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Background There are numerous subtypes of basal cell carcinoma (BCC). Defining the histopathologic subtype is an essential element in patient management, but there is little known data regarding interobserver precision in subtyping BCC. Methods We studied interobserver variance between six board-certified dermatopathologists who subtyped 100 BCCs in a blinded fashion. We used kappa statistic to calculate the concordance in suggested subtype by different dermatopathologists. Provided diagnoses were then re-categorized into low-risk and high-risk phenotypes, and kappa statistic for concordance on high-risk BCC was determined. Results The overall κ statistic was 0.301, indicating fair agreement among the six observers. Superficial and fibroepithelial BCC had the highest individual kappa statistics. When subtypes were re-classified into a two-tier system of high-risk and low-risk phenotypes, there was substantial interobserver agreement on high-risk BCC with a κ statistic of 0.699. Conclusion These results suggest only fair agreement among dermatopathologists on specific BCC subtypes, but substantial agreement on superficial, fibroepithelial and high-risk BCC growth patterns. A simplified classification system comprised of superficial, fibroepithelial, nodular and infiltrative subtypes would increase interobserver precision and facilitate clinical decision-making.

Purpose To identify factors associated with concordance and discordance between clinical and histopathologic diagnoses of oral lichen planus lesions. Materials and Methods A retrospective analysis was conducted on all study cases derived from archival oral pathology reports generated from all cases of oral lichen planus accessioned by the Faculty of Dentistry, University of Malaya. These study cases were diagnosed from January 1980 through December 2010. Predictor variables were diagnosis year, demographics, experience of the examiner, clinical appearance and diagnosis, and final histopathologic diagnosis; these were recorded for each study case. The outcome variable was agreement between the clinical and histopathologic diagnoses, and this was classified as concordant or discordant. Descriptive statistics and multiple linear regression analyses were computed to identify associations between predictors and outcomes. Statistical significance was set at P ≤ .05. Results The sample was composed of 441 study cases with 593 oral mucosal lesions that met the inclusion criteria. The mean age of the sample was 47.5 ± 13.07 years (range, 12 to 82 yr) and 64.4% were female. The mean concordance was 83.2%. Diagnosis year and demographics showed no influence on concordance or discordance. The multiple linear regression model included experience of the examiner, clinical appearance and diagnosis, and final histopathologic diagnosis ( R 2 = 0.82). Except for experience of the examiner ( P = .12), clinical appearance and diagnosis and final histopathologic diagnosis were the variables statistically associated with concordance ( P ≤ .01). Conclusions The present results suggest that concordance is governed primarily by the clinical appearance and diagnosis of the lesion and the final histopathologic diagnosis.

Objective Evaluating correlation estimation between diagnostic ultrasound (U.S.) of breast lesions and fine needle aspiration cytology (FNAC), and the correlation between cytology and histology (I) of these lesions undergo surgery. Materials and methods In 2010 we performed 1589 ultrasound breast. We identified 210 suspicious lesions to be subjected to FNAC, which was performed with pathologist on site, and extemporaneous analysis of the sample to assess their appropriateness. We classified the lesions in 5 ultrasound (U) classes according to the criteria defined by Echographic BIRADS Lexicon. The results of cytology were classified in 5 classes (C) according to the guidelines of F.O.N.Ca.M. Then we evaluated the diagnostic correlation between U.S. and FNAC, and between FNAC and Histology. Results The distribution of lesions in U classes was: 57U2, 55U3, 36U4 and 62U5. The diagnostic concordance between U and FNAC was 96.7%, with a sensitivity of 98%, specificity 93%, negative and positive predictive value respectively of 94.9% and 97.3%, and diagnostic accuracy of 96.6%. The 98 patients with C4-C5 lesions were subjected to surgery and the histology confirmed high-grade malignancy of lesions with a concordance of 99.7%. Conclusions Having achieved high diagnostic concordance between U and FNAC, and then between FNAC and histology, we may say that the FNAC, less invasive and traumatic for the patient than needle biopsy (CB), may be still a valid method when performed with pathologist on-site to assess the adequacy of the sample taken.

OBJETIVO: Determinar a reprodutibilidade da pressão arterial casual de participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) e confirmar o diagnóstico pressórico pela monitorização.MÉTODOS: A pressão arterial casual foi medida em aparelho oscilométrico. Uma subamostra dos participantes do estado do Espírito Santo (N = 255) foi reavaliada com igual metodologia de uma a dez semanas após; além disso, foi realizada monitorização. O diagnóstico de hipertensão seguiu os pontos de corte de 140/90 mmHg ou 130/80 mmHg para a pressão casual e na monitorização, respectivamente. A hipertensão do jaleco branco foi definida pela presença hipertensão na medida casual e normotensão na monitorização e o inverso para a hipertensão mascarada.RESULTADOS: Os dados referem-se a 230 participantes que nas duas ocasiões estavam sem medicação (N1 = 153) ou sob a mesma medicação anti-hipertensiva (N2 = 77). No N1, a normotensão casual foi confirmada em 120 dos 134 pela monitorização. No N2, a monitorização confirmou o controle pressórico em 43 dos 54 participantes com pressão controlada pela medida casual. A concordância geral de diagnósticos entre a pressão casual e monitorada foi de 78% (kappa = 0,44). No grupo N1, seis indivíduos (4%) apresentaram hipertensão do jaleco branco e 23 (25%), mascarada.CONCLUSÕES: A concordância de diagnósticos entre a pressão arterial casual e a monitorada foi moderada. A padronização rigorosa da medida casual adotada no ELSA-Brasil foi capaz de reduzir a hipertensão do jaleco branco. A alta frequência de hipertensão mascarada sugere que a medida pressórica da monitorização indique grau elevado de estresse no trabalho. OBJECTIVE: To determine the reproducibility of casual arterial pressure measurement and to confirm pressure diagnosis by monitoring of participants in the ELSA-Brasil (Estudo Longitudinal de Saúde do Adulto - Brazilian Longitudinal Study for Adult Health).METHODS: Casual blood pressure was measured with an oscilometric device. A sub-sample of participants (N = 255) from Espírito Santo state (Southeastern Brazil) was reevaluated using the same methodology following one to ten weeks and, in addition, underwent arterial blood pressure monitoring. Diagnosis of hypertension used cut off points of 140/90 mmHg for casual pressure and 130/80 mmHg for arterial blood pressure monitoring. White coat hypertension was defined as the presence of hypertension in casual blood pressure and normal arterial blood pressure monitoring, and converse findings characterized masked hypertension.RESULTS: Data are from 230 participants that on the two occasions were free from antihypertensive medication (N1 = 153) or under the same antihypertensive regimen (N2 = 77). Normotension was confirmed by arterial blood pressure monitoring in120 out of 134 participants of the N1 group. In N2, blood pressure control was confirmed by arterial blood pressure monitoring in 43 of 54 participants with controlled hypertension per casual blood pressure. Overall diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was 78% (kappa = 0.44). In the N1 group, six subjects (4%) presented white coat hypertension, and 23 subjects (25%) presented with masked hypertension.CONCLUSIONS: Diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was moderate. The rigorous standardization of casual blood pressure measurement adopted in the ELSA-Brasil study was able to reduce white coat hypertension. The high frequency of masked hypertension may suggest that pressure values obtained by arterial blood pressure monitoring indicate an elevated degree of stress at work.

