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Background: No validated score is available for the prediction of return to sport (RTS) after proximal hamstring avulsion (PHA) surgery. Purpose: To validate a new assessment tool for patients after PHA surgery: the Parisian Hamstring Avulsion Score (PHAS). Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: All patients at our clinic who had surgery for PHA between January 2015 and March 2018 were included in this study. A suspected clinical diagnosis of PHA was confirmed by magnetic resonance imaging. PHA was repaired by surgical reinsertion with suture anchors. Minimum postoperative follow-up was 2 years, and the PHAS, University of California, Los Angeles (UCLA), score, and Tegner score were used. The PHAS is a patient-reported outcome measure, evaluating the effect of PHA injury with 9 items. It was validated by calculating its psychometric properties, and then correlation analysis was performed to determine the relationship between the PHAS, UCLA score, and Tegner score. Cutoff values for the prediction of RTS were determined. Results: A prospective case series study was performed. A total of 156 patients were included. Median age (first quartile; third quartile) was 54.2 years (44.7 years; 61.3 years), and the mean ± SD time of the final follow-up was 69 ± 11.6 months. Two years after surgery, 66.7% (n = 104) of patients were able to RTS. A strong correlation was noted between all 3 scores at 1 year postoperatively. Overall internal consistency was high, with a Cronbach alpha coefficient of 0.86. The intraclass correlation coefficient was 0.96, showing excellent reliability. The minimal detectable change was 12.9. No patients reached the maximum score at 2 years. Analysis of the receiver operating characteristic curves of the 3 scores at postoperative 9 months in relation to the RTS at 1 and 2 years showed area under the curve values of >0.7, indicating significant discriminant capacity for the RTS. A PHAS cutoff value of 86 at 9 months for the prediction of RTS at postoperative 1 year had a sensitivity of 65.6% (95% CI, 53.7%-77.5%) and a specificity of 81.4% (95% CI, 69.8%-93%). Conclusion: PHAS is a valid and reliable tool for follow-up after PHA surgery. It also offers a simple way to predict RTS. [ABSTRACT FROM AUTHOR]

Background: The minimal clinically important difference (MCID) is a term synonymous with orthopaedic clinical research over the past decade. The term represents the smallest change in a patient-reported outcome measure that is of genuine clinical value to patients. It has been derived in a myriad of ways in existing orthopaedic literature. Purpose: To describe the various modalities for deriving the MCID. Study Design: Narrative review; Level of evidence, 4. Methods: The definitions of common MCID determinations were first identified. These were then evaluated by their clinical and statistical merits and limitations. Results: There are 3 primary ways for determining the MCID: anchor-based analysis, distribution-based analysis, and sensitivity- and specificity-based analysis. Each has unique strengths and weaknesses with respect to its ability to evaluate the patient's clinical status change from baseline to posttreatment. Anchor-based analyses are inherently tied to clinical status yet lack standardization. Distribution-based analyses are the opposite, with strong foundations in statistics, yet they fail to adequately address the clinical status change. Sensitivity and specificity analyses offer a compromise of the other methodologies but still rely on a somewhat arbitrarily defined global transition question. Conclusion: This current concepts review demonstrates the need for (1) better standardization in the establishment of MCIDs for orthopaedic patient-reported outcome measures and (2) better study design—namely, until a universally accepted MCID derivation exists, studies attempting to derive the MCID should utilize the anchor-based within-cohort design based on Food and Drug Administration recommendations. Ideally, large studies reporting the MCID as an outcome will also derive the value for their populations. It is important to consider that there may be reasonable replacements for current derivations of the MCID. As such, future research should consider an alternative threshold score with a more universal method of derivation. [ABSTRACT FROM AUTHOR]

Background: Description of possible detrimental effects of sport specialization specific to adolescent female athletes is limited in current literature with no consensus on sport specialization classification. Hypothesis: Specialized female athletes will have higher rates of injury, body image issues, and menstrual dysfunction, regardless of the specialization classification utilized. Study Design: Cross-sectional. Level of Evidence: Level 3. Methods: Retrospective data was obtained from questionnaires from female athletes in local high schools (n = 229; 13–18 years of age). The 3-point specialization scale was used to analyze differences in injury rates, body image issues, and menstrual dysfunction within low, moderate, and highly specialized athletes. When comparing accuracy of specialization scales in identifying high risk athletes, three peer-reviewed specialization classification scales were utilized—a 3-point scale, a 6-point scale, and a binary self-selection scale. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for studied variables (a priori p ≤ 0.05). Results: Of 229 athletes surveyed, 219 (95.6%) completed the 3-point specialization classification questions and were included in the study. 91 athletes (41.6%) were categorized as low specialization (LS), 59 (26.9%) were moderately specialized (ModS), and 69 (31.5%) were highly specialized (HS). ModS athletes were more likely to have a history of stress fractures (SFx) compared to LS athletes (p = 0.02; OR 3.62; 95% CI 1.27–10.26). Compared to LS athletes, HS athletes were more likely to have injury history (p = 0.01; OR 2.93; 95% CI 1.38–6.24) and a history of concussion (p < 0.01; OR 5.00; 95% CI 1.86–13.42). Conclusion: Among female high school athletes, higher levels of specialization are associated with greater risk of injuries overall, and greater risk of concussions and SFx. This study did not demonstrate significant associations between specialization and body image issues or menstrual dysfunction. Clinical Relevance: This study further strengthens the association between injury and sport specialization and suggests that combining specialization scales better improves risk stratification which overall aids in preventing athlete injury. [ABSTRACT FROM AUTHOR]

