Reliability of the measurement of glenoid bone defect in anterior shoulder instability / 中华医学杂志(英文版)

Background@#The size of the glenoid bone defect is an important index in selecting the appropriate treatment for anterior shoulder instability. However, the reliability of glenoid bone defect measurement is controversial. The purpose of the present study was to investigate the reliabilities of measurements of the glenoid bone defect on computed tomography and to explore the predisposing factors leading to inconsistency of these measurements.@*Methods@#The study population comprised 69 consecutive patients who underwent surgery for recurrent anterior shoulder dislocation in Peking University Fourth School of Clinical Medicine from March 2016 to January 2017. The glenoid bone defect was measured by three surgeons on 'self-confirmed’ and 'designated’ 3-D en-face views, and repeated after an interval of 3 months. Measurements included the ratio of the defect area to the best-fit circle area, and the ratio of the defect width to the diameter of the best-fit circle. The inter- and intra-observer reliabilities of the measurements were evaluated using intraclass correlation coefficients (ICCs). The maximum absolute inter- and intra-observer differences and the cumulative percentages of cases with inter- and intraobserver differences greater than these respective levels were calculated.@*Results@#Almost all linear defect values were bigger than the areal defect values. The inter-observer ICCs for the areal defect were 0.557 and 0.513 in the 'self-confirmed’ group and 0.549 and 0.431 in the 'designated’ group. The inter-observer reliabilities for the linear defect were moderate or fair in the 'self-confirmed’ group (ICC = 0.446, 0.374) and 'designated’ group (ICC = 0.402, 0.327). The ICCs for intra-observer measurements were higher than those for inter-observer measurements. The respective maximum interand intra-observer absolute differences were 13.9% and 13.2% in the 'self-confirmed’ group, and 15.8% and 9.8% in the 'designated’ group.@*Conclusions@#The areal measurement of the glenoid bone defect is more reliable than the linear measurement. The reliability of the glenoid defect areal measurement is moderate or worse, suggesting that a more accurate and objective measurement method is needed in both en-face view and best-fit circle determination. Subjective factors affecting the glenoid bone loss measurement should be minimized.

Evaluation of quality of multivariable logistic regression in Indian medical journals using multilevel modeling approach.

Background: Availability of user-friendly statistical software has increased the application of multivariable logistic regression (MLR) in the medical journal many fold. The reporting quality in terms of checking assumptions, model building strategies, proper coding, and report format need proper care and attention to communicate correct and reliable model results. Objective: The objective of this article is to evaluate the quality of MLR article based on 10-point well establish criteria and to study the factors that may influence the quality. Methods: Study included PubMed indexed Indian medical journals as on March 2010 and published at least ten original articles that applied MLR during 10 years was included in the study. Multilevel modeling was applied to assess the role of journal and article attributes on MLR quality. Results: Twelve out of 39 Indian PubMed indexed journals fulfilled the inclusion criterion. Of a total 5599 original articles in these journals, 262 (4.68%) applied MLR in their study. Conformity of linear gradient assumption for continuous covariate was the least fulfilled criterion. One-third of the MLR articles involved statistician or epidemiologist as co-author, and almost same number of MLR articles' first author was from outside India. The trend of 10-point criteria remained consistent although the number of MLR articles increased over the period. The average quality score was 3.78 (95% confidence interval: 2.97-4.60) out of a possible 10. Larger sample size, involvement of statistician as co-author, non-Indian as the first author, and use of SAS/STATA software increased the quality of MLR articles. Conclusions: The quality of MLR articles in Indian medical journals is lagging behind as compared to the quality of MLR articles published from the United States and Europe medical journals. Joint effort of editors, reviewers, and authors are required to improve the quality of MLR in Indian journals so that the reader gets the correct results.

Impact of Individual, Household and Community Characteristics on Children’s Nutritional Indicators.

This study analyzed WHO-standardized nutritional indicators of children from selected households within communities that were sampled from all districts of Botswana. Data from the 2007 Botswana Family Health Survey were fitted into multilevel models that seek to account for variability due to the macro- and micro-units that have been hierarchically selected. This allowed for estimation of different levels of intraclass correlations while simultaneously assessing the model-fit by accounting for the influence on the nutritional indicators due to the fixed variables attributable to these macro- and micro-units. The results show that variation in nutritional status of under-five children in Botswana is a function of characteristics of the households and communities within which they live. As much as 17% of variation is due to differences in the communities and households. Economic status of households holds an important key in predicting the nutritional status of children.