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1.
Rev. bras. ginecol. obstet ; 43(12): 911-918, Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1357089

ABSTRACT

Abstract Objective Currently, there are up to three different classifications for diagnosing septate uterus. The interobserver agreement among them has been poorly assessed. To assess the interobserver agreement of nonexpert sonographers for classifying septate uterus using the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE), American Society for Reproductive Medicine (ASRM), and Congenital Uterine Malformations by Experts (CUME) classifications. Methods A total of 50 three-dimensional (3D) volumes of a nonconsecutive series of women with suspected uterine malformation were used. Two nonexpert examiners evaluated a single 3D volume of the uterus of each woman, blinded to each other. The following measurements were performed: indentation depth, indentation angle, uterine fundal wall thickness, external fundal indentation, and indentation-to-wall-thickness (I:WT) ratio. Each observer had to assign a diagnosis in each case, according to the three classification systems (ESHRE/ESGE, ASRM, and CUME). The interobserver agreement regarding the ESHRE/ESGE, ASRM, and CUME classifications was assessed using the Cohen weighted kappa index (k). Agreement regarding the three classifications (ASRM versus ESHRE/ESGE, ASRM versus CUME, ESHRE/ESGE versus CUME) was also assessed. Results The interobserver agreement between the 2 nonexpert examiners was good for the ESHRE/ESGE (k = 0.74; 95% confidence interval [CI]: 0.55-0.92) and very good for the ASRM and CUME classification systems (k = 0.95; 95%CI: 0.86-1.00; and k = 0.91; 95%CI: 0.79-1.00, respectively). Agreement between the ESHRE/ESGE and ASRM classifications was moderate for both examiners. Agreement between the ESHRE/ESGE and CUME classifications was moderate for examiner 1 and good for examiner 2. Agreement between the ASRM and CUME classifications was good for both examiners. Conclusion The three classifications have good (ESHRE/ESGE) or very good (ASRM and CUME) interobserver agreement. Agreement between the ASRM and CUME classifications was higher than that for the ESHRE/ESGE and ASRM and ESHRE/ESGE and CUME classifications.


Resumo Objetivo Atualmente, existem até três classificações diferentes para o diagnóstico de útero septado. A concordância interobservador entre eles tem sido pouco avaliada. Avaliar a concordância interobservador de ecografistas não especialistas para classificar úteros septados usando as classificações European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE, na sigla em inglês), American Society for Reproductive Medicine (ASRM, na sigla em inglês) e Congenital Uterine Malformations by Experts (CUME, na sigla em inglês). Métodos Foram utilizados50volumes tridimensionais (3D)deuma série não consecutiva de mulheres com suspeita de malformação uterina. Dois examinadores não especialistas avaliaram um único volume 3D do útero de cada mulher, mutuamente cegos. As seguintes medidas foram aferidas: profundidade de indentação, ângulo de indentação, espessura da parede do fundo uterino, indentação externa do fundo e relação entre indentação e a espessura da parede (I:WT, na sigla em inglês). Cada observador teve que atribuir um diagnóstico em cada caso, de acordo com os três sistemas de classificação (ESHRE/ESGE, ASRM e CUME). A concordância interobservador em relação às classificações ESHRE/ESGE, ASRM e CUME foi avaliada usando o índice kappa ponderado de Cohen (k). A concordância em relação às três classificações (ASRM versus ESHRE/ESGE, ASRM versus CUME e ESHRE/ ESGE versus CUME) também foi avaliada. Resultados A concordância interobservador entre os 2 examinadores não especialistas foi boa para a classificação ESHRE/ESGE (k = 0,74, intervalo de confiança [IC] 95%: 0,55-0,92) e muito boa para os sistemas de classificação ASRM e CUME (k = 0,95; IC 95%: 0,86-1,00; e k = 0,91; IC95%: 0,79-1,00, respectivamente). A concordância entre as classificações ESHRE/ESGE e ASRM foi moderada para ambos os examinadores. A concordância entre as classificações ESHRE/ESGE e CUME foi moderada para o examinador 1 e boa para o examinador 2. A concordância entre as classificações ASRM e CUME foi boa para ambos os examinadores. Conclusão As três classificações apresentam concordância interobservador boa (ESHRE/ESGE) ou muito boa (ASRM e CUME). A concordância entre as classificações ASRM e CUME foi maior do que entre as classificações ESHRE/ESGE e ASRM e ESHRE/ESGE e CUME.


Subject(s)
Humans , Female , Urogenital Abnormalities/diagnostic imaging , Uterus/diagnostic imaging , Observer Variation , Reproducibility of Results , Ultrasonography
2.
Rev. chil. ortop. traumatol ; 62(1): 27-33, mar. 2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1342658

ABSTRACT

INTRODUCCIÓN: Una de las complicaciones de la osteosíntesis retrógrada del escafoides es la protrusión del tornillo en la articulación radiocarpiana, dada la limitada visualización intraoperatoria del polo proximal del escafoides con las proyecciones tradicionales. OBJETIVO: Evaluar la capacidad de una nueva proyección radiológica, la proyección "tangencial del escafoides dorsal", o TED, para identificar tornillos prominentes radiocarpianos durante la osteosíntesis retrógrada del escafoides con tornillos canulados. MATERIALES Y MÉTODOS: Estudio cadavérico en muñecas frescas congeladas. Se introdujo en el escafoides un tornillo canulado con técnica retrógrada estándar. La proyección TED fue evaluada en 5 muñecas, con angulaciones del antebrazo de 15°, 30° y 45° para definir la mejor visualización del polo proximal del escafoides y del tornillo. Se comparó la capacidad para identificar la prominencia del tornillo en el polo proximal de la proyección TED de 30° con 5 proyecciones tradicionales de escafoides en 9 muñecas. El tornillo se posicionó a nivel de la superficie del escafoides, y luego se avanzó a intervalos de 0,5 mm bajo visualización directa por artrotomía dorsal. Tras cada intervalo, se repitieron todas las proyecciones para determinar su capacidad de detectar tornillos prominentes en el escafoides. RESULTADOS: La mejor visualización del polo proximal del escafoides se logró con la proyección TED de 30°. Al comparar la proyección TED de 30° y las tradicionales, con la TED se logró identificar tornillos prominentes a 0,8 mm promedio, seguida por la proyección posteroanterior con cubitalización y extensión a 1.3 mm (p » 0.014), con una alta precisión y correlación interobservador de estas proyecciones. CONCLUSIÓN: La proyección TED demostró ser la más sensible para detectar tornillos prominentes en la articulación radiocarpiana. Su uso rutinario podría evitar complicaciones durante la osteosíntesis.


INTRODUCTION: One of the complications of the retrograde percutaneous scaphoid fixation is the protrusion of the screw in the radiocarpal joint due to the limited intraoperative visualization of the proximal pole of the scaphoid with the traditional radiographic views. OBJETIVE: To evaluate the sensitivity of a novel radiographic view (the skyline scaphoid view, SSV) to detect screws protruding in the radiocarpal joint during the retrograde fixation of the scaphoid. MATERIALS AND METHODS: We studied nine cadaverous fresh frozen wrists. A retrograde cannulated screw was inserted in the scaphoid. To validate the SSV, 5 wrists were studied, comparing 3 forearm angulations (15°, 30° and 45°) to get the best visualization of the proximal pole and screw. We compared the ability to identify the protrusion of the screw in the proximal pole of the 30° SSV with that of 5 standard scaphoid radiographic views in 9 wrists. The screw was positioned at the level of the surface of the scaphoid, and was sequentially protruded in 0.5 mm increments, with direct visualization of its tip through a dorsal capsulotomy. After each increment, all views were repeated to determine if they were able to detect screws projecting from the scaphoid. RESULTS: The best visualization of the proximal pole of the scaphoid was found with the 30° SSV. In the comparison of the 30° SSV and the standard views, with the SSV we were able to identify the protrusion of the screws at an average of 0.8 mm, followed by the posterior-anterior view with ulnar deviation and extension at 1.3 mm (p » 0.014), with high precision and interobserver agreement regarding these views. CONCLUSION: The SSV was the most sensitive view to detect protruding screws in the proximal pole of the scaphoid. Its routine use could avoid complications during osteosynthesis.


