Observer variation in assessment of results of surgery for peptic ulceration.

Hall, Robert A.; Horrocks, Jane C.; Clamp, Susan; Dombal, F. T. de

doi:10.1136/bmj.1.6013.814

Cited by 33 publications

(10 citation statements)

References 4 publications

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“…However, as far as the present authors are aware, none of the aforementioned studies demonstrate how to improve the moderate reliability observed in EEG interpretations. In fact there are only a few studies that show how to improve reliability in the clinical laboratory overall 11–13 . It is generally agreed that jointly examining the sources of interrater variability and establishing a consensus guideline to address the uncertainties can enhance the reliability.…”

Section: Introductionmentioning

confidence: 99%

An intervention to improve the interrater reliability of clinical EEG interpretations

Azuma¹,

Hori²,

Nakanishi

et al. 2003

Psychiatry Clin Neurosci

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Several studies have noted modest interrater reliability of clinical electroencephalogram (EEG) interpretations. Moreover, no study to date has investigated a means to improve the observed interrater agreement. The purpose of the present study was to examine (i) the interrater reliability of EEG interpretations among three raters (two psychiatrists and one pediatrician); and (ii) how to improve the reliability by establishing a consensus guideline for EEGinterpretation. Three raters, two psychiatrists and a pediatrician, interpreted 100 consecutive EEG recorded at Tajimi General Hospital. After discussing the results of the first trial, the raters established a consensus guideline for EEG interpretation. They then interpreted 50 consecutive EEG recorded at Nagoya City University Hospital following this guideline. Kappa for global judgment of EEG abnormality in three grades (abnormal/borderline/normal) was 0.42 on the first and 0.63 on the second trial. Kappa significantly improved by using the guideline ( P = 0.004). It is suggested that discussing and establishing the consensus guideline among the raters offers a feasible method to improve interrater reliability in clinical EEG interpretations.

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Section: Introductionmentioning

confidence: 99%

An intervention to improve the interrater reliability of clinical EEG interpretations

Azuma¹,

Hori²,

Nakanishi

et al. 2003

Psychiatry Clin Neurosci

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“…Clinical disagreement over patients' histories is also observed in other studies where clinicians agreed about the history in only 75% of cases [7,8]. It is not less of a problem in the physical examination.…”

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confidence: 73%

“…The diagnostic yield of D-dimer and ventilationperfusion lung scan is reduced in elderly patients [7], while that of lower limb venous compression US increases in parallel with the increasing proportion of patients with PE-associated deep vein thrombosis with older age [8]. On the other hand, the performance of single-detector helical CT is not influenced by increasing age [9], and similar results may be expected for multidetector helical CT.…”

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confidence: 93%

Observer variability in the assessment of clinical probability in patients with suspected pulmonary embolism

Leclercq

Kruip

Gillavry

et al. 2004

Journal of Thrombosis and Haemostasis

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5 Nolan TE, Smith RP, Devoe LD. Maternal plasma D-Dimer levels. in normal and complicated pregnancies. Obstet. Gynaecol. 1993; 81: 235. 6 Observer variability in the assessment of clinical probability in patients with suspected pulmonary embolism Assessment of the clinical pretest probability in patients with clinically suspected pulmonary embolism (PE), based on clinical judgement alone (further referred to as Ôclinical probability estimateÕ) or a structured prediction model, in order to guide further diagnostic testing has aroused new interest. Wells and colleagues derived a clinical model based on information from the medical history, physical examination, blood gas analyses, chest X-ray, electrocardiography and the likelihood of an alternative diagnosis [1]. This model was subsequently simplified [1,2]. These models have now successfully been applied in several management studies in patients with suspected PE [3][4][5]. However, the diagnostic accuracy of the clinical probability assessment in previous studies varied significantly [1][2][3][4]6]. The reasons for this observed heterogeneity in test accuracy is not fully explained. An important determinant of test accuracy is its reproducibility, which so far has not been studied. We therefore evaluated the interobserver variability of the original clinical probability assessment using a previously described structured clinical model. In addition, we compared the results of the clinical model with those of the clinical probability estimate in the same patient as assessed by the same physician.The investigation was performed within the framework of a management study in a large teaching hospital, in which the outcome of the clinical probability was used in combination with a D-dimer test to guide further diagnostic and therapeutic management [4]. In consecutive in-and outpatients with clinically suspected PE, clinical probability was assessed by two independent physicians using estimate and a structured clinical model as described by Wells and colleagues (further referred to as Ôextended clinical modelÕ) with the classification of low, moderate or high probability of PE [1]. After completion of the study, the obtained information was used to calculate the result (low, moderate or high and unlikely or likely probability) of the simplified clinical model, as described by Wells and colleagues [2]. The primary analysis was performed in the patient group with a duplicate assessment of the clinical probability of PE using the extended and simplified clinical model. The agreement between distinct observers was expressed by a weighted kappa (j). A weighted j value of 1 corresponds to perfect agreement, 0 to agreement as expected by chance. We also calculated a weighted j for the agreement between the results of the extended clinical model and the clinical probability estimate.In a total of 45 consecutive patients independent, duplicate assessments of the clinical pretest probability of PE using the clinical model were available for analyses. Of the 45 patients, 13 h...

