Training improves interobserver reliability for the diagnosis of scaphoid fracture displacement

Background The diagnosis of displacement in scaphoid fractures is notorious for poor interobserver reliability.

Questions/purposes We tested whether training can improve interobserver reliability and sensitivity, specificity, and accuracy for the diagnosis of scaphoid fracture displacement on radiographs and CT scans.

Methods Sixty-four orthopaedic surgeons rated a set of radiographs and CT scans of 10 displaced and 10 nondisplaced scaphoid fractures for the presence of displacement, using a web-based rating application. Before rating, observers were randomized to a training group (34 observers) and a nontraining group (30 observers). The training group received an online training module before the rating session, and the nontraining group did not. Interobserver reliability for training and nontraining was assessed by Siegel’s multirater kappa and the Z-test was used to test for significance.

Results There was a small, but significant difference in the interobserver reliability for displacement ratings in favor of the training group compared with the nontraining group. Ratings of radiographs and CT scans combined resulted in moderate agreement for both groups. The average sensitivity, specificity, and accuracy of diagnosing displacement of scaphoid fractures were, respectively, 83%, 85%, and 84% for the nontraining group and 87%, 86%, and 87% for the training group. Assuming a 5% prevalence of fracture displacement, the positive predictive value was 0.23 in the nontraining group and 0.25 in the training group. The negative predictive value was 0.99 in both groups.

Conclusions Our results suggest training can improve interobserver reliability and sensitivity, specificity and accuracy for the diagnosis of scaphoid fracture displacement, but the improvements are slight. These findings are encouraging for future research regarding interobserver variation and how to reduce it further.

Patient safety issues and concerns in Bhutan’s healthcare system: a qualitative study.

This study identified medication errors, healthcare associated infections, diagnostic errors, surgical errors, laboratory errors and a lack of infrastructure to progress patient safety in hospital contexts as major concerns in the resource poor nation of Bhutan. A culturally adaptive Bhutanised approach to redress these concerns and improve patient safety is proposed.

Using the results of diagnostic testing to promote mathematical pedagogical knowledge

Teachers require a range of knowledge bases, including both content knowledge and pedagogical knowledge (Shulman, 1986). In recent times there have been calls from a variety of sources for teacher preparation courses to improve the mathematical knowledge of teachers, particularly primary teachers. These calls have been underlined by the recent formation of bodies such as the Institutes of Teachers in Victoria and NSW, as well as the development of teaching standards by professional bodies including the Australian Association of Mathematics Teachers. Rather than simply adopt a "back-to-basics" approach, work is required that uses the results of educational research to design courses that help pre-service students to understand how and why errors are made (by themselves and by children in their own classrooms). Diagnostic testing of preservice students is the first step in the process. However, it is not enough to simply test students and to remediate their misconceptions. Instead, the aim is to use the results of the testing to improve students' pedagogical knowledge as well as their subject content knowledge. This paper outlines one approach to the use of diagnostic testing with pre-service students and how the results can be used to assist in the development of pedagogical knowledge.

Algebra skills and traps and diagnostic teaching for the future

Explores on some research about teaching and learning algebra and related classroom issues. Diagnostic instruments that may be used by senior secondary teachers in teaching algebra to senior classes; Strategies for remediating algebraic difficulties and misconceptions; Impact of technology on the algebra curriculum; Usefulness of copying algebraic expressions while using Computer Algebra Systems or mathematics processing software in a calculus class.

Geometric shape errors in forging: developing a metric and an inverse model

The complexity of the forging process ensures that there is inherent variability in the geometric shape of a forged part. While knowledge of shape error, comparing the desired versus the measured shape, is significant in measuring part quality the question of more interest is what can this error suggest about the forging process set-up? The first contribution of this paper is to develop a shape error metric which identifies geometric shape differences that occur from a desired forged part. This metric is based on the point distribution deformable model developed in pattern recognition research. The second contribution of this paper is to propose an inverse model that identifies changes in process set-up parameter values by analysing the proposed shape error metric. The metric and inverse models are developed using two sets of simulated hot-forged parts created using two different die pairs (simple and 'M'-shaped die pairs). A neural network is used to classify the shape data into three arbitrarily chosen levels for each parameter and it is accurate to at least 77 per cent in the worst case for the simple die pair data and has an average accuracy of approximately 80 per cent when classifying the more complex 'M'-shaped die pair data.

Mathematical knowledge of some entrants to a pre-service education course

Standards for teaching emphasise the need for teachers to have deep content knowledge. To assess the mathematical knowledge of students enrolling in its B.Ed. program, the University of New England has introduced a mathematics diagnostic test. This work is the first stage of an ongoing research project into the numeracy needs of students entering the B.Ed. program. The test is a pen-andpaper test that replaces previous on-line, multiple-choice tests. This paper reports on the test results, discusses some common errors made by students and outlines the future direction of the research.