Assessment of lower extremity bilateral asymmetries in soccer players is important for both injury prevention and performance. The purpose of this investigation was to compare isokinetic knee extensor assessment of asymmetry with a more specific countermovement jump (CMJ). Forty-six Brazilian male professional soccer players participated in this study. The maximal power, maximal force and impulse were determined during CMJ and the total work and peak torque at 60, 180, and 300°·s during isokinetic leg extension, separately for each leg. Factor analysis was performed for all investigated variables, and the diagnostic concordance between different criteria was analyzed by McNemar's χ test. The factor analysis showed that the isokinetic and CMJ tests were widely independent methods for the assessment of bilateral differences. Concordance of the diagnostic information could only be found between the maximal force during CMJ and the total work and peak torque at 180 and 300°·s during isokinetic leg extension. Impulse and maximal power during CMJ on a double force platform appear to be appropriate additional variables for the identification of bilateral differences. Therefore, it might be pertinent to perform, in addition to isokinetic assessment, a vertical jump test on a force platform to assure widespread and reliable diagnostic information.

Objective This study aims to investigate the diagnostic concordance between skeletal cephalometrics and soft-tissue cephalometrics in identifying facial lower third characteristics. Materials and methods We compared a skeletal cephalometric analysis (SCA) to a soft-tissue analysis performed on cephalometric radiographs (rSTCA) and to one performed on profile photograph (pSTCA). Ninety-six pre-treatment digital lateral cephalometric radiographs and 96 digital profile photographs were randomly selected for this study (patients' mean age: 18.33, SD: 3.38, age range: 14-29). Inclusion criteria were as follows: no skeletal asymmetry, well-aligned upper and lower dental arches, no history of orthodontic treatment, prosthodontic treatment, facial surgery and trauma, patient's age between 14 and 30 years, high-resolution images, exams taken with natural head position. Kruskas-Wallis and post hoc pairwise comparisons tests were used to find differences among the considered cephalometric methods. The diagnostic performance of the three methods was also assessed using the receiver-operating characteristic (ROC) curve analysis. Results Significant differences were found between SCA and rSTCA and between SCA and pSTCA in defining sagittal and vertical facial lower third characteristics (P 0.05) for the same facial characteristics. For each parameters investigated, pSTCA showed an area under the curve much closer to the perfect value of 1.00. Conclusion Poor diagnostic concordance was found between SCA and rSTCA and between SCA and pSTCA. pSTCA is a reliable method for evaluating the soft-tissue profile characteristics compared to that performed on cephalograms.

Previous concordance studies examining accuracy of breast diagnosis by pathologists, typically targeting difficult, histologically challenging breast lesions using artificial and restrictive environments, have reported aberrantly high levels of diagnostic discordance. The results of these studies may be misinterpreted by non-pathologists and raise concerns relating to routine practice. This study aims to assess the diagnostic agreement among UK breast pathologists.Two hundred and forty consecutive breast lesions, submitted by participants from their routine practice, included in the UK National Health Service Breast Screening Programme (NHSBSP) breast pathology EQA scheme during the last 10 years were reviewed. An average of approximately 600 participants viewed each case. Data on diagnostic categories (benign, atypical, in-situ malignant and invasive malignant) were collected. In this study, benign and atypical diagnoses were grouped together.The overall diagnostic agreement level was in the almost perfect range. Thirty-five cases (14.6%) showed diagnostic concordance of ≤95%. Reasons for discordance included one or more of: (1) scheme methodology limitations such as: (i) miscoding of certain lesions (e.g. phyllodes tumours and lobular neoplasia) (n = 7) and (ii) variable representation of the index lesion on glass slides (n = 18); and (2) diagnostically challenging cases that may be interpreted more easily using immunohistochemistry (n = 28). These latter included benign and malignant papillary lesions (n = 12), complex sclerosing lesions (n = 7), intraductal epithelial proliferative lesions (n = 6) and an unusual special tumour type (n = 1). Further review identified pathologists' misinterpretation in 13 cases (5.4%), with an average discordance rate of only 4.2%.The performance of breast pathologists is high. Exclusion of the effect of the scheme methodology limitations highlights further the high performance rate and identifies true diagnostically challenging entities. These difficult cases may benefit from additional diagnostic work-up and second opinions.

BACKGROUND Recently, a 23‐gene signature was developed to produce a melanoma diagnostic score capable of differentiating malignant and benign melanocytic lesions. The primary objective of this study was to independently assess the ability of the gene signature to differentiate melanoma from benign nevi in clinically relevant lesions. METHODS A set of 1400 melanocytic lesions was selected from samples prospectively submitted for gene expression testing at a clinical laboratory. Each sample was tested and subjected to an independent histopathologic evaluation by 3 experienced dermatopathologists. A primary diagnosis (benign or malignant) was assigned to each sample, and diagnostic concordance among the 3 dermatopathologists was required for inclusion in analyses. The sensitivity and specificity of the score in differentiating benign and malignant melanocytic lesions were calculated to assess the association between the score and the pathologic diagnosis. RESULTS The gene expression signature differentiated benign nevi from malignant melanoma with a sensitivity of 91.5% and a specificity of 92.5%. CONCLUSIONS These results reflect the performance of the gene signature in a diverse array of samples encountered in routine clinical practice. Cancer 2017;123:617–628. © 2016 American Cancer Society., A 23‐gene signature has recently been developed to differentiate malignant and benign melanocytic lesions. This study shows that the gene expression signature differentiates benign nevi from malignant melanoma with a sensitivity of 91.5% and a specificity of 92.5% in comparison with a triple‐concordant histopathologic review.

Context.—Light microscopy (LM) is considered the reference standard for diagnosis in pathology. Whole slide imaging (WSI) generates digital images of cellular and tissue samples and offers multiple advantages compared with LM. Currently, WSI is not widely used for primary diagnosis. The lack of evidence regarding concordance between diagnoses rendered by WSI and LM is a significant barrier to both regulatory approval and uptake.Objective.—To examine the published literature on the concordance of pathologic diagnoses rendered by WSI compared with those rendered by LM.Data Sources.—We conducted a systematic review of studies assessing the concordance of pathologic diagnoses rendered by WSI and LM. Studies were identified following a systematic search of Medline (Medline Industries, Mundelein, Illinois), Medline in progress (Medline Industries), EMBASE (Elsevier, Amsterdam, the Netherlands), and the Cochrane Library (Wiley, London, England), between 1999 and March 2015.Conclusions.—Thirty-eight studies were included in the review. The mean diagnostic concordance of WSI and LM, weighted by the number of cases per study, was 92.4%. The weighted mean κ coefficient between WSI and LM was 0.75, signifying substantial agreement. Of the 30 studies quoting percentage concordance, 18 (60%) showed a concordance of 90% or greater, of which 10 (33%) showed a concordance of 95% or greater. This review found evidence to support a high level of diagnostic concordance. However, there were few studies, many were small, and they varied in quality, suggesting that further validation studies are still needed.

