Browsing by Subject "AGREEMENT"

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  • Palojoki, Sari; Makela, Matti; Lehtonen, Lasse; Saranto, Kaija (2017)
    The aim of this study was to analyse electronic health record-related patient safety incidents in the patient safety incident reporting database in fully digital hospitals in Finland. We compare Finnish data to similar international data and discuss their content with regard to the literature. We analysed the types of electronic health record-related patient safety incidents that occurred at 23 hospitals during a 2-year period. A procedure of taxonomy mapping served to allow comparisons. This study represents a rare examination of patient safety risks in a fully digital environment. The proportion of electronic health record-related incidents was markedly higher in our study than in previous studies with similar data. Human-computer interaction problems were the most frequently reported. The results show the possibility of error arising from the complex interaction between clinicians and computers.
  • Salminen, Jarno; van Gils, Mark; Paloheimo, Markku; Yli-Hankala, Arvi (2016)
    Neuromuscular blockade is usually monitored using train-of-four (TOF) stimulation pattern. A TOF ratio of higher than 90 % is recommended to reduce the risk of adverse effects after anaesthesia. TOF ratio 90 % is used in clinical practice with all different neuromuscular monitors. Kinemyography (KMG) is one commercialized method to obtain numerical TOF values. We compared the KMG data obtained with Datex M-NMT MechanoSensor (TM) module, to the EMG data collected with Datex ElectroSensor (TM), during clinical anaesthesia. Ipsilateral comparisons of the sensors were performed in 20 female patients during clinical procedures in propofol-remifentanil anaesthesia. After initial bolus dose of rocuronium (0.6 mg/kg), the spontaneous recovery of TOF ratio and T1 % were monitored. KMG gave higher TOF values than EMG. The difference was significant at KMG TOF values of 40 % or higher. After anaesthetic induction, but before administration of rocuronium, both TOF sensor values drifted from the TOF value of 1.0, showing either significant spontaneous fade (T1 > T4) or tendency of reverse fade (T1 <T4). KMG overestimates the recovery from neuromuscular blockade when compared with EMG. KMG and EMG cannot be used interchangeably, and TOF ratio 90 % cannot be considered as adequate level of recovery with all monitoring devices.
  • Lenzen, Christoph; Rybicki, Joel; Suomela, Jukka (2017)
    Consider a complete communication network of n nodes, where the nodes receive a common clock pulse. We study the synchronous c-counting problem: given any starting state and up to f faulty nodes with arbitrary behavior, the task is to eventually have all correct nodes labeling the pulses with increasing values modulo c in agreement. Thus, we are considering algorithms that are self-stabilizing despite Byzantine failures. In this work, we give new algorithms for the synchronous counting problem that (1) are deterministic, (2) have optimal resilience, (3) have a linear stabilization time in f (asymptotically optimal), (4) use a small number of states, and, consequently, (5) communicate a small number of bits per round. Prior algorithms either resort to randomization, use a large number of states and need high communication bandwidth, or have suboptimal resilience. In particular, we achieve an exponential improvement in both state complexity and message size for deterministic algorithms. Moreover, we present two complementary approaches for reducing the number of bits communicated during and after stabilization.
  • Ilmarinen, Ville-Juhani; Vainikainen, Mari-Pauliina; Verkasalo, Markku Johannes; Lonnqvist, Jan-Erik (2017)
    Even though homophily (love of the same) is often thought of as a standard feature of friendships, the empirical evidence for attraction based on personality trait similarity is mixed at best. One reason for the inconsistent findings across studies could be variation in the large-scale social environment in which the studies have been conducted. We investigated whether diversity in the everyday social ecologies of 7- to 8-year-old children (N=549) moderates whether friendships are formed on the basis of similar personality traits and similar levels of Cognitive ability. Moderated polynomial regression and response surface analyses showed that classroom size moderated homophily based on Openness to Experience: children similar in Openness were more likely to form friendship ties, but only in larger classrooms. Moreover, we found homophily for Cognitive ability, especially among girls. The results for Openness and Cognitive ability were independent of each other. We discuss the social relevance of trait Openness and the notion that capacity to reciprocate underlies homophily based on Cognitive ability. Copyright (c) 2017 European Association of Personality Psychology
  • Kilmartin, Darren; O'Loughlin, Mark; Andreu, Xavier; Bago-Horvath, Zsuzsanna; Bianchi, Simonetta; Chmielik, Ewa; Cserni, Gabor; Figueiredo, Paulo; Floris, Giuseppe; Foschini, Maria Pia; Kovacs, Aniko; Heikkilä, Päivi; Kulka, Janina; Laenkholm, Anne-Vibeke; Liepniece-Karele, Inta; Marchio, Caterina; Provenzano, Elena; Regitnig, Peter; Reiner, Angelika; Ryska, Ales; Sapino, Anna; Stovgaard, Elisabeth Specht; Quinn, Cecily; Zolota, Vasiliki; Webber, Mark; Roshan, Davood; Glynn, Sharon A.; Callagy, Grace (2021)
