Intra- and inter-examiner reliability for diagnostic criteria of temporomandibular disorders (DC/TMD) - axis 1: assessment in a sample of students

Objective: The aim of this study was to analyze the intra- and inter-examiner reliability when using the DC/TMD axis 1 and verify the replicability and validity of the data obtained.Methods: The sample comprised 30 volunteers (students) of the Instituto Universitário de Ciências da Saúde Norte (Portugal). The calibration process consisted of a volunteer selection, theoretical and practical training, data collection, and agreement calculation. Examiners received proper previous training. Three dental practitioners applied the questionnaire (T1) and re-examined all the participants one week later (T2). To measure the degree of inter and intra-examiner agreement, multiple Kappa coefficients were obtained when nominal or ordinal variables were involved. When the correspondence between quantifiable variables was assessed, Pearson correlation coefficients and their statistical significance were replicated.Results: Regarding opening patterns, a strong overall agreement was obtained, only showing discrepancies in left-assisted and unassisted maximum openings (from -0.034 to -0.370 and -0.630 to -0.933, respectively). A high level of inter-examiner agreement during TMJ noise during the opening assessment was obtained, only displaying variations in clicks (Kappa -0.423 to 0.757). Protrusion movement showed negative kappa and weaker agreement of all measurements (Kappa between -0.034 and -0037). Small discrepancies were obtained from palpation assessment (left lateral pole- Kappa -0.034).Conclusion: There was no discernible and persistent difference in the amount of agreement among the three examiners, demonstrating that all three examiners were capable of participating in data collecting by employing the DC/TMD questionnaire. The findings indicated nearly perfect intra- and inter-examiner concordance scores.

"Shadow" OSCE examiner. A cross-sectional study comparing the "shadow" examiner with the original OSCE examiner format

OBJECTIVES: Feedback is a powerful learning tool, but a lack of appropriate feedback is a very common complaint from learners to teachers. To improve opportunities for feedback on objective structured clinical examinations (OSCEs), a modified examiner role, termed the "shadow" examiner, was tested. This study aims to present and analyze comparisons between the "shadow" examiner and the original OSCE examiner format. METHODS: In 2011, experiments were carried out with modifications to the examiner's role to define the "shadow" examiner format. From February 2012 to May 2014, research was conducted with 415 6th-year medical students. Of these students, 316 were randomly assigned to assessments by both "shadow" and "fixed" examiners. Pearson correlation analysis with linear regression, Student's t-tests and Bland-Altman plots were the statistical methods used to compare the assessment modes. To strengthen the analysis, checklist items were classified by domain. RESULTS: High correlations between the "shadow" and "fixed" examiners' global scores were observed. The results of the analysis of specific domains demonstrated higher correlations for cognitive scores and lower correlations for affective scores. No statistically significant differences between the mean examiner global scores were found. The Bland-Altman analysis showed that the "shadow" examiners' affective scores were significantly higher than those of the "fixed" examiners, but the magnitude of this difference was small. CONCLUSION: The modified examiner role did not lead to any important bias in the students' scores compared with the original OSCE examiner format. This new strategy may provide important insights for formative assessments of clinical performance.

Concordancia inter-examinador en la evaluación de hallazgos periodontales mediante radiografías panorámicas / Inter-examiner concordance in the assessment of periodontal findings by means of panoramic X-rays

RESUMEN Objetivo Estimar el grado de concordancia inter-examinador en la interpretación de hallazgos periodontales en radiografías panorámicas en estudiantes de último año de la Facultad de Odontología de la Universidad de Cartagena. Material y métodos Se realizó un estudio descriptivo de concordancia-consistencia inter-observador para la interpretación de hallazgos periodontales en radiografías panorámicas entre estudiantes de último año de pregrado de la Facultad de Odontología de la Universidad de Cartagena, con relación a un especialista en periodoncia. La evaluación de la concordancia se realizó a través del coeficiente kappa utilizando SPSS Statistics 2.0. Resultados Se evaluaron a 80 estudiantes del último año de pregrado. Cada uno valoró dos radiografías panorámicas, para un total de 160 observaciones. La concordancia general estableció un valor de kappa mínimo de 0.011 y un valor máximo de 0.720. Conclusiones La concordancia entre los estudiantes observadores y el estándar de oro fue pobre. Lo que indica que los estudiantes no aplican los conocimientos obtenidos durante el pregrado de odontología, dando así una errónea impresión del estado periodonto.