Background: The ability to consistently and accurately assess oral mucositis (OM) is critical to descriptions of its incidence and severity and in evaluating the effectiveness of potential interventions. The lack of a single grading scale compounds outcome interpretation. Consequently, we assessed the concordance of three of the most commonly used OM grading criteria (World Health Organization (WHO), Radiation Therapy Oncology Group (RTOG), and the common terminology criteria for adverse events (CTCAE). Methods: Data was evaluated from two hundred patients with oropharyngeal or oral cavity cancers who underwent chemoradiation therapy and were enrolled in a double-blind, randomized, placebo-controlled trial in which trained assessors evaluated patients twice weekly. WHO, RTOG, and CTCAE scores were assigned centrally by independent evaluators blinded to the study group. Concordance among the three scales for all OM scores and severe OM scores (score ≥ 3) was defined as the percentage agreement and measured using Cohen's weighted Kappa. Results: Of 3,578 OM assessments, 57% had identical scores for all three scales. When any score was considered, the concordance between WHO and RTOG scales was 71% (kappa 0.58; 95%CI: 0.56-0.60), 62% for the WHO and CTCAE scales (kappa 0.46; 95%CI: 0.44-0.48) and 78% for the CTCAE and RTOG scales (kappa 0.69; 95%CI: 0.68-0.71). When patients had severe OM (WHO score ≥ 3), 99.6% (521/523) of the CTCAE OM assessments had scores of 3 or 4 (kappa 0.98; 95%CI: 0.98-0.999) and 97.7% of the RTOG ones (511/523) had scores of 3 or 4 (kappa 0.69; 95%CI: 0.62-0.75). Among patients who had a WHO score of 4, 31.7% (63/199) and 96.0% (196/199) of patients had RTOG or CTCAE scores of 2 or 3, respectively. Conclusions: Discordance was seen with patients who exhibited mild to moderate OM or most severe OM (grade 4) as described by WHO criteria. Whereas scale selection seems less critical in studies in which general "severe mucositis" is the primary outcome, it is particularly important in accurately describing OM's clinical trajectory and the frequency and impact in its most severe forms. [ABSTRACT FROM AUTHOR]

Background: The Tooth Wear Evaluation System (TWES) is a type of tooth wear index. To date, there is the lack of data comparing the reliability of the application of this index on gypsum cast records and digital greyscale intra‐oral scan records. Objectives: A comparative evaluation between the use of gypsum cast records and digital greyscale intra‐oral scan records with the reliability of tooth wear scoring using the TWES amongst a group of patients with tooth wear. Methods: Records for 10 patients with moderate to severe tooth wear (TWES ≥ 2) were randomly selected from a larger clinical trial. TWES grading of the occlusal/incisal, buccal and palatal/lingual surfaces was performed to determine the levels of intra‐ and interobserver agreement. Intra‐observer reproducibility was based on the findings of one examiner only. For the interobserver reproducibility, the findings of two examiners were considered. One set of models/ records were used per patient. Cohen's weighted kappa (κW) was used to ascertain agreement between and within the observers. Comparison of agreement was performed using t tests (P <.05). Results: For the scoring of the of the total occlusal/incisal surfaces, the overall levels of intra‐ and interobserver agreement were significantly higher using the gypsum cast records than with the digital greyscale intra‐oral scan records, (P <.001) and (P <.001), respectively. For the overall buccal surfaces, only a significant difference was found in the intra‐observer agreement using gypsum casts, (P =.013). For the palatal/lingual surfaces, a significant difference was only reported in the interobserver agreement using gypsum casts, (P =.043). At the occlusal/incisal surfaces, grading performed using gypsum casts, culminated in significantly higher TWES scores than with the use of the digital greyscale intra‐oral scans (P <.001). At the buccal and palatal/lingual surfaces, significantly higher wear scores were obtained using digital greyscale intra‐oral scan records (P <.009). Conclusions: The TWES can offer a reliable means for the scoring of wearing occlusal/incisal surfaces using gypsum casts. The reliability offered by digital greyscale intra‐oral scans for consecutive scoring was in general, inferior. [ABSTRACT FROM AUTHOR]