Integrating errors into developmental assessment: 'time' for ages 8-13

It is widely agreed that measurement is of paramount importance to students’ overall development in mathematics. This paper describes a developmental ‘map’ of students’ understanding and skills in measurement, focussed on the topic of Time, that integrates correct and incorrect student ideas. The map is based on a Rasch analysis of data from a large-scale UK national survey for standardising assessment for children from 5 to 14 years of age. It is demonstrated how a partial credit strategy enables a developmental map to be constructed to show students’ strengths and weaknesses in a meaningful and useful summative and formative manner. This map provides evidence, of both a summative and a formative nature, which may enable teachers to craft appropriate and successful learning experiences for children.

Carpal tunnel syndrome: diagnostic usefulness of sonography

PURPOSE: To prospectively evaluate accuracy of sonography for diagnosis of carpal tunnel syndrome (CTS) in patients clinically suspected of having the disease in one or both hands.
MATERIALS AND METHODS: A prospective cohort of 133 patients suspected of having CTS were referred to a teaching hospital between October 2001 and June 2002 for electrodiagnostic study. One hundred twenty patients (98 women, 22 men; mean age, 49 years; range, 19–83 years) underwent sonography within 1 week after electrodiagnostic study. Radiologist was blinded to electrodiagnostic study results. Seventy-five patients had bilateral symptoms; 23 patients, right-hand symptoms; and 22 patients, left-hand symptoms (total, 195 symptomatic hands). Cross-sectional area of median nerve was measured at three levels: immediately proximal to carpal tunnel inlet, at carpal tunnel inlet, and at carpal tunnel outlet. Flexor retinaculum was used as a landmark to margins of carpal tunnel. Optimal threshold levels (determined with classification and regression tree analysis) for areas proximal to and at tunnel inlet and at tunnel outlet were used to discriminate between patients with and patients without disease. Sensitivity, specificity, and false-positive and false-negative rates were derived on the basis of final diagnosis, which was determined with clinical history and electrodiagnostic study results as reference standard.
RESULTS: For right hands, sonography had sensitivity of 94% (66 of 70); specificity, 65% (17 of 26); false-positive rate, 12% (nine of 75); and false-negative rate, 19% (four of 21) (cutoff, 0.09 cm2 proximal to tunnel inlet and 0.12 cm2 at tunnel outlet). For left hands, sensitivity was 83% (53 of 64); specificity, 73% (24 of 33); false-positive rate, 15% (nine of 62); and false-negative rate, 31% (11 of 35) (cutoff, 0.10 cm2 proximal to tunnel inlet).
CONCLUSION: Sonography is comparable to electrodiagnostic study in diagnosis of CTS and should be considered as initial test of choice for patients suspected of having CTS.

A diagnostic 'profile' for chance (probability)

This article presents a profiling tools for identifying students knowledge in chance.

Stat5 as a diagnostic marker for leukemia

The Jak-Stat-Socs pathway is an important component of cytokine receptor signaling. Not surprisingly, perturbation of this pathway is implicated in diseases of hematopoietic and immune origin, including leukemia, lymphoma and immune deficiencies. This review examines the role of a key component of this pathway, Stat5. This has been shown to be activated in a variety of leukemias and myeloproliferative disorders, including downstream of a range of key oncogenes where it has been shown to play an important role in mediating their effects. Therefore, Stat5 represents a useful pan-leukemia/myeloproliferative disorder diagnostic marker and key therapeutic end point, as well as representing an attractive therapeutic target for these disorders.

Convergent interviewing : a qualitative diagnostic technique for researchers

Purpose – This paper aims to widen knowledge of and explore how convergent interviewing can be used to identify key issues within an organization.
Design/methodology/approach – This paper introduces the convergent interviewing technique and describes the method of selecting the interview subjects. The construction of a round of interviews is explained. The content of the interviews is described and the particular probing nature of the questions demanded by the convergent interview process is explained. The ways to analyze the full set of interviews for groupings or categories is also described. The case study example of a broad research question about influences on work behaviors in a local government council is used to illustrate the convergent interviewing technique.
Findings – The key issues revealed by using the technique can be subsequently used for a variety of research and consulting purposes and settings. Convergent interviewing is an effective research method, which conserves resources.
Originality/value – Convergent interviewing enables researchers to determine the most important and/or key issues within a population rather than a full list of issues in an organization or barriers to change in a particular organizational context.