ABSTRACT Objective To assess the degree of inter-examiner concordance in the interpretation of periodontal findings in panoramic X-rays in last year students of the School of Dentistry at the University of Colombia. Material and methods A descriptive inter-observer concordance-consistency study was conducted for interpretation of periodontal findings in panoramic X-rays among last year students of the School of Dentistry of the University of Colombia and compared results to thos obtained by a periodontics specialist. Concordance evaluation was achieved by means of a kappa coefficient using SPSS Statistics 2.0 program. Results 80 last year students (undergraduate seniors) were evaluated each one assessed two panoramic X-rays, for a total of 160 observations. General concordance established a minimum kappa value of 0.011, and maximum value of 0.720. Conclusions Concordance among observing students and the gold standard was poor. This indicated that students did not apply acquired knowledge during their undergraduate dental studies, and provided thus a misleading impression on the circumstances of the periodontium.

Valoración de casos de habeas corpus, en la clínica médico forense del poder judicial, Costa Rica / Rating habeas corpus cases in forensic medical clinic judiciary, Costa Rica

En la Sección Clínica Médico Forense del Departamento de Medicina Legal se valoran pacientes enviados por la Sala Constitucional por interposición de Recursos de Hábeas Corpus, ésto, debido a las presuntas lesiones causadas por parte de funcionarios de alguna Autoridad Estatal. Este artículo pretende revisar qué es un Recurso de Hábeas Corpus y cómo se elabora, al unísono la relación directa con la valoración médico forense y las conclusiones médico legales respectivas, por lo que ejemplificamos un caso real de la Sección supra mencionada.

In Sección Clínica Médico Forense of Departamento de Medicina Legal we valued clients referred by the Constitutional Court by filing habeas corpus, this, because the alleged injuries caused by officials of any state authority. This article reviews what is a writ of habeas corpus and how it is produced, together with the direct and forensic evaluation forensic respective conclusions, so that exemplify a real case of above mentioned Section.

Diagnóstico de cárie secundária e substituição de restauração / Diagnosis of secondary caries and substitution of restoration

O objetivo deste estudo foi avaliar o grau de concordância entre Odontopediatras e Clínicos gerais quando ao diagnóstico de cárie secundária e substituição de restaurações em molares decíduos. Para isso, examinaram um quarenta (40) molares decíduos restaurados. Em seguida responderam a um questionário com três perguntas: 1. Em sua opinião existe cárie neste dente? 2. Em sua opinião essa restauração deveria ser substituída? 3. Caso sua resposta seja positiva, qual ou quais os motivos da substituição? O teste Kappa evidenciou um nível de concordância leve 0,14 (p<0,05) entre os Odontopediatras e Clínicos quanto ao diagnóstico de cárie secundária. Quanto a decisão de substituir ou não a restauração e qual o motivo, a concordância foi sofrível 0,28 (p<0,05) e 0,32 (p<0,05), respectivamente. Concluiu-se que entre os Odontopediatras e os Clínicos gerais houve divergência quanto ao diagnóstico e decisão de substituição de restauração; a cárie secundária foi o principal motivo da substituição. Existe a necessidade de estabelecer critérios para o diagnóstico de cárie secundária e substituição de restaurações.

The aim of this study was to evaluate the agreement degree between Pedodontist and General Dentist about the diagnosis of secondary caries and the restoration replacement in primary molars. One group of Pedodontist and another group of general practioners evaluated 40 restored primary molars. In the following stepe each examinator had to answer a questionary, which had three questions: 1. In your opinion, is there caries in this tooth? 2. In your opinion, should this restoration be replaced? 3. If your answer is positive, what are the reasons for the replacement? The Kappa statistics indicated a light level of agreement 0,14 (p<0,05) between Pedodontist and General Practitioners about the diagnosis of secondary caries. About the replacement decision of the restoration and the reason for it, the agreement was critical 0,28 (p<0,05) and 0,32 (p<0,05), respectively. It was concluded that there was divergency about the diagnosis and the replacement decision of restoration among the Pedodontists and Clinical Practitioners; the secondary caries was the main reason for the replacement. There is a need to establish criterials to judge the diagnosis of secondary caries and replace the restorations.