This study was planned to evaluate the effectiveness of acupuncture treatment for the treatment Bell's palsy sequelae. In this study, forty patients with Bell's palsy sequelae were randomly allocated to either the acupuncture or the control group. The clinical outcomes before and after treatment were assessed using the following assays: the facial nerve compound motor action potential and HouseeBrackmann (HB) and Sunnybrook (SB) grading scales. Agreement analysis was performed between the SB and HB grading scales. There was significant difference between pretreatment and posttreatment compound motor action potential values of the patients within the acupuncture group (p = 0.036). In pretreatment and posttreatment SB and HB scores, significant differences within the two groups were observed. However, the significance level in the improvement rate in the acupuncture group was higher than that of the control group. General agreement between the SB and HB scores of groups was an acceptable value, and weighted agreement between the scales was a moderate agreement. In this study, we found that acupuncture treatment is effective in improving Bell's palsy sequelae. Acupuncture can be used as a safe method in the treatment of Bell's palsy sequelae. [ABSTRACT FROM AUTHOR]

Oral mucositis is a common acute complication of a head and neck squamous cell carcinoma treatment. Multiple scales can be used to diagnose and grade this lesion, but they all have some limitation regarding this group of patients. Most of these issues are associated with the hardness to differentiate signs and symptoms from oral mucositis vs. the inherent neoplasm. This study highlights the importance of a specifically developed scale for patients with head and neck squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the performance of lissamine green strips from different manufacturers. Additionally, the repeatability, need for sequential dye instillation and impact of repeated lid evertion on lid wiper staining were assessed.Methods: Study 1 was a prospective, randomised cross-over study where controlled volumes of lissamine green solution prepared from strips (Biotech, Lissaver, GreenGlo, OPGreen) were instilled (right eye: single; left eye: double instillation) on five different days, with OPGreen being tested twice. Lids were everted and digital photographs taken, which were later assessed by a masked observer. Study 2 was an investigator-masked, randomised, controlled study testing the impact of single versus repeated lid evertion. Lid wiper staining was graded (0 to 3 in 0.5 steps).Results: Lid wiper staining differed significantly between lissamine green solutions, with GreenGlo showing the highest amount of staining, and Lissaver the least (all p>0.009). There were no differences in lid wiper staining over two days, using the OPGreen solution (all p>0.05). The number of drops instilled (single versus double) did not significantly affect lid wiper staining (all p>0.05). Repeated lid evertion increased lid wiper staining (p=0.007 when combined with double drop instillation). Light absorbance patterns and measured concentrations aligned with clinical findings.Conclusion: There were significant differences in performance between lissamine green solutions. Lid wiper staining was impacted by repeated lid evertion but sequential instillation and use of the Korb grading scale provided little advantage over simpler methods Clinicians must consider this when investigating lid wipers, especially when interpreting a negative finding. [ABSTRACT FROM AUTHOR]

Ototoxicity is a well-established toxicity associated with a subgroup of antineoplastic therapies that includes platinum chemotherapy, radiation or surgery involving the ear and auditory nerve, and supportive care agents such as aminoglycoside antibiotics and loop diuretics. The reported prevalence of ototoxicity in patients who have received potentially ototoxic therapy ranges from 4% to 90% depending on factors such as age of the patient population, agent(s) used, cumulative dose, and administration techniques. The impact of ototoxicity on subsequent health-related and psychosocial outcomes in these patients can be substantial, and the burden of morbidity related to ototoxic agents is particularly high in very young children. Considerable interindividual variability in the prevalence and severity of ototoxicity has been observed among patients receiving similar treatment, suggesting genetic susceptibility as a risk factor. The development and testing of otoprotective agents is ongoing; however, to the author's knowledge, no US Food and Drug Administration-approved otoprotectants are currently available. Prospective monitoring for ototoxicity allows for comparison of auditory outcomes across clinical trials, as well as for early detection, potential alterations in therapy, and auditory intervention and rehabilitation to ameliorate the adverse consequences of hearing loss. Cancer 2016;122:1647-58. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: In this retrospective case series, we utilize arthroscopy as the gold standard to determine if magnetic resonance imaging (MRI) of the knee can predict osteochondritis dissecans (OCD) lesion stability, the most important information to guide patient treatment decisions. It is hypothesized that the classification system of the International Cartilage Repair Society (ICRS) will allow for improved assessment of lesion grade and stability in OCD.Materials and Methods: Routine MRI studies of 46 consecutive patients with arthroscopically proven OCD lesions (mean age: 23.7 years; 26 male, 16 female) were assessed by three radiologists who were blinded to arthroscopic results. Arthroscopic images were evaluated by two orthopedic surgeons in consensus. The OCD criteria of the ICRS were applied to arthroscopy and imaging interpretations. Inter-rater correlation statistics and accuracy of magnetic resonance (MR) grading with respect to arthroscopy were determined.Results: Only 56% of the available MR reports assigned a label of stable or unstable to the lesion description. Of these, 58% of the lesions were deemed unstable and 42% were stable. Accuracy was 53% when reports addressed stability. Utilizing the ICRS classification system, for all three readers combined, the respective sensitivity, specificity, and accuracy of MR imaging to determine lesion stability were 70%, 81%, and 76%. When compared to the original MRI report, the overall accuracy increased from 53% to 76% when readers were given the specific criteria of the OCD ICRS classification. However, inter-reader variability remained high, with Krippendorf's alpha ranging from 0.48 to 0.57.Conclusions: In this paper, we utilize arthroscopy as the gold standard to determine if MRI can predict OCD lesion stability, the most important information to guide patient treatment decisions. To our surprise, the analysis of the existing radiology reports that addressed stability revealed an overall accuracy in defining OCD lesion stability of about 53%. The classification system of the ICRS, created by an international multidisciplinary, multi-expert consortium, did markedly improve the accuracy, but consistency among different readers was lacking. This retrospective study on OCD reporting and classification highlights the inadequacy of existing classification schemes, and emphasizes the critical need for improved diagnostic MRI protocols in musculoskeletal radiology in order to propel it toward evidence-based medicine. [ABSTRACT FROM AUTHOR]