Hand injuries are common, contributing up to 30% of accident and emergency (AE) attendances. The aim of this study was to prospectively analyse the pathological demographics of hand injuries in a level 1 trauma centre with a Hand Trauma Unit and direct AE links, and compare clinical and intra-operative findings. The null hypothesis was that there would be no differences between clinical and intra-operative findings (100% diagnostic concordance).Data were prospectively collected for referrals during 2012. Referral diagnosis, additional pathologies found on clinical assessment and intra-operative findings were documented on a live database accessible from both the Hand Unit and associated operating theatres. Odds ratios were calculated using SAS.Injuries (1526) were identified in 1308 patients included in the study. Diagnostic concordance between Hand Unit clinical examination and intra-operative findings was 92.5% ± 2.85% (mean ± SEM); this was lower for flexor tendon injuries (56.3%) because a greater number of additional pathologies were found intra-operatively (2.25 ± 0.10). This 'trend' was noted across multiple referral pathologies including phalangeal fractures (1.28 ± 0.02; 82.9%), lacerations (1.33 ± 0.04; 79.1%), extensor tendon injuries (1.30 ± 0.05; 87.8%) and dislocations (1.18 ± 0.05; 87.8%). Odds ratio analysis indicated a relationship between primary referral diagnoses that were more or less likely to be associated with additional injuries (p 0.05); referral diagnoses of flexor tendon injuries and lacerations were most likely to be associated with additional injuries.As hand injuries are a common presentation to AE departments, greater emphasis should be placed on training clinicians in the management of hand trauma. Our findings, coupled with the presented relevant literature reports, lead us to advocate that AE departments should move towards a system wherein links to specialist hand trauma services are in place; we hereby present useful data for hospitals implementing such services.

The persistence of attention-deficit/hyperactivity disorder (ADHD) into adulthood, particularly in women, is an unresolved question. Using a diverse, prospectively followed female sample (ADHD: n = 140; comparison: n = 88), we examined (a) informant (parent- vs. self-report) and (b) symptom threshold (DSM-IV cutoffs vs. a developmentally referenced criterion [DRC]) with respect to estimates of ADHD persistence into young adulthood (M = 19.6 years). We also ascertained the linkages of ADHD status (as measured by each informant and via the different symptom cutoffs) with impairment in key outcome domains. Informant diagnostic concordance was significant but small (κ = 0.22). Via parent report, more childhood-ascertained probands (44 %) than comparison participants (1 %) met full ADHD criteria in adulthood (p

Background: Digital slides obtained from whole slide imaging (WSI) platforms are typically viewed in two dimensions using desktop personal computer monitors or more recently on mobile devices. To the best of our knowledge, we are not aware of any studies viewing digital pathology slides in a virtual reality (VR) environment. VR technology enables users to be artificially immersed in and interact with a computer-simulated world. Oculus Rift is among the world′s first consumer-targeted VR headsets, intended primarily for enhanced gaming. Our aim was to explore the use of the Oculus Rift for examining digital pathology slides in a VR environment. Methods: An Oculus Rift Development Kit 2 (DK2) was connected to a 64-bit computer running Virtual Desktop software. Glass slides from twenty randomly selected lymph node cases (ten with benign and ten malignant diagnoses) were digitized using a WSI scanner. Three pathologists reviewed these digital slides on a 27-inch 5K display and with the Oculus Rift after a 2-week washout period. Recorded endpoints included concordance of final diagnoses and time required to examine slides. The pathologists also rated their ease of navigation, image quality, and diagnostic confidence for both modalities. Results: There was 90% diagnostic concordance when reviewing WSI using a 5K display and Oculus Rift. The time required to examine digital pathology slides on the 5K display averaged 39 s (range 10-120 s), compared to 62 s with the Oculus Rift (range 15-270 s). All pathologists confirmed that digital pathology slides were easily viewable in a VR environment. The ratings for image quality and diagnostic confidence were higher when using the 5K display. Conclusion: Using the Oculus Rift DK2 to view and navigate pathology whole slide images in a virtual environment is feasible for diagnostic purposes. However, image resolution using the Oculus Rift device was limited. Interactive VR technologies such as the Oculus Rift are novel tools that may be of use in digital pathology.

Introduction The diagnosis of cutaneous pigmented lesions remains a challenge for both dermatologists and pathologists. Our aim was to determine the diagnostic concordance between the conventional face-to-face diagnosis and the telediagnosis of 10 dermatologists with expertise in dermato-oncology of 10 challenging pigmented lesions. Methods Using a store-and-forward teledermatology method, clinical and dermoscopic digital images of all selected lesions were transmitted via e-mail to 10 dermatologists. Dermatologists were called to provide their telediagnoses with a step-by-step approach. When the dermatologists responded with their first clinical telediagnosis, they received a second email that contained dermoscopic images of the 10 cases. Final histopathological diagnosis was considered the gold standard for comparison with face-to-face and teledermatology diagnoses in statistical analysis. Results Face-to-face results indicated moderate agreement between clinical and histopathological diagnoses (K = 0.6). After the first clinical step, interobserver concordance of telediagnosis was lower than face-to-face diagnosis (K = 0.52). After the second dermoscopy step, the concordance declined further (K = 0.38). Conclusions Teledermatology was inferior to face-to-face dermatology. Moreover, the diagnostic concordance of telediagnosis decreased after the teledermoscopic step. This finding may be justified by the dermoscopic difficulty of the selected lesions, including Spitzoid proliferations and atypical melanocytic nevi of the elderly. These lesions may represent a potential diagnostic pitfall given their confounding dermoscopic aspects.

OBJECTIVES To compare the images of the mental canal in panoramic radiography (PR) and computed tomography (CT) by analyzing the concordance with diagnostic tests and examiners. MATERIAL AND METHODS The position of the mental foramen (MF), distance to the lower mandibular border, anterior length of the mental loop (ML), agreement between examiners and diagnostic concordance were registered in 50PR and 50CT. RESULTS ML was identified (34.5/41%, PR/CT). PR magnification was 36.6% higher than in CT. The anterior extension and distance to the inferior border of the MF was higher for PR (2-6.2 mm). Inter-examiner agreement on CT was good (κ = 0.628) and very good on PR (κ = 0.845). CONCLUSION There is a magnification (36.6%) of the images in PR with respect to the CT. Identification of MF and ML is not related to the bone quality. Inter-examiner agreement is better on PR.

The use of high-resolution digital images of histopathology slides as a routine diagnostic tool for surgical pathology was investigated. The study purpose was to determine the diagnostic concordance between pathologic interpretations using whole-slide imaging and standard light microscopy. Two hundred fifty-one consecutive surgical pathology cases (312 parts, 1085 slides) from a single pathology service were included in the study after cases had been signed out and reports generated. A broad array of diagnostic challenges and tissue sources were represented, including 52 neoplastic cases. All cases were digitized at ×20 and presented to 2 pathologists for diagnosis using whole-slide imaging as the sole diagnostic tool. Diagnoses rendered by the whole-slide imaging pathologists were compared with the original light microscopy diagnoses. Overall concordance between whole-slide imaging and light microscopy as determined by a third pathologist and jury panel was 96.5% (95% confidence interval, 94.8%-98.3%). Concordance between whole-slide imaging pathologists was 97.7% (95% confidence interval, 94.7%-99.2%). Five cases were discordant between the whole-slide imaging diagnosis and the original light microscopy diagnosis, of which 2 were clinically significant. Discordance resulted from interpretive criteria or diagnostic error. The whole-slide imaging modality did not contribute to diagnostic differences. Problems encountered by the whole-slide imaging pathologists primarily involved the inability to clearly visualize nuclear detail or microscopic organisms. Technical difficulties associated with image scanning required at least 1 slide be rescanned in 13% of the cases. Technical and operational issues associated with whole-slide imaging scanning devices used in this study were found to be the most significant obstacle to the use of whole-slide imaging in general surgical pathology.