Subject(s)
Humans , Wrist Joint/diagnostic imaging , Bone Screws/adverse effects , Scaphoid Bone/diagnostic imaging , Fracture Fixation, Internal/adverse effects , Radiology/methods , Wrist Joint/surgery , Cadaver , Observer Variation , Scaphoid Bone/surgery , Fracture Fixation, Internal/instrumentation
3.
Rev. bras. med. esporte ; 27(1): 42-48, Jan.-Mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1156118

ABSTRACT

ABSTRACT Introduction The upper limbs are segments of the human body responsible for primary activities of daily life, and the muscles are essential structures for performing these activities. There have been few studies on intra- and inter-examiner reliability of the hand-held dynamometer (HHD) in healthy subjects, and none have been published that compare dynamometric evaluation methods in the main muscles in this segment. Objective Evaluate intra-examiner and inter-examiner assessment reliability of the hand-held dynamometry of upper limb muscles in healthy individuals, as well as comparing the assessment reliability between fixed and non-fixed methods. Methods Healthy subjects aged over 18 years were recruited for the study. The isometric contraction for ten muscle groups of the dominant upper limb was tested. For the fixed method, we used a system of suction cups, connected to the HHD by an inelastic belt. For the non-fixed method, the examiner supported the device by hand. The isometric contraction was sustained for three seconds. Each measurement was repeated three times, considering the highest value obtained. The reliability was calculated using the intraclass correlation coefficient (ICC). The dispersion between measurements was expressed by a Bland-Altman plot. Results The sample consisted of 25 volunteers, all right-handed. The intra-examiner ICC was 0.89-0.99 for the non-fixed method, and 0.43 to 0.85 for the fixed method. Inter-examiner reliability showed equivalent behavior. This study showed that evaluation of upper limb muscle strength using an isometric dynamometer has excellent intra-examiner and inter-examiner reliability. The supine position was chosen due to the need to propose a feasible protocol for clinical practice that could be replicated for the majority of publics and in different environments. The non-fixed method showed better reliability overall, demonstrating the feasibility of this tool without the need for adaptations, additional devices, or increased operating costs for this evaluation. Conclusion Comparison between the fixed and non-fixed HHD methods demonstrated superiority of the non-fixed method in terms of reliability. Level of evidence II; Investigation of a diagnostic exam - Development of diagnostic criteria with consecutive patients.


RESUMO Introdução Os membros superiores são segmentos do corpo humano responsáveis por atividades primordiais do nosso cotidiano, e os músculos são estruturas imprescindíveis para isso. Ainda são escassos na literatura os estudos sobre a confiabilidade intra e interexaminadores da dinamometria Hand-Held em indivíduos saudáveis, sendo inédita a comparação entre os métodos de avaliação da dinamometria nos principais músculos desse segmento. Objetivo Avaliar a confiabilidade da avaliação intraexaminador e interexaminador da dinamometria manual de músculos do membro superior em indivíduos saudáveis, bem como comparar a confiabilidade da avaliação entre métodos fixos e não fixos. Métodos Foram recrutados indivíduos saudáveis, maiores de 18 anos. A contração isométrica para dez grupos musculares do membro superior dominante foi testada. Para o método fixado, foi empregado um sistema de ventosas conectado ao Dinamomêtro Hand-Held (DHH) por um cinto inelástico. No método não fixado, o examinador apoiou o aparelho com a mão. A contração isométrica foi sustentada por três segundos. Cada medida foi repetida três vezes, considerando o maior valor obtido. A confiabilidade foi calculada através do coeficiente de correlação intraclasse (CCI). A dispersão entre as medidas foi expressa pelo diagrama de Bland-Altman. Resultados A amostra foi composta por 25 voluntários, todos destros. O coeficiente de correlação intraclasse (CCI) dos intraexaminadores para método não fixado foi de 0,89 a 0,99 e, para o método fixado, situou-se entre 0,43 e 0,85. A confiabilidade interexaminadores teve comportamento equivalente. O presente estudo demonstrou que a avaliação da força dos músculos dos MMSS com dinamômetro isométrico apresenta excelente confiabilidade tanto intra como interexaminadores. A escolha do posicionamento em supino vem da necessidade de propor um protocolo factível na prática clínica, replicável para a maioria dos públicos e em ambientes diversos. O fato de o método não fixado demonstrar maior confiabilidade, em geral, expõe a viabilidade do uso dessa ferramenta sem necessidade de adaptações, dispositivos adicionais ou aumento do custo operacional nessa avaliação. Conclusão A comparação entre os métodos fixados e os não fixados da dinamometria Hand-Held demonstrou superioridade do método não fixado quanto à confiabilidade. Nível de evidência II; Estudos diagnósticos - Investigação de um exame para diagnóstico - Desenvolvimento de critérios diagnósticos com pacientes consecutivos.


RESUMEN Introducción Los miembros superiores son segmentos del cuerpo humano responsables de las actividades primordiales de nuestro cotidiano, y los músculos son estructuras imprescindibles para eso. Aún son escasos los estudios sobre la confiabilidad intra e interexaminadores de la dinamometría Hand-Held en individuos saludables, siendo inédita la comparación entre los métodos de evaluación de la dinamometría en los músculos principales de ese segmento. Objetivos Evaluar la confiabilidad de la evaluación intraexaminador e interexaminador de la dinamometría manual de músculos del miembro superior en individuos saludables, bien como comparar la confiabilidad der la evaluación entre métodos fijos y no fijos. Métodos Se reclutaron individuos saludables, mayores de 18 años. Se probó la contracción isométrica para diez grupos musculares del miembro superior dominante. Para el método fijado, se utilizó un sistema de ventosas, conectado al Dinamómetro Hand-Held (DHH) a través de un cinturón inelástico. En el método no fijado, el examinador apoyó el aparato con la mano. La contracción isométrica fue sustentada por tres segundos. Cada medición fue repetida tres veces, considerando el valor más alto obtenido. La confiabilidad fue calculada a través del coeficiente de correlación intraclase (CCI). La dispersión entre las mediciones se expresó por el diagrama de Bland-Altman. Resultados La muestra fue compuesta por 25 voluntarios, todos diestros. El coeficiente de correlación intraclase (CCI) de los intraexaminadores para método no fijado fue de 0,89 a 0,99 y, para el método fijado fue entre 0,43 y 0,85. La confiabilidad intraexaminadores tuvo comportamiento equivalente. El presente estudio demostró que la evaluación de la fuerza de los músculos de los MMSS con un dinamómetro isométrico presenta excelente confiabilidad tanto intra como interexaminadores. La elección del posicionamiento en supino viene de la necesidad de proponer un protocolo factible en la práctica clínica, replicable para la mayoría de los públicos y en ambientes diversos. El hecho de que el método no fijado demuestre mayor confiabilidad, en general, expone la viabilidad del uso de esa herramienta sin necesidad de adaptaciones, dispositivos adicionales o aumento del costo operacional, en esa evaluación. Conclusión La comparación entre los métodos fijados y no fijados de la dinamometría Hand-Held demostró superioridad del método no fijado cuanto a la confiabilidad. Nivel de evidencia II; Estudios diagnósticos - Investigación de un examen para diagnóstico - Desarrollo de criterios diagnósticos con pacientes consecutivos.


Subject(s)
Humans , Male , Female , Adult , Arm/physiology , Muscle Strength/physiology , Muscle Strength Dynamometer , Observer Variation , Reproducibility of Results
4.
Fisioter. Bras ; 21(6): 586-591, Jan 6, 2021.
Article in Portuguese | LILACS | ID: biblio-1283720

ABSTRACT

A tarefa de levantar-se do solo a partir do decúbito dorsal (STS) tem apresentado recursos avaliativos complementares, em termos de julgamento do desempenho motor, físico e funcional em idosos por meio de medidas quantitativas e qualitativas. Especificamente, em medidas de processo (qualitativas) há sete protocolos que categorizam o desempenho do STS em idosos. Objetivo: Determinar o nível de confiabilidade intra e entre avaliadores da análise de processo do STS em idosos, segundo protocolo adaptado de Manini et al. Métodos: 25 idosos (12 mulheres) realizaram a tarefa de levantar-se do solo a partir do decúbito dorsal sem auxílio. Dois codificadores de vídeo, estudantes de graduação no nível superior de educação - tempo de experiência > 2 anos em Educação Física e ± 6 meses de uso do protocolo classificaram o desempenho dos idosos de acordo com o protocolo. A confiabilidade intra-avaliador e entre avaliadores foi considerada moderada (K = 0,533; p = 0,001; K = 0,466; p = 0,001) e substancial para a medida intra-avaliador 2 (K = 0,736; p = 0,001). O nível de confiabilidade intra e entreavaliadores do STS segundo o protocolo adaptado de Manini foi considerado moderado para sujeitos idosos. (AU)