Introduction: The Glasgow Coma Scale (GCS) provides a structured method for assessment of the level of consciousness. Its derived sum score is applied in research and adopted in intensive care unit scoring systems. Controversy exists on the reliability of the GCS. The aim of this systematic review was to summarize evidence on the reliability of the GCS.Methods: A literature search was undertaken in MEDLINE, EMBASE and CINAHL. Observational studies that assessed the reliability of the GCS, expressed by a statistical measure, were included. Methodological quality was evaluated with the consensus-based standards for the selection of health measurement instruments checklist and its influence on results considered. Reliability estimates were synthesized narratively.Results: We identified 52 relevant studies that showed significant heterogeneity in the type of reliability estimates used, patients studied, setting and characteristics of observers. Methodological quality was good (n = 7), fair (n = 18) or poor (n = 27). In good quality studies, kappa values were ≥0.6 in 85%, and all intraclass correlation coefficients indicated excellent reliability. Poor quality studies showed lower reliability estimates. Reliability for the GCS components was higher than for the sum score. Factors that may influence reliability include education and training, the level of consciousness and type of stimuli used.Conclusions: Only 13% of studies were of good quality and inconsistency in reported reliability estimates was found. Although the reliability was adequate in good quality studies, further improvement is desirable. From a methodological perspective, the quality of reliability studies needs to be improved. From a clinical perspective, a renewed focus on training/education and standardization of assessment is required. [ABSTRACT FROM AUTHOR]

Background The American Association for the Surgery of Trauma (AAST) recently developed a grading scale for measuring anatomic severity of emergency general surgery (EGS) diseases. Grades were developed by expert consensus and have not been validated. The study purpose was to measure inter-rater reliability of the grading scale using colonic diverticulitis and to measure the association between disease grade and patient outcomes. Methods All charts were reviewed and independently assigned AAST grades based on specific disease criteria. Inter-rater reliability was measured using a kappa coefficient. Multivariate regression models were used to determine the relationship between AAST disease grade and patient outcomes adjusted for age, comorbidities, and patient physiology. Results Over 70% of patients demonstrated mild disease (grades I and II). No deaths were encountered. Inter-rater reliability for grade assignment was moderate (kappa coefficient, 0.43; 95% confidence interval, 0.31-0.56), with 67% concordance in grades. Compared to grade I, complications were similar in grade II but increased significantly with higher grades (grade III odds ratio [OR], 3.13 [1.32-7.41]; grade IV OR, 8.18 [2.09-32.0]; and grade V OR, 10.2 [2.68-38.90]). Compared to grade I, length of stay increased with higher grades (grade II incidence rate ratio [IRR], 1.30 [1.07-1.60]; grade III IRR, 2.4 [1.93-2.98]; grade IV IRR, 3.2 [2.27-4.60]; and grade V IRR, 2.6 [1.82-3.60]). Conclusions The EGS grading scale for diverticulitis demonstrated moderate inter-rater reliability. Higher grades were independently associated with complications and length of stay. The findings provide a positive validation that the EGS scale is easily used and effective. [ABSTRACT FROM AUTHOR]