Gunderson (2010) recently offered a sharp criticism of the draft proposal for diagnosing personality disorders in DSM-5. Based on a review of phenomenological, factor analytic, social psychology, family, neurobiological, and treatment studies of borderline personality disorder (BPD), he proposed an alternative revision of the BPD criteria. One of the suggested changes was a modification of the DSM-IV diagnostic algorithm. Gunderson did not, however, provide any data on the impact this new diagnostic algorithm would have on the prevalence of BPD, or the validity of this alternative approach compared to the DSM-IV algorithm. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project we administered semi-structured diagnostic interviews to 3,081 psychiatric outpatients and examined diagnostic concordance between DSM-IV and Gunderson's proposal, and whether there is incremental validity in Gunderson's diagnostic approach. The results did not indicate that...

Teledermatology is the practice of dermatology from a distance and can be used in several ways. This emerging technology has the potential to impact the current health care delivery system and provide dermatology care to a greater number of patients in underserved areas. Current research shows that the diagnostic concordance rates and accuracy rates are high, but there are also limitations with teledermatology use. Nurse practitioners have the potential to become active participants in the practice of teledermatology and ensure the provision of dermatology services to underserved populations.

The aim of this study was to demonstrate the feasibility and usefulness of addition of the right parasternal approach to the conventional left parasternal and apical approaches using two-dimensional (2D) and three-dimensional (3D) transthoracic echocardiography (TTE) for morphologic evaluation in cases of transcatheter closure of atrial septal defects (ASDs).In 112 consecutive patients with ASDs, the morphology of the defects was evaluated for transcatheter closure in the right parasternal view in addition to the conventional left views using 2D and 3D TTE. Measurements of the maximal ASD diameter and detection of deficient rim obtained on 2D TTE were compared with those obtained by 2D transesophageal echocardiography. The shapes and locations of ASDs visualized by 3D TTE were compared with those visualized by 3D transesophageal echocardiography.In 88 patients (80.0%), optimal images from the right parasternal approach for morphologic evaluation of ASDs were obtained. Although there was a significant difference in maximal ASD diameter obtained only in the conventional left approach compared with transesophageal echocardiographic measurements (P.05), when the right parasternal approach was applied, a significant difference was not found (P = .18), and the diagnostic concordance of the rim deficiency was improved from 85.2% to 90.9%. Three-dimensional TTE from the right parasternal approach improved visualization of the shape and location of ASDs from 65.5% to 74.5%.Additional use of the right parasternal approach enables detailed morphologic evaluation for transcatheter closure of ASDs. In patients with suboptimal images on 3D TTE in the left conventional approach, additional 3D TTE in the right parasternal approach can improve the feasibility of obtaining optimal 3D images to evaluate the shapes and locations of ASDs.

The conventional tube test (CTT) and microcolumn gel card test (MG) were used to measure immunoglobulin G (IgG) antibody titres to blood group A (anti-A) and blood group B (anti-B) in 288 serum samples. Diagnostic concordance and correlations between the two methods were analysed. MG was more sensitive than CTT in the detection of both anti-A and anti-B IgG. Correlation coefficients for the two methods for the titration of anti-A and anti-B were 0.8470 and 0.8336, respectively. The regression equation representing the relationship between the two methods was calculated and used to convert critical values for anti-A and anti-B IgG antibodies determined by CTT to critical values for MG titration. Analyses showed 86.8% and 89.9% diagnostic concordant rates for the detection of anti-A and anti-B IgG, respectively. It was concluded that titration results obtained by MG correlate well with those obtained by CTT, but critical values determined by CTT need to be converted into corresponding MG values.

Telemedicine holds promise as a tool for improving the delivery of specialty care, especially in underserved regions, including those in South Africa. However, data that demonstrate the extent of its sustainable benefits to referring providers are currently insufficient. This study investigates whether utilization of a teledermatology network enhances the diagnostic acumen of primary care providers (PCPs) in underserved areas of South Africa.A longitudinal descriptive pilot study was conducted after establishing a telemedicine network linking University of Cape Town dermatology consultants to six providers from five underserved primary care sites using store-and-forward technology between October 2004 and January 2007. Of 120 total referrals, trend analysis was performed using 72 sets of patient histories, digital images, and corresponding consultant responses to evaluate the diagnostic concordance between six PCPs and teleconsultants over 12 consecutive referrals.Strong positive Spearman rank-order correlations were observed between the number of referrals sent per PCP and proportion of primary diagnostic agreement with teledermatologists, rs=0.86 (p0.001). The mean primary diagnostic concordance trend that started at 13% for the first four referrals increased nearly fourfold after referring as few as nine patients to the network.If a simple and inexpensive teledermatology solution is carefully implemented in a resource-limited setting, an improvement of PCP diagnostic acumen can be achieved with a relatively small number of referrals. This educational benefit to referring PCPs could be sustainable and would ultimately enhance the quality of dermatological care in these underserved regions.

Background The expansion of store-and-forward teledermatology into underserved regions of the world has long been hampered by the requirement for computers with Internet connectivity. To our knowledge, this study is one of the first to demonstrate the feasibility of teledermatology using newer-generation mobile telephones with specialized software and wireless connectivity to overcome this requirement in a developing country. Objective We sought to demonstrate that mobile telephones may be used on the African continent to submit both patient history and clinical photographs wirelessly to remote expert dermatologists, and to assess whether these data are diagnostically reliable. Methods Thirty patients with common skin diseases in Cairo, Egypt, were given a diagnosis by face-to-face consultation. They were then given a diagnosis independently by local senior dermatologists using teleconsultation with a software-enabled mobile telephone containing a 5-megapixel camera. Diagnostic concordance rates between face-to-face and teleconsultation were tabulated. Results Diagnostic agreement between face-to-face consultation and the two local senior dermatologists performing independent evaluation by teleconsultation was achieved in 23 of 30 (77%) and in 22 of 30 (73%) cases, respectively, with a global mean of 75%. Limitations Limited sample size and interobserver variability are limitations. Conclusion Mobile teledermatology is a technically feasible and diagnostically reliable method of amplifying access to dermatologic expertise in poorer regions of the globe where access to computers with Internet connectivity is unreliable or insufficient.