The Supine-To-Stand task (STS) has presented complementary assessment resources, in terms of motor, physical and functional assessment in the elderly through quantitative and qualitative measures. Specifically, in process measures (qualitative) seven protocols categorize the performance of STS in the elderly. Objective: To determine the level of reliability within and between evaluators of the STS process analysis in the elderly, according to a protocol adapted from Manini et al. Methods: 25 elderly (12 female) performed the task of rising from the ground from the supine position without assistance. Two video encoders, graduate students at the higher education level - time of experience >2 years in Physical Education and ± 6 months in use of the protocol classified the performance of the elderly according to this protocol. Intra-rater and between rater reliability was considered moderate (K = 0.533; p = 0.001; K = 0.466; p = 0.001) and substantial for intra-rater 2 (K = 0.736; p = 0.001). The level of intra- and inter-rater reliability of the STS according to the adapted protocol of Manini was considered moderate for elderly subjects. (AU)


Subject(s)
Humans , Female , Aged/physiology , Geriatric Assessment/methods , Motor Skills , Observer Variation , Reproducibility of Results
5.
Article in Chinese | WPRIM | ID: wpr-878699

ABSTRACT

Objective To investigate the intra-and inter-observer reproducibility of iodine concentrations of abdominal parenchymal organs based on spectral CT.Methods The water-free iodine images of the venous phase were retrospectively obtained from 50 patients with abdominal dynamic spectral CT scans.The iodine concentrations were measured in the left,right and caudate lobes of liver,spleen,pancreas and bilateral kidneys.Intraclass correlation coefficient(ICC)and Bland-Altman plot were employed to analyze the intra-and inter-observer reproducibility.Results The intra-observer ICCs of the left,right and caudate lobes of liver,spleen,pancreas,and left and right kidneys were 0.938(0.894,0.965),0.932(0.884,0.961),0.939(0.895,0.965),0.947(0.909,0.970),0.912(0.851,0.949),0.946(0.906,0.969)and 0.907(0.842,0.946),which indicated good intra-observer reproducibility.The inter-observer ICCs of the left,right and caudate lobes of liver,spleen,pancreas,and left and right kidneys were 0.947(0.909,0.970),0.927(0.875,0.958),0.943(0.902,0.968),0.956(0.924,0.975),0.934(0.887,0.962),0.927(0.875,0.958)and 0.892(0.818,0.937),which indicated good inter-observer reproducibility.Bland-Altman plots presented that more than 95% points of the intra-observer differences located within 95% CI of limits of agreement for the caudate lobe of liver,spleen,pancreas and bilateral kidneys,which was same as inter-observer differences of the caudate lobe of liver,spleen and right kidney.Conclusion The iodine concentration measurement based on the spectral CT presented good intra-and inter-observer reproducibility for the caudate lobe of liver and spleen.


Subject(s)
Humans , Iodine , Observer Variation , Reproducibility of Results , Retrospective Studies , Tomography, X-Ray Computed
6.
Rev. CEFAC ; 23(4): e9720, 2021. tab
Article in English | LILACS | ID: biblio-1250700

ABSTRACT

ABSTRACT Purpose: to evaluate the reliability of the maximum phonation time (MPT) and Vital Capacity intra and inter-examiner, by means of the single-breath counting test (CT) and the sustained /a/ phoneme, and the slow vital capacity (SVC). Methods: a reliability study carried out in three groups of healthy individuals, each group with 30 volunteers, allocated according to age. SVC was measured using a spirometer, while the MPT was assessed by the phoneme /a/ and CT. The data were analyzed using SPSS version 20.0. Initially, descriptive statistics were used and for data reliability, the intraclass correlation coefficient (ICC). Results: the Intraclass Correlation Coefficients (ICC) were considered excellent, with significant results above 0.92 for SVC and greater than 0.79 for CT and phoneme /a/. Regarding the inter-examiner evaluation, the ICCs were also significant for both SVC with values greater than 0.96, and for CT and the phoneme /a/ with values greater than 0.85. The error inherent in the technique was assessed using the standard error of the measurement for intra and inter-examiner analyses with values ranging from 1.79 to 3.29 for phoneme /a/, 3.20 to 6.58 for CT and 65, 05 to 206.73 for SVCml. Conclusion: phonation techniques with the phoneme /a/ and CT, as well as SVC, have an excellent reliability, due to intra and inter-examiner agreement measures.


RESUMO Objetivo: avaliar a concordância do tempo máximo de fonação (TMF) com a Capacidade Vital, intra e interexaminador, por meio da técnica de contagem numérica em uma única respiração (TC) e do fonema /a/ sustentado e da capacidade vital lenta (CVL). Métodos: trata-se de um estudo de concordância realizado em três grupos de indivíduos saudáveis, cada grupo com 30 voluntários, alocados de acordo a idade. A CVL foi mensurada por meio do espirômetro, enquanto o TMF foi avaliado pela emissão do fonema/a/ e da TC. Os dados foram analisados pelo programa SPSS versão 20.0. Inicialmente utilizou-se estatística descritiva e para concordância dos dados foi utilizado o coeficiente de correlação intraclasse (CCI). Resultados: os Coeficientes de Correlação Intraclasse (CCI) intraexaminadores foram considerados excelentes, com resultados significantes acima de 0,92 para a CVL e maiores que 0.79 para a TC e fonema/a/. Em relação à avaliação interexaminadores, os CCIs também foram significantes tanto para a CVL com valores maiores que 0,96 quanto para a TC e o fonema/a/ com valores maiores que 0,85. O erro inerente a técnica foi avaliada por meio do erro padrão da medida para as analises intra e interexaminadores com valores que variaram de 1,79 a 3,29 para fonema/a/, 3,20 a 6,58 para TC e 65,05 a 206,73 para CVLml. Conclusão: as técnicas de fonação com o fonema /a/ e TC, assim como a CVL, demonstraram uma excelente concordância intra e interexaminadores.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Phonation/physiology , Vital Capacity/physiology , Spirometry , Time Factors , Observer Variation
7.
Clinics ; 76: e2476, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153979

ABSTRACT

OBJECTIVE: To determine the correlation between the two tomographic classifications for coronavirus disease (COVID-19), COVID-19 Reporting and Data System (CORADS) and Radiological Society of North America Expert Consensus Statement on Reporting Chest Computed Tomography (CT) Findings Related to COVID-19 (RSNA), in the Brazilian population and to assess the agreement between reviewers with different experience levels. METHODS: Chest CT images of patients with reverse transcriptase-polymerase chain reaction (RT-PCR)-positive COVID-19 were categorized according to the CORADS and RSNA classifications by radiologists with different levels of experience and who were initially unaware of the RT-PCR results. The inter- and intra-observer concordances for each of the classifications were calculated, as were the concordances between classifications. RESULTS: A total of 100 patients were included in this study. The RSNA classification showed an almost perfect inter-observer agreement between reviewers with similar experience levels, with a kappa coefficient of 0.892 (95% confidence interval [CI], 0.788-0.995). CORADS showed substantial agreement among reviewers with similar experience levels, with a kappa coefficient of 0.642 (95% CI, 0.491-0.793). There was inter-observer variation when comparing less experienced reviewers with more experienced reviewers, with the highest kappa coefficient of 0.396 (95% CI, 0.255-0.588). There was a significant correlation between both classifications, with a Kendall coefficient of 0.899 (p<0.001) and substantial intra-observer agreement for both classifications. CONCLUSION: The RSNA and CORADS classifications showed excellent inter-observer agreement for reviewers with the same level of experience, although the agreement between less experience reviewers and the reviewer with the most experience was only reasonable. Combined analysis of both classifications with the first RT-PCR results did not reveal any false-negative results for detecting COVID-19 in patients.


