of intra-rater and inter-rater reliability of a novel Posture Measuring Device.

INTRODUCTION: Medical professionals frequently encounter forward head postures (FHP) in the treatment of cervical spine pain. In the clinical setting, FHP measurements are often described subjectively using the phrase, "patient demonstrates forward head posture." There are reliable tools that can objectively measure FHP, but they are not frequently used in the clinical setting on a regular basis because the tools are unavailable, inconvenient or overly time-consuming. The objective of this study was to confirm if FHP can be reliably measured using a novel posture-measuring device. The Posture Measuring Device (PMD) was designed to quickly obtain objective measurements of FHP in the outpatient clinical setting. A pilot study demonstrated good to excellent reliability in intra-rater (test-retest) measurements and good interrater reliability using two first-year Doctor of Physical Therapy Students as raters. This study is to confirm that the PMD is able to provide intra-rater and interrater reliability using two physical therapists and two second-year Doctor of Physical Therapy students to obtain FHP measurements. METHODS: Twenty-three college-aged subjects were measured individually using a PMD by a panel of four raters consisting of two physical therapists and two second-year physical therapy students to develop interrater reliability. Each rater measured each subject twice on two separate occasions to obtain a measure of intra-rater (relative) reliability. RESULTS: Pearson Correlations demonstrate high intra-rater correlation with inconsistent interrater correlation. The average measured Intraclass Correlation Coefficient (ICC) was .822 with a 95% confidence interval indicating a high degree of reliability between the eight measurements performed on each subject. Cronbach's alpha results confirm the ICC findings of strong correlation among the eight raters (α = 0.87). DISCUSSION AND CONCLUSION: Objective measurement of forward head posture is valuable to document and monitor patient response to treatment. This study identifies a convenient and time-efficient method for measuring forward head in the clinical setting. The PMD demonstrated a high degree of reliability in intra-rater measurements of FHP.

The inter- and intra-rater reliability of Modified Tardieu Scale in assessing spasticity of knee extensors in patients with multiple sclerosis.

INTRODUCTION: Spasticity is one of the most common and disabling symptoms in Multiple sclerosis (MS). The is a clinical tool for assessing spasticity. This study aimed to investigate the inter- and intra-rater reliability of the modified Tardieu scale for assessing knee extensors spasticity in MS patients. METHODS: Twenty-six patients with MS (12 females and 14 males) with a mean age of 40 ± 11.39 years participated in this study. The extensor muscles of both knees were evaluated using the MTS in two sessions. At first session, two examiners randomly assessed the knee extensor spasticity to study the inter-rater reliability and 3-4 days later the first examiner assessed the patients again, to determine intra-rater reliability. Intra-class Correlation Coefficient (ICC) analysis, two-way random effect model was used to determine the reliability of various components of the modified Tardieu scale. RESULTS: The inter-rater reliability for quality of muscle reaction of knee extensor muscles was very good (ICC = 0.89) and for the difference between the angle of muscle response (R1) and full range(R2) of movement (R2- R1), as spasticity intensity criterion, was good (ICC = 0.73). ICC values for R2-R1 and muscle response quality assessments by one rater were 0.73 and 0.82, respectively. CONCLUSION: The findings of the current study showed that the MTS has good to very good inter- and intra-rater reliability for assessing knee extensors spasticity in MS patients.

Inter-Rater Reliability of Kampo Diagnosis for Chronic Diseases.

This single-center observational study aimed to assess the inter-rater reliability (IRR) of Kampo medicine pattern diagnosis, which is modularized into three modules for chronic diseases, using 64 participants' information documents. The linearly weighted percentage of agreement and Gwet's agreement coefficient (AC) 2 for the deficiency-excess module, among three specialists, were 85.9% and 0.708, respectively. The unweighted percentage of agreement and Gwet's AC1 were 64.6% and 0.542 for the cold-heat, and 35.9% and 0.254 for the qi-blood-fluid modules, respectively. Our findings suggest that our modularization method may improve the IRR of Kampo medicine pattern diagnosis.

Citrinin Determination in Food and Food Supplements by LC-MS/MS: Development and Use of Reference Materials in an International Collaborative Study.