ObjectiveIn low resource settings, visual inspection with acetic acid (VIA) by allied health workers, has been suggested as an alternative for cervical cancer screening. However, there are concerns about the objectivity and time to diagnostic concordance with specialists. We evaluated the secular trend in interobserver agreement between nurse providers and a gynecologist/colposcopist over a five-year period.MethodsNurses provided VIA screening with digital cervivography to 4,961 participants in five screening clinics from October 2010 to May 2014 in Nigeria in this observational study. Cervigraphs were reviewed at meetings where a gynaecologist/colposcopist made an assessment from the cervigraphs. We used weighted kappa statistics to calculate agreement in diagnosis between nurse providers and the gynecologist/colposcopist; linear regression models to examine overall trend and investigate potential clinic characteristics that may influence agreement; and time series models to characterize month to month variations.ResultsMean age of participants was 37±8 years. Overall agreement was 0.89 at Site D, 0.78 and 0.73 at Sites A and C respectively, 0.50 for Site E and 0.34 for Site C. The number of trainings attended by nurse providers(β = 0.47,95%CI:0.02-0.93, p = 0.04), high level of engagement by site gynecologists(β = 0.11,95%CI:0.01-0.21,p = 0.04) were associated with increased agreement; while increasing distance from the coordinating site(β = -0.47,95%CI:-0.92-0.02,p = 0.04) was associated with decreased agreement. There were no associations between number of years screening clinics were operational(β = 0.01,95%CI: -0.01-0.03,p = 0.29), cumulative experience of nurse providers(β = 0.04,95%CI:-0.03-0.12,p = 0.19) and agreement. There were no significant increases in weighted kappa statistics over time for all sites considered. Monthly variations were significant for only one of two sites considered in time series models (AR1 term = -0.40, 95%CI:-0.71-0.09,p = 0.01).ConclusionOur results showed a lack of objectivity, persistent variation and lack of convergence of diagnostic capabilities of nurse led VIA cervical cancer screening with the diagnostic capabilities of a specialist in a cervical cancer screening program in Nigeria.

Objective: To analyze the performance of intraoperative cytological diagnosis and its contribution to enhance the diagnostic concordance of intraoperative procedures with definitive histological diagnosis in ovarian lesions. Descriptions of cytologic features of some ovarian lesions as seen in imprint and smear specimens are documented. Advantages and limitations of cytological specimens are underscored. Study Design: We performed a retrospective review of intraoperative consultations of ovarian neoplastic and non-neoplastic lesions of 337 cases identified from the pathologic records of our laboratory. All cases evaluated had intraoperative cytological imprint or smear specimens. The intraoperative diagnosis transmitted to the surgeon was the combined result of a thorough macroscopic study of the surgical specimens, frozen section analysis of tissue samples obtained from the most representative areas, evaluation of smear and imprint cytological specimens, and cyto-histological correlation. The intraoperative diagnosis was compared with the final histological diagnosis. Blinded review of cytological slides in discrepant cases was carried out. Results: Final histological diagnosis showed 268 benign lesions, 49 malignant tumors and 20 borderline epithelial tumors. Diagnostic accuracy was 97%, sensitivity 93%, specificity 98%, positive predictive value 91% and negative predictive value 98%. After the cytological review of the discrepant cases, accuracy increased to 98.5%, specificity to 100%, and positive predictive value to 100%. The sensitivity and negative predictive values did not change, remaining 93 and 98%, respectively. The proportion of false positives dropped from 7 (2.1%) to 0, and the proportion of false negatives from 9 (2.7%) to 5 (1.5%). The new values showed significant differences for specificity (p = 0.0401), positive predictive value (p = 0.0479) and for the proportion of false positives (p = 0.0226). Cytologic evaluation contributed with wider sampling of tumors and excellent cyto-morphological details. Conclusion: Adding cytological evaluation of imprint and smear specimens and cyto-histologic correlation to the traditional gross examination and frozen sections results in better correlation of the intraoperative consultation with the definitive histological diagnosis. In this series cytology was more accurate than frozen sections in some cases. Cytological evaluation of imprints and smears should be considered an important complementary tool in the setting of intraoperative consultation.

Objective: To evaluate the usefulness of a device for collecting and preserving human papilloma virus (HPV) DNA in self-collected vaginal samples stored dry during 14 days. Materials and methods: Diagnostic concordance pilot study that included non-pregnant women over 25 years of age with a biopsy-confirmed result of cervical intraepithelial neoplasia (CIN) grade 1 or more, coming to two referral centres in Bogotá, Colombia. Women with a history of total hysterectomy were excluded. Convenience sampling was used. The device uses real-time PCR (polymerase chain reaction) for DNA detection. Sociodemographic and clinical variables were measured, as well as the results of the test when the sample was collected by the patient and when it was collected by the physician, and the amount of DNA in the samples taken and processed on day 1, and in those processed on day 14, using Ct thresholds. Descriptive statistics were applied. Overall concordance was estimated by means of the kappa coefficient and mean differences in DNA amount. Materials and methods: Diagnostic concordance pilot study that included non-pregnant women over 25 years of age with a biopsy-confirmed result of cervical intraepithelial neoplasia (CIN) grade 1 or more, coming to two referral centres in Bogotá, Colombia. Women with a history of total hysterectomy were excluded. Convenience sampling was used. The device uses real-time PCR (polymerase chain reaction) for DNA detection. Sociodemographic and clinical variables were measured, as well as the results of the test when the sample was collected by the patient and when it was collected by the physician, and the amount of DNA in the samples taken and processed on day 1, and in those processed on day 14, using Ct thresholds. Descriptive statistics were applied. Overall concordance was estimated by means of the kappa coefficient and mean differences in DNA amount. Results: A kappa coefficient of 0.84 (95% CI: 0.71-0.96) was found for concordance in high-risk HPV detection between the self-collected cervicovaginal sample and the sample taken by the clinician. There were no differences in terms of the amount of viral DNA between day 1 and day 14 (DM -0.34 cycles; 95% CI: - 2.29 to 1.61). Conclusion: Self-collected vaginal samples using the storage device are reliable for high-risk HPV detection in patients with cervical dysplasia, and preserve viral DNA for 14 days if stored dry at room temperature. Confirmation studies in the general population are required. RESUMEN Objetivo: Evaluar la utilidad de un dispositivo para toma y preservación del DNA del virus del papiloma humano (VPH) de muestras vaginales recolectadas por autotoma y almacenadas en seco durante 14 días. Materiales y métodos: Estudio piloto de concordancia diagnóstica. Se incluyeron mujeres mayores de 24 años no gestantes con un resultado de neoplasia intraepitelial cervical (NIC) grado 1 o más, confirmado por biopsia en dos instituciones de referencia en Bogotá, Colombia. Se excluyeron mujeres con antecedente de histerectomía total. Se realizó un muestreo por conveniencia. El dispositivo utiliza PCR (reacción en cadena de la polimerasa) en tiempo real para detección del ADN. Se midieron variables sociodemográficas y clínicas, así como el resultado de la prueba por autotoma y tomada por el médico, y la cantidad de ADN de las muestras tomadas el día 1 procesadas ese día, y el día 14, por medio del Ct umbral. Se realizó estadística descriptiva. Se calculó la concordancia global por medio del índice de kappa ponderado y la diferencia de medias de la cantidad de ADN. Resultados: La concordancia en la detección de VPH de alto riesgo mostró un kappa = 0,84 (IC 95 %: 0,71-0,96) entre la muestra cervicovaginal recolectada por autotoma frente a la muestra cervical recolectada por el médico. No hubo diferencias en la cantidad de ADN viral entre el día 1 y el 14 (DM -0,34 ciclos; IC 95 %: -2,29 a 1,61). Conclusión: Las muestras vaginales recolectadas por autotoma usando el dispositivo de almacenamiento son confiables para la detección de VPH de alto riesgo en pacientes con displasia cervical, y preservan el ADN viral por 14 días si se almacenan en seco a temperatura ambiente. Se requieren estudios en población general para poder confirmar.