Subject(s)
Humans , Coronavirus Infections , Coronavirus , Brazil , Tomography, X-Ray Computed , Observer Variation , Betacoronavirus
8.
Acta Paul. Enferm. (Online) ; 34: eAPE001525, 2021. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1349824

ABSTRACT

Resumo Objetivo Avaliar a concordância interobservadores na aplicação um checklist de cuidados em Terapia Nutricional Enteral (TNE). Métodos Estudo de confiabilidade que precedeu um ensaio clínico (NCT03497221), realizado em hospital universitário do sul do Brasil (junho e julho de 2017). Checklist de 25 itens relacionado aos cuidados em TNE foi realizado por uma enfermeira (Padrão de Referência) e por nove Assistentes de Pesquisa (AP). As avaliações foram feitas concomitantemente e de modo independente. A concordância foi testada utilizando-se o Statistical Package for the Social Sciences versão 21.0. Valores de Kappa (k) foram considerados como concordância entre: pobre (0 a 0,19); relativa (0,20 a 0,39); moderada (0,40 a 0,59); substancial (0,60 e 0,79); quase perfeita (0,80 a 0,99); e perfeita (1). O estudo foi aprovado pelo Comitê de Ética da Instituição (nº 16-0534). Resultados Foram realizadas 351 observações em duplicata, sendo o menor número de observações foi com a AP 5 (n=35) e o maior com a AP 8 (n=45). Foram avaliados itens relacionados a TNE em três blocos: identificação dos frascos de infusões e bomba de infusão; materiais de apoio para administração da terapia; e cuidados ao paciente em uso de TNE. Houve concordância quase perfeita ou perfeita em todos os pares de observação, com o menor Kappa para AP 6 (k=0,890; IC95%=0.86, 0.92) e o maior para AP 3 (k=0,965; IC95%=0.93, 0.99). Conclusão A concordância interobservadores ao aplicar um checklist contendo 25 itens foi excelente, o que minimiza a ocorrência de viés de aferição nas etapas subsequentes.


Resumen Objetivo Evaluar la concordancia interobservadores en la aplicación de una checklist de cuidados en terapia nutricional enteral (TNE). Métodos Estudio de fiabilidad que precedió un ensayo clínico (NCT03497221), realizado en un hospital universitario de la región Sur de Brasil (junio y julio de 2017). Una checklist de 25 ítems relacionados con los cuidados en TNE fue realizada por una enfermera (Estándar de Referencia) y por nueve Asistentes de Investigación (AI). Las evaluaciones fueron llevadas a cabo simultánea e independientemente. La concordancia se comprobó utilizando el Statistical Package for the Social Sciences versión 21.0. Los valores de Kappa (k) se consideraron como concordancia entre: pobre (0 a 0,19); relativa (0,20 a 0,39); moderada (0,40 a 0,59); considerable (0,60 a 0,79); casi perfecta (0,80 a 0,99); y perfecta (1). El estudio fue aprobado por el Comité de Ética de la institución (n.° 16-0534). Resultados Se realizaron 351 observaciones duplicadas, de las cuales el menor número de observaciones fue de la AI 5 (n=35) y el mayor de la AI 8 (n=45). Se evaluaron ítems relacionados con la TNE en tres grupos: identificación de los frascos de infusiones y bomba de infusión, material de apoyo para la administración de la terapia y cuidados del paciente en uso de TNE. Se observó concordancia casi perfecta o perfecta en todos los pares de observación, con el menor Kappa de la AI 6 (k=0,890; IC95 %=0.86, 0.92) y el mayor de la AI 3 (k=0,965; IC95 %=0.93, 0.99). Conclusión La concordancia interobservadores al aplicar una checklist de 25 ítems fue excelente, lo que minimiza la ocurrencia de sesgo de medición en las etapas subsiguientes.


Abstract Objective To assess interobserver agreement in the application of a checklist of care in enteral nutritional therapy (ENT). Methods This is a reliability study that preceded a clinical trial (NCT03497221), carried out at a university hospital in southern Brazil (June and July 2017). A checklist of 25 items related to care in ENT was performed by a nurse (reference standard) and nine research assistants (RA). Assessments were carried out concurrently and independently. Agreement was tested using the Statistical Package for the Social Sciences, version 21.0. Kappa values (k) were considered as poor (0 to 0.19), relative (0.20 to 0.39), moderate (0.40 to 0.59), substantial (0.60 and 0.79), almost perfect (0.80 to 0.99), and perfect (1). The study was approved by an Institutional Review Board (number 16-0534). Results Three hundred fifty-one observations were made in duplicate; the lowest number of observations was with RA, 5 (n = 35) and the highest with RA, 8 (n = 45). Items related to ENT were assessed in three blocks: identification of infusion bottles and infusion pump; support materials for administering the therapy; care for patients using ENT. There was almost perfect or perfect agreement in all observation pairs, with lowest Kappa for RA 6 (k = 0.890; 95% CI = 0.86, 0.92) and the highest for RA 3 (k = 0.965; 95% CI = 0.93, 0.99). Conclusion Interobserver agreement, when applying a checklist containing 25 items, was excellent, which minimizes the occurrence of measurement bias in subsequent steps.


Subject(s)
Humans , Adolescent , Observer Variation , Enteral Nutrition/nursing , Enteral Nutrition/methods , Nutrition Therapy/methods , Reproducibility of Results
9.
Rev. chil. pediatr ; 91(5): 711-721, oct. 2020. tab
Article in Spanish | LILACS | ID: biblio-1144270

ABSTRACT

INTRODUCCIÓN: La nutrición adecuada durante los primeros dos años de vida es fundamental para el desarrollo pleno del potencial del ser humano. La introducción inadecuada, precoz o tardía de la alimentación complementaria trae consecuencias a corto y largo plazo. La alimentación complementaria depende en gran medida de los conocimientos del cuidador que en los países de Latinoamérica generalmente es la madre. OBJETIVO: construir y validar un instrumento para medir los conocimientos maternos y de cuidadores sobre alimentación complementaria. SUJETOS Y MÉTODO: Estudio de observación. Participaron 80 madres comunitarias y 12 pediatras expertos. Se desarrolló en dos etapas: la creación del instrumento a partir de las 7 fases propuestas por Sampieri, y la validación mediante la evaluación de validez aparente, de constructo, de contenido, consistencia interna y fiabilidad intra-observador. RESULTADOS: Se creó un instrumento autoadministrado que incluyó inicialmente 14 preguntas sobre conocimientos maternos y de cuidadores. Durante la validación de constructo se identificaron 3 dominios y se eliminaron cuatro preguntas. En la validación de contenido, 10 preguntas del instrumento definitivo obtuvieron calificaciones superiores a 9 (en una escala de 0-10) en las características: calidad, vocabulario, relevancia y actualidad. La consistencia interna global del instrumento fue moderada (Alfa de Cronbach: 0,64) y la fiabilidad intra-observador fue aceptable (k: 0,21-0,40) para el 80% de ítems del instrumento. CONCLUSIONES: Se presenta el primer instrumento autoadministrado validado en la región, que permite medir conocimientos de las madres y los cuidadores sobre alimentación complementaria. A futuro, permitirá diseñar y desarrollar estrategias de evaluación e intervención en relación con los conocimientos maternos y de los cuidadores sobre alimentación complementaria.


INTRODUCTION: Adequate nutrition during the first two years of life is crucial for the full development of human potential. Inadequate, early, or late introduction of complementary feeding has consequences in the short- and long-term. Complementary feeding depends largely on the knowledge of the caregiver who, in Latin American countries, is usually the mother. OBJECTIVE: To create and validate an ins trument to measure knowledge about complementary feeding. SUBJECTS AND METHOD: Observational study in which 80 community mothers and 12 expert pediatricians participated. It was carried out in two stages, the creation of the instrument (following the 7 phases proposed by Sampieri) and the va lidation through the evaluation of the apparent validity, construct and content validity, internal con sistency, and intra-observer reliability. RESULTS: A self-administered instrument was created that ini tially included 14 questions about maternal and caregiver's knowledge. During the validation of the construct, 3 domains were identified and four questions were eliminated. In the content validation, 10 questions of the final instrument scored higher than 9 (on a scale of 0-10) in the characteristics of quality, vocabulary, relevance, and topicality. The global internal consistency of the instrument was moderate (Cronbach's alpha: 0.64) and the intra-observer reliability was acceptable (k: 0.21-0.40) for 80% of its items. CONCLUSIONS: the first self-administered instrument validated in the region to measure the knowledge of mothers and caregivers about complementary feeding is presented. It will allow to design and develop strategies in relation to maternal and caregiver's knowledge of comple mentary feeding.