Endovascular revascularization techniques are increasingly used to treat arterial occlusions in patients with acute ischemic stroke. To monitor and communicate treatment results, a valid, reproducible, and clinically relevant, yet easy to use grading scheme of arterial recanalization and tissue reperfusion for digital subtraction angiography is needed. An ideal scoring system would consider the target arterial lesion, the perfusion deficit, and the collateral status before treatment and measure recanalization, reperfusion, early venous shunting, vasospasm, as well as distal embolization after flow restoration. Currently, a variety of different flow restoration scales are in use, including the Thrombolysis in Myocardial Infarction scoring system, the Thrombolysis in Cerebral Infarction score, and the Arterial Occlusive Lesion score, which describe the local recanalization result. These scores are not used homogeneously throughout the literature, are often modified and not fully documented, which make them inept to compare treatment effects across studies. In addition, none of these scores cover all of the above-mentioned aspects, nor are they able to describe satisfactorily all relevant angiographic findings, and data on their reliability and predictive power regarding clinical outcome are sparse. We aimed to review and illustrate the different revascularization scales, discuss their advantages and limitations as well as the available data regarding standardization, reliability testing, and outcome prediction. In addition, we give examples for the use of the scales and show potential pitfalls. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to propose an ototoxicity grading system sensitive to the effect of ototoxicity on specific daily life situations like speech intelligibility and the perception of ultra-high sounds and to test its feasibility compared to current criteria. Methods: Pure tone averages (PTAs) for speech perception (1-2-4 kHz) and ultra-high frequencies (8-10-12.5 kHz) were incorporated. Threshold shift and hearing level posttreatment were taken into account. Criteria were tested on head and neck cancer patients treated with (chemo-)radiotherapy ([C]RT) and compared with the Common Terminology Criteria for Adverse Events version 4 (CTCAEv4) and the American Speech-Language-Hearing Association criteria (ASHA). Results: Grades 1 and 2 were based on threshold shifts from baseline (in dB) and subjective complaints. Grades 3 and 4 were defined as treatment-induced hearing loss of ≥ 35 dB at PTA 1-2-4 kHz and ≥ 70 dB at PTA 1-2-4 kHz, respectively. In high-dose cisplatin CRT incidences by the new criteria, CTCAEv4 and ASHA were comparable (78%-88%). In RT and low-dose cisplatin CRT, incidences were 36% to 39% in the new criteria versus 22% to 53% in CTCAEv4 and ASHA. Conclusion: The new criteria show an increased sensitivity to ototoxicity compared to CTCAEv4 and ASHA and provide insight into the effect of hearing loss on certain daily life situations. The new grading system seems feasible for clinic and research purposes. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The first objective of this survey was to determine if there is a common grading scale utilized in Doctor of Pharmacy programs throughout the United States. Based on preliminary research, this question has not been addressed for professional pharmacy education. The study’s second objective was to begin to explore different aspects of grading scales used, academic freedom in grading, and the institutional breakdown of grading scales. Methods: An online survey tool was developed and distributed to the School of Pharmacies’ respective Dean of Academic Affairs or alternate via e-mail to elicit responses. Subsequent second and third e-mail requests were sent at one-week intervals after a nonresponse. Results: The net survey response rate was 61%. The overall study results determined that there was no grade scale predominately used by pharmacy schools or colleges, whether compared across all courses or across only specific type courses (didactic, laboratory, and experiential), and regardless of whether public or private, or what size the enrollment. There were significant consistencies in what constitutes a passing grade as well as the percentages that correlate to specific grades. Conclusions: The results provide guidance for both established and new schools of pharmacy, in that any grading scale adoption is essentially acceptable among pharmacy schools. Future research should compare Doctor of Pharmacy program grading policies with other professional doctorate programs, to determine if other professional programs have developed common grading policies. [Copyright &y& Elsevier]

In this article we offer a first attempt at providing a set of universal grading criteria for determining on what basis, and how far, an item of discursive content can be considered “terroristic.” In doing so, we draw loosely on the existing COPINE scale for child abuse images. The scale described in the article is not intended to reflect actual risk of engagement in terrorist violence, nor is it intended to have evidential validity in relation to offenses in certain jurisdictions relating to “terrorist publications.” Rather, by formalising assumptions which seem already to be latent in the literature on terrorist use of the Internet, it aspires to serve as a starting point for a more methodologically coherent approach to relationships between content—particularly online content—and terrorism. [ABSTRACT FROM PUBLISHER]

Background: The aim was to develop tools to measure the condition of ocular prostheses and the socket's response to prosthetic eyewear. Methods: A novel staining technique for displaying deposits on prosthetic eyes was developed. Equal interval perceptual grading scales for measuring inferior palpebral conjunctival inflammation, and anterior and posterior stained surface deposits on prosthetic eyes were developed from 800 photographs of 43 volunteers. The photographs for each scale were chosen by the authors. A group of four ophthalmologists, three optometrists and three senior students was consulted about selection criteria and asked to position the photographs along a 1.5 m rule to determine equal intervals. Photographs judged not to represent exactly equal perceptual intervals were exchanged with others from the original pool. The final scales (a five-photograph scale for inflammation and two 11 photograph scales for deposits) were assessed for inter-rater reliability and test-retest reliability by groups of senior optometry students. Results: Standard deviations for inter-rater reliability tests were 0.52 scale units for the inflammation scale, 0.99 for the anterior surface deposits scale and 1.03 for the posterior surface deposits scale. The standard deviation of the test-retest differences for inflammation was 0.6 scale units and for both anterior and posterior surface deposits it was 0.71. Conclusions: A novel technique for displaying and measuring the intensity and extent of deposit formation on prosthetic eye surfaces has been described. The two equal interval perceptual grading scales that have been developed to quantify the extent of deposit formation together with the equal interval perceptual scale for grading severity of palpebral conjunctival inflammation will for the first time allow the effects of prosthetic eye wear to be evaluated. Further research to validate the scale for palpebral conjunctival inflammation in a clinical setting is recommended. The technique for staining deposits on prosthetic eyes is recommended for clinical practice. [ABSTRACT FROM AUTHOR]