Spitz nevus was first described in 1948 by Dr Sophie Spitz, who termed it juvenile melanoma based on its striking cytologic resemblance to melanoma, being composed of large epithelioid and spindle cells, and its prevalence among children. Several changes in terminology have since occurred with increased knowledge and experience, particularly regarding its occurrence in adult populations and rather indolent clinical behavior. Nevertheless, the distinction of Spitz nevus from melanoma still remains a significant problem in dermatopathology. Most classic examples of Spitz nevi can be easily distinguished histopathologically from melanoma, although lesions with unusual or atypical features still pose diagnostic difficulties, particularly in small or partial samples. In general, poor interobserver diagnostic concordance is not uncommon. Herein, we review the histopathological features of Spitz nevi, including common and recently reported variants, and spitzoid melanoma, and discuss recent advances in ancillary...

Retrospective review of surgical pathology cases is a sensitive and effective method for identifying diagnostic discrepancies. As such studies from developing countries are limited, we undertook a retrospective review of 2408 surgical pathology cases (excluding skin, liver, and kidney biopsies) by two review pathologists to evaluate the quality of histopathology reporting, to identify the variations therein, and to classify them as major and minor according to the impact these would have on patient diagnosis, prognosis, or management. Diagnostic concordance was achieved in 93.1% of cases. The frequencies of overall and major differences in opinion were 6.9% and 3.4%, respectively. Major discrepancies were more common in non-neoplastic lesions than tumors. Endometrial pathologies were misdiagnosed maximally. The overall diagnostic agreement rate in the present study is in tune with those reported earlier although the frequency of major differences is higher. This is definitely a cause for concern and calls for remedial action.

Human cancers are still diagnosed and classified using the light microscope. The criteria are based upon morphologic observations by pathologists and tend to be subject to interobserver variation. In preoperative biopsies of non-small cell lung cancers, the diagnostic concordance, even amongst experienced pulmonary pathologists, is no better than a coin-toss. Only 25% of cancer patients, on average, benefit from therapy as most therapies do not account for individual factors that influence response or outcome. Unsuccessful first line therapy costs Canada CAN$1.2 billion for the top 14 cancer types, and this extrapolates to $90 billion globally. The availability of accurate drug selection for personalized therapy could better allocate these precious resources to the right therapies. This wasteful situation is beginning to change with the completion of the human genome sequencing project and with the increasing availability of targeted therapies. Both factors are giving rise to attempts to correlate tumor characteristics and response to specific adjuvant and neoadjuvant therapies. Static cancer classification and grading systems need to be replaced by functional classification systems that not only account for intra- and inter- tumor heterogeneity, but which also allow for the selection of the correct chemotherapeutic compounds for the individual patient. In this review, the examples of lung and breast cancer are used to illustrate the issues to be addressed in the coming years, as well as the emerging technologies that have great promise in enabling personalized therapy.

e18862Background: We present a system for automated estimation of diagnostic concordance between radiology and pathology reports, with a focus on prostate. Such a system can play a critical monitor...

Background Store-and-forward teledermatology is an emerging means of access for patients with skin disease lacking direct access to dermatologists. Objectives We sought to examine the patient demographics, diagnostic concordance, and treatment patterns in teledermatology for patients younger than 13 years. Methods We conducted a descriptive retrospective cohort study involving 429 patients. Results Diagnoses were concordant in 48% of cases, partially concordant in 10%, and discordant in 42%. Management recommendations were concordant in 28% of cases, partially concordant in 36%, and discordant in 36%. Primary care providers tended to underuse topical steroids and overuse topical antifungals and systemic antibiotics. Only 1.4% and 6.0% of patients required repeated teledermatology consultation and in-person dermatology consultation, respectively. Limitations Limitations were the inability to generalize the data from the population studied and the chances of error and bias in teledermatology diagnoses. Conclusions Store-and-forward teledermatology can improve diagnostic and therapeutic care for skin disease in children who lack direct access to dermatologists.

The diagnosis of Barrett's esophagus (BE) requires an accurate recognition of the columnar-lined esophagus at endoscopy. However, a universally accepted standardized endoscopic grading system of BE was lacking prior to the development of the Prague 'circumferential and maximal' criteria. In this system, the landmark for the esophagogastric junction (EGJ) is the proximal end of the gastric folds, not the distal end of the palisade vessels, which are used to endoscopically identify the EGJ in Japan. Although the circumferential and maximal criteria are clinically relevant, an important shortcoming of this system may be failure to identify short-segment BE, a lesion that is found frequently in the Japanese. To compare the diagnostic yield for BE when using the palisade vessels versus gastric folds as a landmark for the EGJ, we evaluated interobserver diagnostic concordance. The endoscopic identification of the EGJ using both landmarks resulted in unacceptably low kappa coefficients of reliability. However, there was a statistically significant improvement after the participants were thoroughly trained in identification of the EGJ during the endoscopic study. Although it remains controversial which landmark is better for the endoscopic diagnosis of BE, it is important to systematically educate and train endoscopists in order to improve diagnostic consistency in patients with BE.

Teledermatology studies have examined diagnostic concordance between live-interactive (LI) and in-person examinations (IP); and between store-and-forward (SF) and IP examinations. However, no studies have looked simultaneously across all three care delivery modalities, and few have measured management concordance and diagnostic confidence of the dermatologist. The purpose of this study was to compare LI and SF modalities with IP with respect to diagnostic and management concordance and to compare physician diagnostic confidence across the three modalities. Four dermatologists, in random rotation among all three care modalities, examined 110 new patients. Confidence was rated on a Likert scale from 1 to 5 (5 = total confidence; 1 = no confidence). Identical diagnoses were given to the patient by examiners from all three examination modalities in 70/110 patients (64%). More identical diagnoses were given for IP and LI examinations than for IP and SF examinations (80% vs. 73%); however, the difference was not statistically significant (p = 0.13). The highest self-reported confidence rating was given for 87% of IP examinations, 59% for LI, and 54% for SF. Diagnostic confidence ratings for SF and LI were not significantly different from each other (p = 0.50); however, diagnostic confidence ratings for LI and SF were both statistically lower than IP (p < 0.0001). Dermatologists were more confident with IP examination than either form of teledermatology. The percent of diagnostic and management agreement among IP, LI, and SF modalities was high.

Objective To determine if video otoscope still images of the tympanic membrane taken in remote clinics are comparable to an in-person microscopic examination for follow-up care. Design Comparative concordance, diagnostic reliability. Methods Community health aide/practitioners in remote Alaska imaged 70 ears following tympanostomy tube placement. The patients were then examined in person by two otolaryngologists. Images were later reviewed at 8 and 14 weeks. Results Intraprovider concordance for physical examination findings was: “Tube in,” 94 percent –97 percent (κ = 0.89–0.94); “Tube patent,” 94 percent –97 percent (κ = 0.89–0.94); “Drainage,” 90 percent –96 percent (κ = −0.04–0.38); “Perforation,” 90 percent –96 percent (κ = 0.61–0.82); “Granulation,” 97 percent –100 percent (κ = 0.49–1.0); “Middle ear fluid,” 88 percent –96 percent (κ = 0.28–0.71); “Retracted,” 83 percent –91 percent (κ = 0.26–0.58). These agreement rates are similar to interprovider concordance when two otolaryngologists examine the same patient in person. Intraprovider concordance for diagnoses was 76 percent –80 percent (κ = 0.64–0.71) and 77 percent –88 percent (κ = 0.66–0.81) when poor images were excluded. Interprovider diagnostic concordance for the in-person exam was 89 percent (κ = 0.83). Conclusion Video-otoscopy images of the tympanic membrane are comparable to an in-person examination for assessment and treatment of patients following tympanostomy tubes. Store-and-forward telemedicine is an acceptable method of following patients post tympanostomy tube placement.