Subject(s)
Humans , Male , Female , Infant , Adult , Middle Aged , Health Knowledge, Attitudes, Practice , Surveys and Questionnaires , Caregivers/psychology , Infant Care/methods , Infant Nutritional Physiological Phenomena , Mothers/psychology , Psychometrics , Observer Variation , Reproducibility of Results , Infant Care/psychology
10.
Rev. chil. ortop. traumatol ; 61(2): 53-59, oct. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1342412

ABSTRACT

OBJETIVOS: Determinar el rendimiento de las clasificaciones de Outerbridge (OB) e International Cartilage Repair Society (ICRS). MÉTODO: Estudio de test diagnóstico, diseño y recolección de datos prospectivo. Siete traumatólogos sub-especialistas observaron un mismo video donde se exponían 30 lesiones condrales bajo visión artroscópica, para luego clasificarlas según OB e ICRS y consignar el tratamiento de elección para cada una de las lesiones, eligiendo entre 6 alternativas: observación, debridamiento mecánico o térmico, microfractura, OATS o terapias biológicas. Tras 7 días, los evaluadores debían repetir el mismo procedimiento. RESULTADOS: La concordancia entre los observadores fue débil para clasificación de ICRS (k 0,25 p < 0,001) y moderada para la clasificación de OB (k 0,45 p < 0,001). La concordancia intra-observador para ICRS oscilaba entre moderada y excelente (k promedio de 0,67), y para la clasificación de OB entre buena y excelente (k promedio 0,83). Ninguna de las dos clasificaciones mostró correlación con la experiencia del cirujano. En la elección de tratamiento, la concordancia entre observadores fue débil (k 0,33 p < 0,001), sin embargo, la concordancia intra-observador fue en todos los casos buena o excelente (k 0,82), mostrando una correlación directamente proporcional a la experiencia del cirujano. La capacidad de discriminación terapéutica, evaluada mediante una regresión logística, mostró un área bajo la curva roc en el rango del no-efecto. CONCLUSIÓN: Ambas clasificaciones mostraron una baja correlación inter-observador y una elevada concordancia intra-observador. En ambas categorías, Outerbridge fue más concordante que ICRS. En cuanto al tratamiento, ninguna de las dos clasificaciones logra unificar criterios quirúrgicos. NIVEL DE EVIDENCIA: Nivel I (test diagnóstico).


OBJECTIVES: Assess de diagnostic accuracy of Outerbridge (OB) and ICRS (International Cartilage Repair Society) classifications. METHODS: We performed a diagnostic test study, with a prospective design and data collection. Seven knee surgeons were asked to observe a video were the 30 chondral lesions were shown through arthroscopic view. Simultaneously they were asked to classify them according to OB and ICRS. Besides, they had to define how they would manage the chondral lesion, choosing among six treatment options (observation, mechanical or thermic chondroplasty, microfracture, osteochondral autologous transfer system (OATS) or biological therapies). A week later, they repeated the same procedure. Intra and interobserver agreement were characterized by κ statistical analysis, and a logistic regression was used to assess the ability of both classifications to discriminate among treatment options. P values < 0,05 were considered significant. RESULTS: Interobserver agreement was weak (κ 0.25 p < 0.001) for ICRS classification and moderate for OB classification (κ 0.45 p < 0.001). Intraobserver agreement for ICRS ranged from moderate to excellent (average κ of 0.67), and for the OB classification ranged from good to excellent (average kappa 0.83). Neither classification correlated with the surgeon's experience. Interobserver agreement for therapeutic choice was poor (κ 0.33 p < 0.001). However, intraobserver agreement was good to excellent (κ 0.82) in all cases, showing a direct correlation with the surgeon's experience. Logistic regression used to assess the ability of both classifications to discriminate among treatment options, showed in both cases an area under the roc curve in the no-effect range. CONCLUSION: Both classifications showed low interobserver and high intraobserver agreements for arthroscopic grading of chondral lesions. In both, Outerbridge was more reliable than ICRS. As for guiding therapeutic management, none of the classifications could unify surgical criteria.


Subject(s)
Humans , Arthroscopy , Cartilage Diseases/classification , Cartilage Diseases/diagnosis , Knee Injuries/classification , Knee Injuries/diagnosis , Severity of Illness Index , Cartilage Diseases/surgery , Observer Variation , Prospective Studies , ROC Curve , Knee Injuries/surgery
11.
Säo Paulo med. j ; 138(4): 310-316, July-Aug. 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1139710

ABSTRACT

ABSTRACT BACKGROUND: The accuracy of magnetic resonance imaging (MRI) for making the diagnosis of subscapularis tears presents wide variation in the literature and there are few prospective studies. OBJECTIVE: To compare the findings from MRI and arthroscopy for diagnosing subscapularis tears. DESIGN AND SETTING: Diagnostic test study performed in a tertiary care hospital. METHODS: We included patients who underwent arthroscopic rotator cuff repair and who had firstly undergone high magnetic field MRI without contrast. The images were independently evaluated by a shoulder surgeon and two musculoskeletal radiologists. Sensitivity, specificity, positive and negative predictive values, accuracy and inter and intra-observer agreement were calculated. RESULTS: MRIs on 200 shoulders were evaluated. The incidence of subscapularis tears was 69.5% (41.5% partial and 28.0% full-thickness). The inter and intra-observer agreement was moderate for detection of subscapularis tears. The shoulder surgeon presented sensitivity of 51.1% to 59.0% and specificity of 91.7% to 94.4%. The radiologists showed sensitivity of 83.5% to 87.1% and specificity of 41% to 45.9%. Accuracy ranged from 60.5% to 73.0%. CONCLUSION: The 1.5-T MRIs without contrast showed mean sensitivity of 70.2% and mean specificity of 61.9% for detection of subscapularis tears. Sensitivity was higher for the musculoskeletal radiologists, while specificity was higher for the shoulder surgeon. The mean accuracy was 67.6%, i.e. lower than that of rotator cuff tears overall.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Tendon Injuries/diagnostic imaging , Magnetic Resonance Imaging/methods , Rotator Cuff/diagnostic imaging , Rotator Cuff Injuries/diagnostic imaging , Arthroscopy , Observer Variation , Predictive Value of Tests , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Rotator Cuff/surgery , Diagnostic Tests, Routine , Rotator Cuff Injuries/surgery
12.
Rev. chil. pediatr ; 91(4): 500-506, ago. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138663

ABSTRACT

La auscultación pulmonar es parte fundamental del examen físico para el diagnóstico de las enfermedades respiratorias. La estandarización que ha alcanzado la nomenclatura de los ruidos respiratorios, sumado a los avances en el análisis computacional de los mismos, han permitido mejorar la utilidad de esta técnica. Sin embargo, el rendimiento de la auscultación pulmonar ha sido cuestionado por tener una concordancia variable entre profesionales de la salud. Aun cuando la incorporación de nuevas herramientas diagnósticas de imágenes y función pulmonar han revolucionado la precisión diagnóstica en enfermedades respiratorias, no existe tecnología que permita reemplazar la técnica de auscultación pulmonar para guiar el proceso diagnóstico. Por una parte, la auscultación pulmonar permite seleccionar a aquellos pacientes que se beneficiarán de una determinada técnica diagnóstica, se puede repetir cuantas veces sea necesario para tomar decisiones clínicas, y frecuentemente permite prescindir de exámenes adicionales que no siempre son fáciles de realizar o no se encuentran disponibles. En esta revisión se presenta el estado actual de la técnica de auscultación pulmonar y su rendimiento objetivo basado en la nomenclatura actual aceptada para los ruidos respiratorios, además de resumir la evidencia principal de estudios de concordancia de auscultación pediátrica y su análisis objetivo a través de nueva tecnología computacional.


Lung auscultation is an essential part of the physical examination for diagnosing respiratory diseases. The terminology standardization for lung sounds, in addition to advances in their analysis through new technologies, have improved the use of this technique. However, traditional auscultation has been questioned due to the limited concordance among health professionals. Despite the revolu tionary use of new diagnostic tools of imaging and lung function tests allowing diagnostic accuracy in respiratory diseases, no technology can replace lung auscultation to guide the diagnostic process. Lung auscultation allows identifying those patients who may benefit from a specific test. Moreover, this technique can be performed many times to make clinical decisions, and often with no need for- complicated and sometimes unavailable tests. This review describes the current state-of-the-art of lung auscultation and its efficacy based on the current respiratory sound terminology. In addition, it describes the main evidence on respiratory sound concordance studies among health professionals and its objective analysis through new technology.