Background: The aim of the research was to define model characteristics of special fitness in pole vault jumpers of different age categories. Materials and methods: Experimental research was conducted between 2002 and 2009 involving 78 sportsmen doing pole vault at sports club "Zawisza" Bydgoszcz, "Gwardia" Piła, "Śląsk" Wrocław, pole vault centre Gdańsk, and TS "Olimpia" Poznań. In comprised: an assessment of physical development, testing physical fitness, and recording sports results. Results: An analysis of the contestants' physical development dynamics gave a chance to isolate significant moments of differentiation of somatic build features as a result of the applied training stimulus in pole vault. It can also be observed that the sportsmen achieving the best scores in pole vault achieved better results in particular physical fitness attempts than their peers. Results of a correlative analysis, taking into account statistical distribution, allowed defining special fitness indices in a uniform grading scale. Conclusions: The above grading scale allows assessing the level of development of particular indices in a normalised scale making it possible to compare them against the value of changes occurring during the training process. The analysis of particular indices in a uniform grading scale creates the basis for a generalised assessment of special preparation of pole vault jumpers, presentation of their individual model and programming further development. Generalised characteristics in qualitative and quantitative approach make it possible to define the level of special preparation in categories: high, above average, average, below average, low. The determination of model characteristics of pole vault jumpers aged 12-17 allowed defining specific trainings tasks and individualisation in programming and realization of training loads. [ABSTRACT FROM AUTHOR]

Ototoxicity monitoring is particularly critical in patients receiving platinum-based chemotherapy or long-term aminoglycoside antibiotic administration. Furthermore, as new otoprotective agents are developed, audiologists need to not only be able to monitor for ototoxicity but know the various criteria for early detection of ototoxicity and how to grade ototoxic adverse events. The three primary methods for ototoxicity monitoring are conventional audiometry, highfrequency audiometry, and otoacoustic emissions. However, early detection and adverse event criteria depend primarily on conventional and high-frequency audiometry. No consensus exists on determining significant changes in otoacoustic emissions secondary to ototoxic drugs. Also, no consensus exists on how to monitor for tinnitus, although it is a common complication in these patients. Currently, tinnitus surveys can be helpful. A baseline evaluation is critical for accurate interpretation of auditory threshold results. Thus, a team approach is needed to ensure adequate care of these children. For clinical trials and in reading the literature, audiologists need to be aware of the American Speech Language Hearing Association's 1994 criteria for detection of ototoxic change, and the Common Terminology Criteria for Adverse Events, Brock, and the Change scales for classification of adverse events. These methods and scales are reviewed and discussed. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the extent and pattern of use of grading scales for contact lens complications ('grading scales') in optometric practice. An anonymous postal survey was sent to all 756 members of the Queensland Division of Optometrists Association Australia. Information was elicited relating to level of experience, practice type and location, and mode of usage of grading scales. Survey forms were returned by 237 optometrists, representing a 31 per cent response rate. The majority of respondents (61 per cent) reported using grading scales frequently in practice, while 65 per cent of these preferred to use the Efron Grading Scales for Contact Lens Complications. Seventy-six per cent of optometrists use a method of incremental grading rather than simply grading with whole numbers. Grading scales are more likely to be used by optometrists who have recently graduated (p < 0.001), have a postgraduate certificate in ocular therapeutics (p = 0.018), see more contact lens patients (p = 0.027) and use other forms of grading scales (p < 0.001). The most frequently graded ocular conditions were corneal staining, papillary conjunctivitis and conjunctival redness. The main reasons for not using grading scales included a preference for sketches, photographs or descriptions (87 per cent) and unavailability of scales (29 per cent). Grading scales for contact lens complications are used extensively in optometric practice for a variety of purposes. This tool can now be considered as an expected norm in contact lens practice. We advocate the incorporation of such grading scales into professional guidelines and standards for good optometric clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: Grading contact lens complications is a time-effective process, which, if performed accurately, may improve patient management significantly. Multiple factors have been identified that influence grading accuracy, such as the knowledge, training, and experience of the observer. The aim of this study was to further explore the effect of knowledge on grading accuracy, both in terms of intensity and specificity, and to do so by avoiding the need to require the subjects to interpolate between whole number grades. Material and Methods: Optometry students were divided into three knowledge groups according to their academic progress and in such a way that knowledge intensity and specificity could be evaluated separately. A vertical visual analog scale was devised to allow subjects to grade three different conditions of medium severity (position 50 of the scale) from the Institute for Eye Research grading scale, mainly, bulbar hyperemia, limbal vascularization, and lid redness. Results: Bulbar hyperemia was graded lowest (mean = 21.5; SD = 1.4), followed by limbal vascularization (mean = 40.7; SD = 1.6) and lid redness (mean = 51.2; SD = 1.3), and these differences were found to be statistically significant (ANOVA, p = 0.000). Knowledge was found to influence the grading process, resulting in statistically significant differences in the overall grading performance of the three knowledge groups (ANOVA, p = 0.048). Furthermore, even if knowledge intensity failed to improve grading accuracy over a certain threshold, a combination of knowledge intensity and specificity resulted in an enhancement of the homogeneity of the grading data. Conclusions: Knowledge intensity and specificity both contribute to improve grading skills, albeit through different mechanisms. An intermediate knowledge of contact lens complications is required to attain good grading accuracy, and a basic training in pathology is also advised. [ABSTRACT FROM AUTHOR]