ObjetivoAnalizar el índice de concordancia diagnóstica entre atención primaria y salud mental.DiseñoEstudio descriptivo, retrospectivo.EmplazamientoCentro de Salud Mental de Estella (Navarra).ParticipantesInclusión de pacientes adultos nuevos consecutivos remitidos a salud mental (n=1.005) entre julio de 2002 y marzo de 2005.Mediciones principalesAnálisis de los diagnósticos realizados en atención primaria y salud mental en el período de tiempo establecido. Cálculo del índice kappa de concordancia interjueces.ResultadosLa concordancia global diagnóstica tiene un índice kappa = 0,385 (± 0,018). En los trastornos por uso de alcohol y otras sustancias y los trastornos psicóticos se obtienen índices de concordancia elevados (kappa > 0,7). Los trastornos de la alimentación y el trastorno mental orgánico reflejan una concordancia moderada (índice kappa entre 0,4 y 0,7). Sin embargo, en los trastornos de ansiedad, adaptativos y afectivos se obtiene una concordancia baja (kappa < 0,3).ConclusionesEn general, la concordancia entre los diagnósticos realizados en atención primaria y salud mental es baja. En concreto, destaca la dificultad para identificar adecuadamente los trastornos adaptativos, y se observa una importante tendencia por parte de atención primaria a filiar como cuadros ansiosos o afectivos estos trastornos.ObjectiveTo analyse the diagnostic concordance index between primary care and mental health.DesignRetrospective and descriptive study.SettingMental health centre, Estella, Navarra, Spain.ParticipantsNew consecutive adults patients referred to mental health (n=1005) from july 2002 to march 2005.Main MeasurementsAnalysis of diagnoses made in primary care and mental health during the time period. Calculation of kappa index for inter-observer concordance.ResultsGeneral diagnostic concordance had a kappa index =0.385 (±0.018). High concordance index (>0.7) was obtained for alcohol and other substance use disorders and psychotic disorders. Moderate concordance index (0.4-0.7) was obtained for eating disorders and organic mental disorders. However, low concordance index (

Musculoskeletal impairments affect one-third of the adult population, are one of the major contributors to lost time from work, and account for one-third of a general practitioner's caseload. These injuries respond well to physiotherapy, but access can be limited in a publicly funded health care system. Improved access to physiotherapy occurs in a collaborative model of care in orthopedic clinics however the extent to which the patient receives similar diagnoses and treatment recommendations has not been reported. The purpose of this study was to determine diagnostic concordance and accuracy, and treatment concordance between a physiotherapist and orthopedic surgeons. Twenty-five subjects in an orthopedic clinic were assessed by a physiotherapist and an orthopedic surgeon. Diagnosis and treatment recommendations were made by each separately. These were compared for concordance between professionals and diagnostic accuracy. The physiotherapist and the orthopedic surgeon had 90% concordance in diagnoses of knee and shoulder impairments, and 75% accuracy when compared to definitive diagnostic methods. They had 87% agreement in treatment recommendations, however, the physiotherapist gave three treatment recommendations per patient where the surgeon gave two. In a collaborative care context therefore, this study suggests, that physiotherapists have similar diagnostic capabilities to orthopedic surgeons, and they will enhance the conservative treatment options offered to orthopedic patients.

Background Measurement of thyroid peroxidase autoantibodies (TPOAb) is useful in diagnosing patients with autoimmune thyroid disease. Measurement of thyroglobulin autoantibodies (TgAb) is used to detect potential interferences with thyroglobulin immunoassays and in limited situations for the diagnosis of autoimmune thyroid disease. Methods The limit of detection, imprecision, reference interval, method comparison and diagnostic concordance for the ADVIA Centaur, ARCHITECT i2000, AxSYM, Immulite 2000, Modular E170 (TPOAb only), and UniCel DxI 800 (TgAb only) methods were evaluated. The Advantage was used as the comparison method. Results Total imprecision ranged from 2.6% to 14.9% for TgAb and 2.1% to 15.8% for TPOAb. Passing–Bablok slopes ranged from 0.51 to 10.4 (TgAb) and 1.05 to 7.12 (TPOAb) with correlation coefficients of 0.48 to 0.82 (TgAb) and 0.66 to 0.78 (TPOAb). Assay cutoffs were adjusted using a common set of reference interval samples. Concordance with the Advantage assay using the new cutoffs was found to be improved and ranged from 68.5% to 84.7% (TgAb) and 77.5% to 84.7% (TPOAb). Conclusions Although all assays generally performed well, assay concordance for a negative or positive result ranged from 54.2 to 84.7%. Quantitative agreement between methods was generally poor and methods could not be used interchangeably. Additional standardization efforts are required to improve inter-method agreement.

Methodology of pressure–flow assessment needs to be standardized for the diagnosis of exercise pulmonary hypertension http://ow.ly/YMgZw

Initial qualitative findings from a study of uncompressed and compressed high definition live interactive video, and store and forward teledermatology (photographs and written histories for later review) are presented. Quantitative data collected in the study are still being compiled and analyzed comparing diagnostic concordance and confidence with in-person exams. The early qualitative findings suggest bifurcated patient and physician preferences for the different remote exam methods.

SummaryIntroduction An accurate and rapid analysis of cells in body fluids (BFs) is important for diagnosis and follow-up in many pathological conditions. We evaluated the analytical performance of the module BF Mindray BC-6800 (BC-6800-BF) for cytometric analysis of ascitic and pleural fluids. Methods A total of 99 ascitic and 45 pleural samples were collected and assessed with BC-6800-BF and optical microscopy. This study also includes the evaluation of limit blank (LoB), limit detection (LoD), limit quantitation, (LoQ), carryover, linearity, and diagnostic concordance between the two methods. Results For TC-BF, LoB was 1 × 106 cells/L, LoD was 3 × 106 cells/L, and LoQ was 4 × 106 cells/L. Linearity was excellent (r2 = 0.99) and carryover was negligible. TC-BF performed with the two methods showed Pearson's correlation of 0.99 (P < 0.0001), Passing–Bablok regression y = 1.04x − 1.17, and bias 33.7 cells. In ascitic fluids, polymorphonuclear cells (PMN) showed an area under curve (AUC) of 0.98 (P < 0.0001). In pleural fluids, mononuclear cells (MN) and PMN % displayed an AUC of 0.79 (P < 0.0001) and 0.93 (P < 0.0001), respectively. Conclusions BC-6800-BF in ascitic and pleural fluids offers rapid and accurate cell and differential counts in clinically relevant concentration ranges. The use of BC-6800-BF may allow to replace routine optical counting, except for samples displaying abnormal cell counts or abnormal DIFF scattergram.