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“…'Regurgitation' and 'acid brash' refer to regurgitation of bitter, sour or acid fluid into the mouth so that an effort has to be made either to spit the fluid out or to swallow it again. Symptoms were graded using the York classification (Hall et al, 1976 help to reduce observer error in grading (De Dombal and Horrocks, 1975). There was no significant difference between the two groups regarding postoperative symptoms (Table ZV) apart from the incidence of de nouo acid brash (PGV group 6 of 28, PGV and gastropexy group 0 of 17) and the amelioration in PGV and gastropexy cases of heartburn and acid brash in grade 3 refluxers (Table V ) .…”

Section: Clinical Descriptionmentioning

confidence: 99%

The combination of proximal gastric vagotomy with a rotational posterior gastropexy for duodenal ulcer

Hancock¹,

Sankar²,

Old³

et al. 1978

British Journal of Surgery

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(Fuber et al., 1975) We have now applied Maybury's criterion (Maybury et al., 1977) Patients and methodsBetween September 1971 and February 1977, 98 duodenal ulcerpatients had either a proximal gastric vagotomy (46 cases) or a proximal gastric vagotomy combined with a rotational posterior gastropexy (52 cases). Randomization was not carried out because 28 patients with grade 3 oesophageal reflux symptoms had a PGV and gastropexy while only 5 such cases had a PGV alone. Also the PGV series was started 5 months earlier than the PGV and gastropexy series. However, the two groups matched well in respect of age, sex, weight and symptoms.Despite non-randomization, we think the results of the two operations can be fairly compared. It might be argued that the first 10 or so operations constituted a 'learning period' during which vagotomy might be expected to be incomplete. In fact, on insulin testing at 1 year or more postoperatively, only 1 of the first 9 PGV patients (completed before the PGV and gastropexy series was started) was Faber positive (Faber et al., 1975). This compares with 9 Faber positives out of a total of 31 tests carried out in males after PGV. If the runs test for randomness is applied to the Faber positives they are found to be evenly scattered through the group of male PGV insulin tests. Similarly, the runs test shows an even scatter of Maybury positives (Maybury et al., 1977) through the whole group of insulin tests carried out after both PGV and PGV and gastropexy in both males and females. In this respect the series is not non-random.One of us (D. M. H.), who carried out most of the operations, was taught the technique of highly selective vagotomy (HSV) or proximal gastric vagotomy by Professor David Johnston before commencing this work. By this procedure the body, fundus, cardia and lower 4-5 cm of oesophagus are denervated, preserving the nerves of Latarjet to the antrum up to 6-7 crn from the pylorus.In PGV and rotational posterior gastropexy the raw areas that have been dissected in PGV are rotated away from each other by suturing the strong sling fibres of Willis at midanterior gastro-oesophageal junction level to the tough pre-aortic fascia. Two or three good sutures leave the oesophagus under slight tension with the fundus rolled up over its front. At this stage a no. 38-40 stomach tube should pass from the oesophagus into the stomach without let o r hindrance. With the large tube in place the anterior fundoplication (which has formed automatically if the pre-aortic fascia sutures have been correctly inserted) is fixed in place by two to three more sutures between the anterior stomach wall and the oesophagus. The gastro-oesophageal fat pad must be excised as the first step after completion of PGV in order to demonstrate the sling fibres of Willis. This procedure produces an intraabdominal segment of oesophagus witha flapvalve at the gastrooesophageal junction. It also separates nerve twigs (cut during PGV) by traction and rotation at gastro-oesophageal level and rotation at lesser cu...

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Observer variation in assessment of results of surgery for peptic ulceration.

Cited by 33 publications

References 4 publications

An intervention to improve the interrater reliability of clinical EEG interpretations

An intervention to improve the interrater reliability of clinical EEG interpretations

Observer variability in the assessment of clinical probability in patients with suspected pulmonary embolism

The combination of proximal gastric vagotomy with a rotational posterior gastropexy for duodenal ulcer

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