Context: Various consensus and position statements recommend a multifaceted approach when diagnosing a possible concussion. The effectiveness of these materials depends largely on their content being disseminated to educators and to those in the clinical setting. Objective: To identify the concussion management methods and guidelines currently taught in the athletic training classroom and clinical settings and to track the dissemination of the Vienna guidelines throughout the educational curriculum. Design: A 17-question Internet survey. Setting: A Web link was e-mailed to the program directors and certified athletic trainers holding educational positions in athletic training at 300 accredited programs in the United States. Patients or Other Participants: 513 program directors and athletic trainers. Main Outcome Measure(s): Survey questions addressed education level, years of certification, employment setting, concussion assessment and return-to-play guidelines used in the clinical setting and the classroom, and clinical and teaching preferences for existing position statements and concussion grading systems. The Vienna guidelines' "simple" and "complex" definitions of concussions were provided with the return-to-play stepwise approach. Results: The National Athletic Trainers' Association position statement was the most widely used method of assessing, managing (61%), and making return-to-play decisions (47%) among participants. More than half of participants (66%) had never heard of the Vienna guidelines. After reading the Vienna guidelines' definitions and return-to-play criteria, nearly three-fourths of participants agreed with them. In addition, 68% said that they would use them, and 84% reported that they would teach them to students. Conclusions: The majority of program directors and certified athletic trainers used a multidimensional approach to assess and manage a concussion. The National Athletic Trainers' Association position statement and Vienna guidelines were underused in both the classroom and clinical settings. [ABSTRACT FROM AUTHOR]

The management of cerebral arteriovenous malformations (AVMs) continues to present a challenge to neurosurgeons. The natural history of this condition, as well as the morbidity and mortality of therapeutic interventions, remains incompletely elucidated. Predictive factors and grading scales in AVM management allow risk-benefit analysis of treatment options and comparison of outcomes. Stereotactic radiosurgery is one of the established treatment modalities for AVMs and is generally used to treat lesions that are high risk for surgical resection. Radiosurgery aims to obliterate AVMs and thus prevent hemorrhage or seizure without any new or worsening of existing symptoms. Lesion characteristics and postsurgical complications differ markedly in patientstreated by radiosurgery versus microsurgery. Radiosurgery-based grading systems account for factors that have been associated with various aspects of radiosurgical outcomes including obliteration, hemorrhage, and postoperative complications, particularly those induced by radiation. The purpose of this paper is to describe the most current predictive factors and grading systems for radiosurgical treatment of cerebral AVMs. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: This study was conducted to investigate grading performance when estimating the severity of static versus dynamic images of contact lens-related ocular pathology. Methods: Thirty-eight subjects used the Efron Grading Scales for Contact Lens Complications to grade the severity of ocular pathological changes depicted in static and dynamic (movie clip) computer-displayed images of each of the following contact lens complications: bulbar conjunctival redness, limbal redness, papillary conjunctivitis, corneal staining, corneal infiltrates and meibomian gland dysfunction. The viewing of static and dynamic images was separated by seven weeks. Results: Grades assigned to dynamic images were 0.6 and 0.7 grading scale units higher than those assigned to static images for limbal redness and papillary conjunctivitis, respectively (p < 0.0001 for both). No difference was observed for the other four complications. There was an apparent trend for grading variability to be reduced (that is, observers grading in closer agreement) when grading dynamic versus static images. Conclusions: Absolute grades based on an assessment of signs of pathology represented in static images may, in some instances, underestimate the true severity of the condition. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The primary objective was to compare measures of bulbar redness objectively using a photometric method with standard grading methods. Measures of redness were made on 24 participants wearing a silicone hydrogel contact lens in one eye for overnight wear. This report compares hyperaemia after 1 week of daily wear (baseline) with redness measured after 6 months of overnight wear. Method: A new method of objectively measuring bulbar conjunctival redness was performed using the Spectrascan650® Photometer by Photo Research® under fixed illumination. Photometric measures in CIEu* chromaticity values involve the measurement of chromaticity, a physical analogue of redness, greenness and blueness in the image. This method was validated in Part 1 of the study using repeated measurements on the photographic CCLRU scale. In Part 2 of the study, the photographic grading scale (CCLRU) from 0 (none) to 100 (extreme) was used to make the comparison. Results: Part 1 indicated that the photometer provides a repeatable and reliable measure of bulbar redness (CCC=0.989). A moderately strong and significant correlation was found between the CIEu* chromaticity values and the analogue data (R =0.795, p =0.000) at each measurement session (from baseline to 1 day, 1 week, and 1, 3 and 6 months of overnight wear). Conclusions: This new standardized and objective method of measuring bulbar redness has great potential to replace subjective grading scales, especially with multi-centre studies, where variability between investigators occurs. This method may also detect smaller changes between visits or between eyes. [Copyright &y& Elsevier]

