Objectives: Clinician reported outcomes (ClinRO's) are often crucial primary endpoints in therapeutic areas where objective clinical assessments are unavailable or infeasible and are routinely used in dermatology clinical trials. Due to the nature and presentation of dermatological symptoms, there is a need for standardized training and assessment in an attempt to reduce variability of subjective ratings and increase data quality. This study assessed the impact of standardising clinician (rater) training on a dermatology outcome measure. Methods: Clinicians were to visually assess severity of dermatological conditions in human examples using a Clinician-Reported Severity Scale ranging from 0 (none), 1 (almost none), 2 (mild), 3 (moderate) to 4 (Severe). Clinician ratings were obtained on example photographic images and on human models. Ratings were recorded for pre-training and post-training and compared to the consensus of an expert panel. Results: 94 clinicians' scores were compared to those from an expert panel through weighted kappa analyses. Pretraining kappa coefficients ranged from 0.33 to 1.00 with a mean of 0.87 and standard deviation of 0.10. Post-training kappa coefficients ranged from 0.90 to 0.98 with a mean of 0.96 and standard deviation of 0.02. A paired t-test comparing pre-and post-training kappa coefficients found a significant increase: M D = 0.09, 95% CI [0.07, 0.11]. t(93) = 8.54, p , .001. Conclusions: Dermatology clinical trials often rely on subjective ClinRO's as common endpoint measures. This research supports that standardization of rater training can help greatly improve data quality of ClinRO's in dermatology clinical trials.
What is all knowledge too but recorded experience, and a product of history: of which, therefore, reasoning and belief, no less than action and passion, are essential materials?" Thomas Carlyle.
The authors have advised on the level of motor vehicle (third party risks) insurance rates of premium in the circumstances under which that business is written in New Zealand and this paper records the approach taken. It has been prepared in the hope that, as no difficult mathematics are involved, the basic ideas may appeal both to actuaries and to persons other than actuaries who are interested in the transaction of non-life insurance. They are relevant not merely to third party motor insurance but also to non-life insurance generally in a situation where insurance is compulsory and the rates of premium are centrally controlled. In those circumstances more sophisticated techniques of deriving premium rates are less necessary.
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