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Auscultation/methods , Respiratory Sounds/diagnosis , Pediatrics , Auscultation/standards , Auscultation/trends , Observer Variation , Respiratory Sounds/classification , Clinical Decision-Making/methods , Terminology as Topic
13.
Arq. bras. oftalmol ; 83(2): 127-131, Mar.-Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088964

ABSTRACT

ABSTRACT Purpose: Inferior eyelid laxity is classically evaluated using "snap-back" and "distraction" tests. This study aimed to assess the reproducibility of the technique used to indirectly quantify the horizontal tension in the lower eyelids using digital image processing. Methods: This longitudinal study was conducted to assess the reproducibility of a new technique that quantifies the horizontal tension in the lower eyelid. The study was conducted at the Hospital das Clínicas of Porto Alegre. The protocol was established by two trained ophthalmologist examiners, allowing intra- and interobserver agreement analyses. Image acquisition was done in two stages: the first image was captured with the eyelid in primary gaze position and the second with the eyelid in traction position. All images and measurements were processed using Image J 1.33m software from the National Institute of Health. The Bland-Altman method, intraclass correlation coefficients, concordance correlation coefficients, and technical measurement error were used to evaluate reproducibility. Results: The study participants comprised healthy individuals with no ophthalmologic pathologies. The measurements obtained in the neutral position showed a slightly higher agreement than those obtained in the traction position. The mean difference between the measurements performed in the traction position was 0.028 ± 0.7 mm and 0.014 ± 0.9 mm in the intra- and interobserver analyses, respectively. The Bland-Altman method demonstrated adequate confidence limits for both measurements. Correlation coefficients for measurements varied between 0.87 [95% confidence interval (CI) 0.68-0.95] and 0.91 (95% CI 0.77-0.97) in the neutral position and between 0.72 (95% CI 0.37-0.89) and 0.76 (95% CI 0.4-0.91) in the traction position. Conclusion: A high intra- and interobserver concordance was observed in the studied method to quantify lower eyelid tension. The proposed method is simple and easily reproducible, and to the best our knowledge, this is the first method that quantifies lower eyelid horizontal tension on the basis of digital image processing. This modified distraction test might be useful in studies quantifying lower eyelid horizontal tension.


RESUMO Objetivo: A frouxidão palpebral inferior é avaliada classicamente por meio de testes de "snap-back" e "distraction test". O objetivo deste estudo foi avaliar a reprodutibilidade da técnica utilizada para quantificar indiretamente a tensão horizontal nas pálpebras inferiores através do processamento digital de imagens. Métodos: Este estudo longitudinal foi realizado para avaliar a reprodutibilidade de uma nova técnica que quantifica a tensão horizontal na pálpebra inferior. O estudo foi realizado no Hospital das Clínicas de Porto Alegre. O protocolo foi estabelecido por dois examinadores oftalmologistas treinados, permitindo análises de concordância intra e interavaliador. A aquisição de imagens foi feita em duas etapas: a primeira imagem foi capturada com a pálpebra na posição primária do olhar e a segunda com pálpebra tracionada. Todas as imagens e medições foram processadas usando o software Image J 1.33m do National Institute of Health. O método de Bland-Altman, os coeficientes de correlação intraclasses, os coeficientes de correlação de concordância e o erro técnico da medida foram utilizados para avaliar a reprodutibilidade. Resultados: Os participantes do estudo foram indivíduos saudáveis e sem patologias oftalmológicas. As medidas obtidas na posição neutra mostraram concordância levemente maior do que as obtidas na posição tracionada. A diferença média entre as medidas realizadas na posição tracionada foi de 0,028 ± 0,7mm e 0,014 ± 0,9mm nas análises intra e interobservadores, respectivamente. O método de Bland-Altman demonstrou limites de confiança adequados para ambas as medidas. Os coeficientes de correlação para as medidas variaram entre 0,87 [intervalo de confiança de 95% (IC) 0,68-0,95) e 0,91 (IC 95% 0,77-0,97) na posição neutra e entre 0,72 (IC 95% 0,37-0,89) e 0,76 (IC 95% 0,46-0,91) na posição tracionada. Conclusão: Observou-se elevada concordância intra e interobservador no método estudado para quantificar a tensão palpebral inferior. O método proposto é simples e facilmente reproduzível, e, do melhor modo possível, este é o primeiro método que quantifica a tensão horizontal da pálpebra inferior com base no processamento digital de imagens. Este teste de distração modificado pode ser útil em estudos que quantifiquem a tensão horizontal da pálpebra inferior.


Subject(s)
Humans , Adult , Middle Aged , Image Processing, Computer-Assisted/methods , Image Processing, Computer-Assisted/standards , Image Interpretation, Computer-Assisted/methods , Eyelid Diseases/physiopathology , Eyelid Diseases/diagnostic imaging , Reference Values , Software , Photography/methods , Observer Variation , Prospective Studies , Reproducibility of Results , Eyelids/physiopathology , Eyelids/diagnostic imaging
14.
Coluna/Columna ; 19(1): 22-25, Jan.-Mar. 2020. tab, graf
Article in English | LILACS | ID: biblio-1089634

ABSTRACT

ABSTRACT Objective The objective of this study was to analyze the intraobserver and interobserver reliability of the Lenke classification among spine surgeons from the city of Salvador, Bahia. Methods Preoperative imaging (front, profile and lateral inclinations) examinations of 20 patients at the Outpatient Clinic of the of Santa Izabel Hospital Orthopedic Department, Salvador, Bahia, who had been diagnosed with adolescent idiopathic scoliosis, were selected to be evaluated by 15 spine surgeons two times at an interval of 30 days, for analysis of the intraobserver and interobserver reliability of the Lenke classification. The project was first submitted for ethical analysis to the Institutional Review Board of the Santa Izabel Hospital - Santa Casa de Misericórdia da Bahia / Prof. Dr. Celso Figueirôa and approved with voucher number 002650/2019. All the participants signed the Informed Consent Form (ICF). Results Analyzing the concordance using the Kappa index, interobserver reproducibilities of 0.755, 0.525 and 0.840 were obtained for the type of curve and the lumbar and sagittal modifiers, respectively, while the intraobserver reliabilities for the same parameters were 0.921, 0.370 and 0.929. Conclusion For the study population, the reliability of Lenke's classification was moderate to almost perfect. Level of evidence III; Interobserver and intraobserver reliability.


RESUMO Objetivo O objetivo do presente trabalho consiste em analisar a confiabilidade intraobservador e interobservador da classificação de Lenke entre cirurgiões de coluna da cidade de Salvador, Bahia. Métodos Foram selecionados exames de imagem pré-operatórios (frente, perfil e inclinações laterais) de 20 pacientes acompanhados no Ambulatório de Coluna do Departamento de Ortopedia do Hospital Santa Izabel, Salvador, Bahia, com diagnóstico de escoliose idiopática do adolescente, para serem avaliados por 15 cirurgiões de coluna, em dois momentos, com intervalo de 30 dias, para análise da confiabilidade intraobservador e interobservador da Classificação de Lenke. O projeto foi, antes de tudo, submetido a análise de ética no CEP Hospital Santa Izabel - Santa Casa de Misericórdia da Bahia/Prof. Dr. Celso Figueirôa e aprovado com número de comprovante 002650/2019. Todos os participantes assinaram o Termo de Livre Consentimento Esclarecido (TCLE). Resultados Analisando-se a concordância por meio do índice Kappa, obteve-se uma reprodutibilidade interobservador de 0,755, 0,525 e 0,840, respectivamente, para o tipo de curva, modificador lombar e sagital, já a confiabilidade intraobservador é de 0,921, 0,370 e 0,929, respectivamente para o tipo de curva, modificador lombar e modificador sagital. Conclusão Para a população em estudo, a confiabilidade da classificação de Lenke é de moderada a quase perfeita. Nível de evidência III; Reprodutibilidade interobservador e intraobservador.