The scales used in schools for the purpose of student assessment are ordinal. The average of ordinal values is often used for the evaluation and comparison of overall student performance. We demonstrate a theorem for the selection of scales invariant with respect to rank of average and compare scales according to this property. A uniformity criterion is also defined for the choice of the scale on which to calculate the average. Concatenated sets of grades from scales not belonging to the same category may bring about errors of rank and absurd averaging, which may have a heavy impact on related decision-making processes. [ABSTRACT FROM AUTHOR]

Abstract Purpose: A study was conducted to investigate the influence of experience and training on grading reliability when assessing the severity of contact lens complications. Methods: Twenty-three optometry students who were unfamiliar with the use of grading scales each used the Efron Grading Tutor computer program to ascertain grading reliability at an ‘initial’ experimental session and a ‘final’ session 3 weeks later. Twelve subjects (the ‘trained’ group) were given a tutorial on grading techniques and were asked to complete two grading exercises between the initial and final sessions. The other 11 subjects (the ‘untrained’ group) received no such training between the two sessions. Differences in grading reliability between the initial and final grading sessions were evaluated. Results: Grading reliability was superior (lower) for the combined subject cohort at the final session (mean ± standard deviation 0.33 ± 0.12) compared with the initial session (0.46 ± 0.25) (p = 0.004). However, there was no difference in the improvement in grading reliability between the two groups. Conclusions: Grading reliability improves statistically with some experience, although perhaps not to a clinically meaningful extent. No added benefit can be derived from supplemental training. [ABSTRACT FROM AUTHOR]

Aim: To examine the use of image analysis to quantify changes in ocular physiology. Method: A purpose designed computer program was written to objectively quantify bulbar hyperaemia, tarsal redness, corneal staining and tarsal staining. Thresholding, colour extraction and edge detection paradigms were investigated. The repeatability (stability) of each technique to changes in image luminance was assessed. A clinical pictorial grading scale was analysed to examine the repeatability and validity of the chosen image analysis technique. Results: Edge detection using a 3×3 kernel was found to be the most stable to changes in image luminance (2.6% over a +60 to −90% luminance range) and correlated well with the CCLRU scale images of bulbar hyperaemia (r=0.96), corneal staining (r=0.85) and the staining of palpebral roughness (r=0.96). Extraction of the red colour plane demonstrated the best correlation–sensitivity combination for palpebral hyperaemia (r=0.96). Repeatability variability was <0.5%. Conclusions: Digital imaging, in conjunction with computerised image analysis, allows objective, clinically valid and repeatable quantification of ocular features. It offers the possibility of improved diagnosis and monitoring of changes in ocular physiology in clinical practice. [Copyright &y& Elsevier]

Objectives: Several scales have been proposed for risk assessment and outcome determination in brain arteriovenous malformations treated by endovascular therapy. We aim to validate and compare the efficacy of these scales in predicting perioperative complications and clinical outcomes., Methods: We retrospectively reviewed brain arteriovenous malformations patients who underwent endovascular therapy at 4 centers in China from January 2012 to December 2015. The primary outcomes were complications, unfavorable outcome (mRS ≥ 3), and complete obliteration. Each patient was assessed using the Spetzler-Martin grading system (SM), Puerto Rico scale, Buffalo score, and arteriovenous malformation embocure score (AVMES). Correlation analysis was performed between primary outcomes incidence rate and the grades of each scale. The area under the receiver operating characteristic curve of these scales was calculated. Pairwise comparison of receiver operating characteristic curves was performed to compare the efficacy of the scales., Results: A total of 270 patients were included. Correlation analysis demonstrated that the complication rate increased with increasing grade in SM (P = 0.002), Puerto Rico scale (P = 0.014), and Buffalo score (P = 0.001); complete obliteration rate decreased with increasing grade in AVMES (P = 0.017); unfavorable outcome rate increased with increasing grade in the Puerto Rico scale (P = 0.005). The area under the receiver operating characteristic curve analysis showed statistical differences between the Puerto Rico score and SM (P = 0.047) in predicting complications and between the Puerto Rico score and SM (P = 0.008) in predicting unfavorable outcomes. The area under the curve of the AVMES in predicting complete obliteration was 0.757., Conclusions: The Puerto Rico score predicts complications and unfavorable outcomes better than the SM. The AVMES scale has medium efficacy in predicting complete obliteration., (Copyright © 2017 Elsevier Inc. All rights reserved.)