Objective We sought to evaluate the accuracy of quantitative three-dimensional (3D) CT angiography (CTA) for the assessment of coronary luminal stenosis using digital subtraction angiography (DSA) as the standard of reference. Method Twenty-three patients with 54 lesions were referred for CTA followed by DSA. The CTA scans were performed with 256-slice spiral CT. 3D CTA were reconstructed from two-dimensional CTA imaging sequences in order to extract the following quantitative indices: minimal lumen diameter, percent diameter stenosis (%DS), minimal lumen area, and percent area stenosis (%AS). Correlation and limits of agreement were calculated using Pearson correlation and Bland–Altman analysis, respectively. The diagnostic performance and the diagnostic concordance of 3D CTA-derived anatomic parameters (%DS, %AS) for the detection of severe coronary arterial stenosis (as assessed by DSA) were presented as sensitivity, specificity, diagnostic accuracy, and Kappa statistics. Of which vessels with %DS >50% or with %AS >75% were identified as severe coronary arterial lesions. Result The correlations of the anatomic parameters between 3D CTA and DSA were significant (r = 0.51–0.74, P

Discrimination of pre-capillary pulmonary hypertension (PH) and pulmonary venous hypertension (PVH) has clinical implications (both entities defined in Table 1). We examined the diagnostic concordance of pulmonary capillary wedge pressure (PCWP) and left ventricular end-diastolic pressure (LVEDP) in

Background: Debiasing education has been recommended for physicians in training. We report on the efficacy of a workshop designed to aid family medicine residents recognize and respond to their risk of misdiagnosis due to cognitive biases during patient care. Methods: Residents participated in a debiasing workshop in which they were taught to recognize and respond to cognitive biases likely to contribute to misdiagnosis. Metacognition was introduced and cognitive forcing strategies were demonstrated and practiced. While precepting clinic visits, attendings evaluated residents in the following areas: 1) diagnostic concordance between resident and attending, 2) ability of the resident to perceive their risk of cognitive bias, 3) the quality of the resident’s plan to mitigate this risk, and 4) the presence of an unrecognized cognitive bias. Pre and post workshop data were compared. Results: Preceptor concurrence with the residents’ diagnoses was unchanged – 74% (63 of 85) vs. 78% (45 of 58, p=0.64). Residents’ ability to recognize their risk of cognitive bias was unchanged – 51% (43 of 85) vs. 57% (33 of 58, p=0.46). Residents’ formulation of an acceptable plan to mitigate the effect of cognitive bias increased from 84% (36 of 43) to 100% (33 of 33, p=0.02). Preceptors’ perception of an unrecognized cognitive bias in the residents’ presentation was unchanged – 12% (10 of 85) vs. 9% (5 of 58, p=0.55). Conclusions: A debiasing workshop for family medicine residents demonstrated improvement in one of four studied outcomes.

We analysed 46 telecytology cases sent from two rural hospitals about 500 km from a tertiary cancer centre. The cases were submitted for second opinion over a period of two years and evaluated using a static store and forward telecytology approach. A total of 715 digital images were studied (average 15 per case). Forty-one of the 46 cases (89%) were reported within 3 days and 54% of cases were reported within one working day. The aspiration smears and images were found to be of diagnosable quality in 89 and 93% of the cases, respectively. The diagnostic concordance was assessed by comparing the telecytology diagnosis, glass slide diagnosis and final histopathology diagnosis (when available). A clinically useful diagnosis was rendered in 91% cases with 74% complete concordance. Five out of 46 cases (11%) were deferred for glass slide review. Store and forward telecytology using the Internet is a rapid and effective method of providing expert diagnosis in cytology.

Objetivo: desarrollar un diagnóstico matemático de la monitoría fetal a partir de la aplicación de la ley de Zipf-Mandelbrot y las concepciones de salud y enfermedad de los sistemas dinámicos a la aparición de Componentes Dinámicos del Sistema (CDS) en el trazado de la monitoría. Esta evaluación se hace calculando el grado de complejidad de la distribución de los CDS.Diseño: este estudio es de concordancia diagnóstica basado en una aplicación de la ley de los lenguajes naturales y de simplificaciones fisiológicas basadas en la teoría de sistemas dinámicos a la aparición de CDS de las frecuencias cardiacas fetales para construir una generalización diagnóstica.Materiales y métodos: se evaluaron 100 monitorías de mujeres gestantes divididas en dos grupos: grupo A, 50 gestantes con factores de riesgo, y grupo B, 50 sin factores de riesgo. Basados en simplificaciones dinámicas, prototipos seleccionados y en la aplicación de la ley de Zipf-Mandelbrot para caracterizar el grado de complejidad usando todos los CDS posibles, se realizaron comparaciones con el resto de las monitorías diferenciando salud de enfermedad.Resultados: la dinámica cardiaca de un feto sano tiene una autorganización matemática caracterizada por su grado de complejidad y la ausencia de CDS Invertidos Pronunciados (CDSiP) y la enfermedad es caracterizada por la pérdida de complejidad o la presencia de uno o más CDSiP, o la presencia de un CDS Invertido (CDSi) mayor o igual a 20x40 hasta 20x50 asociado a la aparición de otro CDSi mayor o igual de 20x50 o de la ausencia de CDS del grupo de 15 y/o de 20 latidos/minuto de altura, o combinaciones de las medidas diagnósticas. De acuerdo a las medidas obtenidas una de cada dos monitorías del grupo B y una de cada seis del grupo A tienen un diagnóstico equivocado según los parámetros clínicos convencionales.Conclusiones: la caracterización matemática de las monitorías permitió diferenciar salud de enfermedad de manera objetiva y reproducible en el desarrollo de un diagnóstico de aplicación clínica.

SUMMARY From January 2001 to January 2002, Broken Hill, New South Wales, served as a trial site for teledermatology as one method of access to dermatologists. Fourteen participating general practitioners referred 46 patients making up 48 teledermatology cases. The mean diagnostic agreement between general practitioners and dermatologists was 35% and 50% for primary and differential diagnoses, respectively. Teledermatology patients formed 12% of the collectively referred dermatology patients (outpatients and teledermatology). In this project, high patient and general practitioner acceptability and positive medical outcomes confirm the value of rural teledermatology. However, this project also revealed unexpected barriers and pitfalls in the effective operation of rural teledermatology. Lack of education of participants, inertia among potential users and patient inconvenience are issues that may adversely affect the effective implementation of rural teledermatology.

Background Anatomic and mucosal obstruction of the frontal sinus outflow tract (FSOT) can result in frontal sinusitis often associated with frontal headache. Thorough evaluation of symptomatic patients requires axial and coronal computerized tomographic (CT) scans of the paranasal sinuses (PNS). With the advent of multichannel multidetector CT scanning, the availability of high-quality sagittal images has become increasingly widespread. However, the utility of these images in the assessment of FSOT patency has not yet been established. Methods A retrospective review of coronal and sagittal images from 25 PNS CT scans (50 sides) were randomized, blinded, and independently evaluated by two neuroradiologists. FSOT obstruction by agger nasi cells, the ethmoid bulla, and mucosal disease was assessed. A degree of confidence was rendered for each of these findings. The results were then compared against a consensus diagnosis, which was rendered based upon simultaneous reading of the coronal and sagittal images. Generalized estimating equations were used to assess the difference between sagittal and coronal images in terms of reader confidence and diagnostic concordance with the consensus. Results Review of sagittal images had a higher degree of concordance with the consensus than did coronal images, and was highest for mucosal disease. Both readers were more confident in rendering a diagnosis based upon the sagittal images. Conclusion Sagittal reformatted CT images of the PNS are helpful in the radiologic evaluation of the FSOT. Experienced neuroradiologists had a higher degree of confidence in the diagnosis of the obstruction of the FSOT using sagittal reformatted images.