RESUMEN Objetivo El objetivo del presente trabajo consiste en analizar la confiabilidad intraobservador e interobservador de la clasificación de Lenke entre cirujanos de columna de la ciudad de Salvador, Bahia. Métodos Fueron seleccionados exámenes de imagen preoperatorios (frente, perfil e inclinaciones laterales) de 20 pacientes acompañados en el Ambulatorio de Columna del Departamento de Ortopedia del Hospital Santa Izabel, Salvador, Bahia, con diagnóstico de escoliosis idiopática del adolescente, para ser evaluados por 15 cirujanos de columna, en dos momentos, con intervalo de 30 días, para análisis de la confiabilidad intraobservador e interobservador de la Clasificación de Lenke. El proyecto fue, antes que nada, sometido a análisis de ética en el CEP Hospital Santa Izabel - Santa Casa de Misericordia de Bahia/Prof. Dr. Celso Figueirôa y aprobado con número de comprobante 002650/2019. Todos los participantes firmaron el Término de Libre Consentimiento Esclarecido (TCLE). Resultados Analizándose la concordancia por medio del índice Kappa, se obtuvo una reproductibilidad interobservador de 0,755, 0,525 e 0,840, respectivamente, para el tipo de curva, modificador lumbar y sagital, ya la confiabilidad intraobservador es de 0,921, 0,370 e 0,929, respectivamente para el tipo de curva, modificador lumbar y modificador sagital. Conclusión Para la población en estudio, la confiabilidad de la clasificación de Lenke es de moderada a casi perfecta. Nivel de evidencia III; Reproductibilidad interobservador e intraobservador.


Subject(s)
Humans , Scoliosis , Observer Variation , Reproducibility of Results , Classification
15.
Rev. bras. ginecol. obstet ; 42(3): 152-159, Mar. 2020. tab, graf
Article in English | LILACS | ID: biblio-1098863

ABSTRACT

Abstract Objective To analyze the interobserver and intraobserver reproducibility of the visualization and continuity of the juncional zone (JZ) by three-dimensional (3D) ultrasound in infertile women, and to evaluate the sociodemographic, hormonal, and structural factors that influence these assessments. Methods A prospective study conducted at the Assisted Reproductive Technology Unit of Hospital Senhora da Oliveira, in the city of Guimarães, Portugal. Transvaginal 3D ultrasonography was performed, and 2 volumes were generated per case. Two observers who were blinded to each other's work analyzed these volumes, choosing the best coronal section. Four months later, one of the observers performed the same methodology. The JZ visualization was classified as optimal, satisfactory, and unsatisfactory, and the JZ continuity, as continuous and discontinuous. The interobserver and intraobserver agreements were analyzed. The influence of hormonal, structural, and sociodemographic factors on the JZ was evaluated. Results In total, 65 women were included in the present study. The interobserver reproducibility was substantial for JZ visualization and continuity (k = 0.635 and 0.753 respectively), and the intraobserver reproducibility was very good for JZ visualization and continuity (k = 0.884 and 0.816 respectively). Trilaminar endometrial pattern was associated with optimal JZ visualization (p = 0.012). The increase of 1 unit in the level of serum estradiol represents a 9.9% decrease in the odds of unsatisfactory visualization of the JZ (odds ratio [OR] = 0.9; 95% confidence interval [95%CI] = 0.814-0.996; p = 0.042). Endometriosis increases the odds of unsatisfactory visualization by 24 times (OR = 23.7; 95%CI = 1.262-437.057; p = 0.034). The prevalence of discontinuous JZs was of 60%. Myomas and endometriosis were associated with discontinuous JZs (p = 0.034 and 0.016 respectively). Conclusion The assessment of JZ visualization and continuity by 3D ultrasound is reproducible enough to be used in the clinical practice.


Resumo Objetivo Analisar a reprodutibilidade inter e intraobservador da visualização e continuidade da zona juncional (ZJ) por ecografia tridimensional (3D) em mulheres inférteis, e avaliar os fatores sociodemográficos, hormonais e estruturais que afetam essas avaliações. Métodos Um estudo prospectivo conduzido no Centro de Procriação Medicamente Assistida do Hospital Senhora da Oliveira, em Guimarães, Portugal. Foi realizada ecografia transvaginal 3D e gerados 2 volumes por caso. Dois observadores, cegos às avaliações um do outro, analisaram os volumes obtidos e escolheram o melhor corte coronal. Após quatro meses, a mesma análise foi realizada por um dos observadores. A visualização da ZJ foi classificada como ótima, satisfatória e não satisfatória, e a continuidade, como contínua ou descontínua. Foram avaliadas as reprodutibilidades inter e intraobservador. A influência de fatores sociodemográficos, hormonais e estruturais na ZJ foi analisada. Resultados No total, 65 mulheres foram incluídas no presente estudo. A reprodutibilidade interobservador foi substancial para a visualização e continuidade da ZJ (k = 0,635 e 0,753, respetivamente). A reprodutibilidade intraobservador foi muito boa para a visualização e continuidade da ZJ (k = 0,884 e 0,816, respetivamente). Endométrio trilaminar associou-se à visualização ótima da ZJ (p = 0.012). O aumento de 1 unidade no nível de estradiol diminuiu a chance de visualização não satisfatória da ZJ em 9,9% (razão de probabilidades [RP] = 0,9; intervalo de confiança de 95% [CI95%] = 0,814-0,996; p = 0,042). Endometriose aumentou a chance de visualização não satisfatória da ZJ em 24 vezes (RP = 23,7; CI95% = 1,262-437,057; p = 0,034). A prevalência de ZJs descontínuas foi de 60%. Miomas e endometriose associaram-se a ZJs descontínuas (p = 0,034 e 0,016, respetivamente). Conclusão A avaliação da visualização e continuidade da ZJ por ecografia 3D é reprodutível, podendo ser utilizada na prática clínica.


Subject(s)
Humans , Female , Adult , Young Adult , Endometrium/diagnostic imaging , Infertility, Female , Myometrium/diagnostic imaging , Observer Variation , Prospective Studies , Reproducibility of Results , Ultrasonography , Imaging, Three-Dimensional
16.
Gac. méd. Méx ; 156(1): 22-26, ene.-feb. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1249865

ABSTRACT

Resumen Introducción: Las clasificaciones de Pell y Gregory y de Winter son básicas en la categorización de terceros molares; la clasificación de Sánchez Torres es usada en México, pero no había sido evaluada previamente. Objetivo: Evaluar el grado de acuerdo en la valoración radiográfica de terceros molares mandibulares impactados, con el empleo de tres clasificaciones: Pell y Gregory, Winter y Sánchez Torres. Método: Estudio observacional, descriptivo, de concordancia interobservador, que incluyó a 10 cirujanos orales y maxilofaciales y 10 residentes en formación, quienes registraron la categorización radiográfica de terceros molares mandibulares (izquierdos y derechos) de acuerdo con las clasificaciones de Pell y Gregory, Sánchez Torres y Winter. Se evaluó el grado de acuerdo entre observadores mediante la prueba de kappa de Fleiss. Resultados: La clasificación de Pell y Gregory obtuvo el menor grado de acuerdo (kappa = 0.05 y 0.185), seguida de la clasificación de Sánchez Torres (kappa = 0.125 y 0.326); el mejor valor lo obtuvo la clasificación de Winter, con kappa = 0.28 y 0.636 para cirujanos orales y maxilofaciales y residentes en formación, respectivamente. Conclusión: La clasificación de Winter mostró un grado de acuerdo aceptable (moderado) para categorizar terceros molares mandibulares en los residentes en formación.


Abstract Introduction: Pell & Gregory and Winter classifications are basic in third molar categorization; Sánchez-Torres classification is used in Mexico, but it has not been previously evaluated. Objective: To assess the degree of agreement in the radiographic evaluation of impacted mandibular third molar with the use of three classifications: Pell & Gregory, Winter and Sánchez-Torres. Method: Observational, descriptive, inter-observer degree of agreement study that included 10 oral and maxillofacial surgeons and 10 training residents, who recorded the radiographic categorization of third mandibular molars (left and right) according to Pell and Gregory, Sánchez-Torres and Winter classifications. Inter-observer degree of agreement was assessed with Fleiss' kappa test. Results: Pell and Gregory classification obtained the lowest degree of agreement (kappa = 0.05 and 0.185), followed by Sánchez-Torres classification (kappa = 0.125 and 0.326); Winter had the best agreement, with kappa = 0.28 and 0.636 for oral and maxillofacial surgeons and training residents, respectively. Conclusion: The Winter classification showed an acceptable (moderate) degree of agreement to classify mandibular third molars by training residents.