The development of incurred reference materials containing citrinin (CIT) and their successful application in a method validation study (MVS) in order to harmonize CIT determination in food and food supplements are demonstrated. CIT-contaminated materials made of red yeast rice (RYR), wheat flour, and Ginkgo biloba leaves (GBL), as well as food supplements made of red yeast rice (FS-RYR) and Ginkgo biloba leaves (FS-GBL), were manufactured in-house via fungal cultivation on collected raw materials. The homogeneity and stability from randomly selected containers were verified according to the ISO 13528. CIT was found to be homogenously distributed and stable in all contaminated materials, with no significant degradation during the timescale of the MVS when storage was performed up to +4 °C. Next, an MVS was organized with eighteen international laboratories using the provided standard operating procedure and 12 test materials, including three RYRs (blank, <50 µg/kg, <2000 µg/kg), two wheat flours (blank, <50 µg/kg), two GBL powders (blank, <50 µg/kg), three FS-RYRs (blank, <50 µg/kg, <2000 µg/kg), and two FS-GBLs (blank, <50 µg/kg). The results of seven CIT-incurred materials showed acceptable within-laboratory precision (RSDr) varying from 6.4% to 14.6% and between-laboratory precision (RSDR) varying from 10.2% to 37.3%. Evidenced by HorRat values < 2.0, the results of the collaborative trial demonstrated that the applied analytical method could be standardized. Furthermore, the appropriateness of producing CIT reference materials is an important step towards food and feed quality control systems and the organization of proficiency tests.

Development and validation of indirect ELISA for antibody detection against different protein antigens of porcine epidemic diarrhea virus in the colostrum and milk of sows.

The objectives of this study are to develop and optimize indirect ELISA based on three coating antigens of porcine epidemic diarrhea virus (PEDV), recombinant spike (S12), nucleocapsid (N), and whole viral (WV) proteins, for the detection of IgG and IgA antibodies in colostrum and milk and to evaluate the diagnostic sensitivity (DSe) and diagnostic specificity (DSp) of the assay as a diagnostic method. Colostrum (n = 347) and milk (n = 272) samples from sows were employed in this assay. Indirect ELISA based on three coating antigens was assessed by receiver operating characteristic (ROC) curve analysis with a virus neutralization (VN) test as a reference method, and the cutoff value for calculating DSe and DSp was determined. S12-ELISA showed higher DSe and DSp of IgG and IgA detection compared to N- and WV-ELISA in both colostrum and milk samples. Moreover, S12-ELISA showed perfect agreement and a high correlation with the VN test, which was better than the N- and WV-ELISA for both IgG and IgA detection in colostrum and milk. In contrast, N-ELISA showed lower DSe and DSp compared to S12- and WV-ELISA, along with a correlation with VN and substantial agreement with the VN test. Nevertheless, our developed ELISAs have accuracy for repeatability in both inter- and intra-assay variation. Overall, this research demonstrates that S12-ELISA is more suitable than WV- and N-ELISA to detect IgG and IgA antibodies against PEDV from both colostrum and milk samples.

Moderate to Substantial Inter-Rater Reliability in the Assessment of Cranial Bone Mobility Restrictions.

Background: The World Health Organization benchmarks for osteopathic training consider cranial osteopathy as an important manual skill. Studies of cranial manual therapy have exhibited poor reliability. The aim of this study was to investigate the inter-rater reliability of the manual mobility tests of the spheno-occipital synchondrosis (SOS), and the temporal, parietal, and frontal bones, as assessed in osteopathic manual therapy. Methods: Twenty-one adults were assessed on a single day by three experienced osteopaths using a standard assessment protocol. Before data collection, the osteopaths participated in a consensus training, which included establishing the criteria for identifying a cranial bone mobility restriction; the application of the seven-step palpation method; a pretesting practice; a fine-tuning palpation training; and a calibration period before the assessment of the subjects. Three subjects were assessed simultaneously with the evaluators rotating to assess each subject. The evaluators were blinded to the subject by a curtain, and each other's assessments. Each bone was rated as restricted or not restricted. The authors applied the Landis and Koch classification to describe the magnitude of inter-rater reliability. Results: Moderate reliability was established for a lateral strain of the SOS (Fleiss' generalized kappa 0.48), substantial reliability was established for the other SOS strain patterns (Fleiss' generalized kappa 0.62-0.75), and almost perfect reliability for temporal, parietal, and frontal bone (Fleiss' generalized kappa 0.81-0.96). Conclusion: The results demonstrate consistency when three experienced osteopaths evaluate cranial bone mobility restrictions. The results highlight the importance of consensus training and rigorous methodology in manual therapy reliability studies.