Subject(s)
Humans , Tooth, Impacted/classification , Oral and Maxillofacial Surgeons , Molar, Third/diagnostic imaging , Tooth, Impacted/diagnostic imaging , Observer Variation , Internship and Residency , Mandible , Mexico
17.
Braz. j. infect. dis ; 24(1): 58-64, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1089331

ABSTRACT

ABSTRACT Background: Although performance of rapid immunochromatographic tests (RITs) for dengue virus (DENV) serotypes 1, 2 and 3 is relatively settled, evidence on accuracy of RITs for DENV-4 are based on studies with small sample sizes and with discrepant results. Objectives: To assess accuracy and inter-observer agreement of RITs targeting dengue nonstructural protein-1 (NS1) antigen - Dengue NS1-Bioeasy™, Dengue NS1 Ag Strip-Bio-Rad™, IVB Dengue Ag NS1-Orangelife™ and Dengue NS1-K130-Bioclin™ in DENV-4 samples. Methods: Study sample (n = 324) included adults presenting at an emergency unit in Rio de Janeiro, Brazil, with fever of ≤72 h and two or more dengue symptoms. A serum sample from each patient was tested by each RIT. A positive reverse-transcription polymerase chain reaction was considered as the reference standard for dengue diagnosis. The diagnostic parameters analyzed for each RIT were sensitivity, specificity, positive and negative predictive values, and likelihood ratios. Each RIT was read by homogeneous (two junior nurses) or heterogeneous (one junior nurse and one senior biologist) pairs. Agreement was estimated by simple kappa with 95% confidence interval, positive (Ppos) and negative (Pneg) proportion concordance and prevalence and bias adjusted kappa, rated from poor (k < 0.0) to almost perfect (0.8 < k < 1.0), and perfect (k = 1). Results: NS1 RITs for DENV-4 diagnosis showed high specificity (95.9%-99.4%), but low sensitivity (14.7%-45.4%). Bioeasy™ had the best performance, with a positive likelihood ratio of 26.0 (95% CI: 8.4;81.0). Inter-observer agreement was almost perfect for all evaluated RITs. Mismatches in confirmed dengue were more common for the Bioclin™ (Ppos 88.3-90.0 %) and Orangelife™ (Ppos 91.7-94.1 %) tests. Conclusions: For DENV-4, the tested RITs had high specificity, but lower sensitivity compared to published results for other serotypes. They should not be used for screening purposes. Different brands may have very different performances. This should be considered upon deciding of using RITs in DENV-4 outbreaks.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Chromatography, Affinity/standards , Dengue/diagnosis , Dengue Virus/isolation & purification , Reference Standards , Brazil , Enzyme-Linked Immunosorbent Assay , Observer Variation , Cross-Sectional Studies , Prospective Studies , Reproducibility of Results , Chromatography, Affinity/methods , Sensitivity and Specificity , Reverse Transcriptase Polymerase Chain Reaction , Dengue/immunology , Dengue/virology , Serogroup
18.
Arch. endocrinol. metab. (Online) ; 64(1): 24-29, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088778

ABSTRACT

ABSTRACT Objective A large number of studies have used abdominal computed tomography (CT) to quantify body composition, and different software programmes have been used to perform these analyses. Thus, this comparison is important to enable researchers to know the performance of more accessible software. Subjects and methods Fifty-four abdominal CT scans of obese (BMI 30 to 39.9 kg/m2), sedentary adults (24-41 years) patients from a Brazilian single center were selected. Two software programs were compared: Slice-O-Matic (Tomovision, Canada) version 5.0 and OsiriX version 5.8.5. The body composition analysis were segmented using standard Hounsfield unit (HU) (adipose tissue: -190 to +30 and skeletal muscle: -29 to +150) and measured at the mid third lumbar vertebra (L3) level on a slice showing both transversal processes. Bland-Altman limits of agreement analyses were used to assess the level of agreement between Slice-O-Matic and OsiriX. Results A total of fifty-four participants were evaluated, with majority women (69%), mean of age 31.3 (SD 6.5) years and obesity grade I most prevalent (74.1%). The agreement, in Bland-Altman analysis, between Slice-O-Matic and OsiriX analisys for the muscle mass tissue, visceral adipose tissue and subcutaneous adipose tissue were excellent (≥ 0.954) with P-values < 0.001. Conclusion These findings show that Slice-O-Matic and OsiriX softwares agreement in measurements of skeletal muscle and adipose tissue and sarcopenia diagnosis in obese patients, suggesting good applicability in studies with body composition in this population and clinical practice.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Body Composition , Intra-Abdominal Fat/diagnostic imaging , Subcutaneous Fat/diagnostic imaging , Obesity/diagnostic imaging , Tomography, X-Ray Computed , Observer Variation , Reproducibility of Results , Sedentary Behavior
19.
Article in English | WPRIM | ID: wpr-787135

ABSTRACT

Although microscopic analysis of tissue slides has been the basis for disease diagnosis for decades, intra- and inter-observer variabilities remain issues to be resolved. The recent introduction of digital scanners has allowed for using deep learning in the analysis of tissue images because many whole slide images (WSIs) are accessible to researchers. In the present study, we investigated the possibility of a deep learning-based, fully automated, computer-aided diagnosis system with WSIs from a stomach adenocarcinoma dataset. Three different convolutional neural network architectures were tested to determine the better architecture for tissue classifier. Each network was trained to classify small tissue patches into normal or tumor. Based on the patch-level classification, tumor probability heatmaps can be overlaid on tissue images. We observed three different tissue patterns, including clear normal, clear tumor and ambiguous cases. We suggest that longer inspection time can be assigned to ambiguous cases compared to clear normal cases, increasing the accuracy and efficiency of histopathologic diagnosis by pre-evaluating the status of the WSIs. When the classifier was tested with completely different WSI dataset, the performance was not optimal because of the different tissue preparation quality. By including a small amount of data from the new dataset for training, the performance for the new dataset was much enhanced. These results indicated that WSI dataset should include tissues prepared from many different preparation conditions to construct a generalized tissue classifier. Thus, multi-national/multi-center dataset should be built for the application of deep learning in the real world medical practice.


Subject(s)
Adenocarcinoma , Classification , Dataset , Diagnosis , Learning , Observer Variation , Stomach
20.
Chinese Medical Journal ; (24): 425-430, 2020.
Article in English | WPRIM | ID: wpr-877916

ABSTRACT

BACKGROUND@#Previously, we developed a novel Coronary Artery Tree description and Lesion EvaluaTion (CatLet©) angiographic scoring system, which was capable of accounting for the variability in the coronary anatomy and assisting in the risk-stratification of patients with acute myocardial infarction (AMI). Our preliminary study revealed that the CatLet score better predicted clinical outcomes for AMI patients than the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score. However, the reproducibility of the CatLet score in both inter- and intra-observer remains to be evaluated.@*METHODS@#A total of 30 consecutive AMI patients, admitted in September of 2015, were independently assessed by two experienced interventional cardiologists to evaluate the inter-observer reproducibility of the CatLet score. Another set of 49 consecutive AMI patients, admitted between September and October in 2014, were assessed by one of the two interventional cardiologists on two occasions 3 months apart to evaluate the intra-observer reproducibility of the CatLet score. The weighted kappa was used to express the degree of agreement.@*RESULTS@#The weighted kappa values (95% confidence interval) for the intra- and inter-observer reproducibility of the CatLet Score were 0.82 (0.59-1.00, Z = 7.23, P 22). Regarding the adverse characteristics pertinent to lesions and dominance parameters, the kappa values for the inter-observer variability were 0.80 (0.56-1.00, Z = 6.47, P < 0.001) for total number of lesions, 0.57 (0.28-0.85, Z = 3.03, P < 0.001) for bifurcation, 0.69 (0.43-0.96, Z = 5.06, P < 0.001) for heavy calcification, 1.00 (0.72-1.00, Z = 6.93, P < 0.001) for tortuosity, 0.54 (0.26-0.82, Z = 3.78, P < 0.001) for thrombus, 0.69 (0.48-0.91, Z = 6.29, P < 0.001) for right coronary artery dominance, 0.69 (0.41-0.96, Z = 4.91, P < 0.001) for left anterior descending artery length, and 0.22 (0.06-0.51, Z = 1.56, P = 0.06) for diagonal size. Equivalent values for the intra-observer variability were moderate to almost perfect (range 0.54-1.00).@*CONCLUSIONS@#The reproducibility of the CatLet angiographic scoring system for evaluation of the coronary angiograms ranged from substantial to excellent. The high reproducibility of the CatLet angiographic scoring system will boost its clinical application to patients with AMI.


Subject(s)
Coronary Angiography , Coronary Artery Disease , Humans , Myocardial Infarction/diagnostic imaging , Observer Variation , Reproducibility of Results , Treatment Outcome , Trees
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