    Simple Summary The stromal tumour infiltrating lymphocytes (sTILs) within a tumour are a strong predictor of outcome for patients with triple negative breast cancer (TNBC). However, the assessment of sTILs is subject to variation and needs to be standardized in order for it to be used more widely as a biomarker. The aim of this study was to determine the level of consistency that can be achieved when an internet-based scoring aid is used to assist with evaluation of sTILs. Twenty-three breast pathologists across Europe scored sTILs in 49 cases of TNBC taken from a routine diagnostic practice using this aid. The consistency of scoring sTILs was good. However, variation in the distribution of sTILs within the tumour resulted in discordance between pathologists scoring cases, particularly as it caused variability in the selection of regions of the tumour to score. More rigorous training of pathologists is needed for standardization of sTILs assessment, which may potentially be improved using automated approaches. Stromal tumour infiltrating lymphocytes (sTILs) are a strong prognostic marker in triple negative breast cancer (TNBC). Consistency scoring sTILs is good and was excellent when an internet-based scoring aid developed by the TIL-WG was used to score cases in a reproducibility study. This study aimed to evaluate the reproducibility of sTILs assessment using this scoring aid in cases from routine practice and to explore the potential of the tool to overcome variability in scoring. Twenty-three breast pathologists scored sTILs in digitized slides of 49 TNBC biopsies using the scoring aid. Subsequently, fields of view (FOV) from each case were selected by one pathologist and scored by the group using the tool. Inter-observer agreement was good for absolute sTILs (ICC 0.634, 95% CI 0.539-0.735, p < 0.001) but was poor to fair using binary cutpoints. sTILs heterogeneity was the main contributor to disagreement. When pathologists scored the same FOV from each case, inter-observer agreement was excellent for absolute sTILs (ICC 0.798, 95% CI 0.727-0.864, p < 0.001) and good for the 20% (ICC 0.657, 95% CI 0.561-0.756, p < 0.001) and 40% (ICC 0.644, 95% CI 0.546-0.745, p < 0.001) cutpoints. However, there was a wide range of scores for many cases. Reproducibility scoring sTILs is good when the scoring aid is used. Heterogeneity is the main contributor to variance and will need to be overcome for analytic validity to be achieved.
  • Participating Labs (2019)
    BACKGROUND: The Islet Autoantibody Standardization Program (IASP) aims to improve the performance of immunoassays measuring type 1 diabetes (T1D)-associated autoantibodies and the concordance of results among laboratories. IASP organizes international interlaboratory assay comparison studies in which blinded serum samples are distributed to participating laboratories, followed by centralized collection and analysis of results, providing participants with an unbiased comparative assessment. In this report, we describe the results of glutamic acid decarboxylase autoantibody (GADA) assays presented in the IASP 2018 workshop. METHODS: In May 2018, IASP distributed to participants uniquely coded sera from 43 new-onset T1D patients, 7 multiple autoantibody-positive nondiabetic individuals, and 90 blood donors. Results were analyzed for the following metrics: sensitivity, specificity, accuracy, area under the ROC curve (ROC-AUC), partial ROC-AUC at 95% specificity (pAUC95), and concordance of qualitative and quantitative results. RESULTS: Thirty-seven laboratories submitted results from a total of 48 different GADA assays adopting 9 different formats. The median ROC-AUC and pAUC95 of all assays were 0.87 [interquartile range (IQR), 0.83-0.89] and 0.036 (IQR, 0.032-0.039), respectively. Large differences in pAUC95 (range, 0.001-0.0411) were observed across assays. Of formats widely adopted, bridge ELISAs showed the best median pAUC95 (0.039; range, 0.036-0.041). CONCLUSIONS: Several novel assay formats submitted to this study showed heterogeneous performance. In 2018, the majority of the best performing GADA immunoassays consisted of novel or established nonradioactive tests that proved on a par or superior to the radiobinding assay, the previous gold standard assay format for GADA measurement. (C) 2019 American Association for Clinical Chemistry
  • Voutilainen, Liisa; Henttonen, Pentti; Stevanovic, Melisa; Kahri, Mikko; Peräkylä, Anssi (2019)
    In her influential paper on stance, alignment, and affiliation in conversational storytelling, Tanya Stivers argued that two basic conversational means of receiving a story, nods and vocal continuers, differ in their function: whereas vocal continuers display alignment with the telling activity, nods, during the mid-telling, convey affiliation with the storytellers' affective stance. In this paper, we elaborate these insights on the basis of a quantitative study informed by conversation analysis. Using a database of 317 stories told in Finnish, we analyzed how story recipients' nods and continuers in different phases of storytelling (before and after the story climax) predict naive raters' judgments of the story recipients' empathy toward the storyteller. We found that vocal continuers accounted for the perception of empathy during mid-telling, whereas the effect of nods remained weak. The study offers further support to the notion of structural organization of storytelling, and suggests that the significance of vocal continuers as a vehicle of empathy may be greater than has been generally thought of.
  • Palojoki, Sari; Saranto, Kaija; Lehtonen, Lasse (2019)
    The European Union Medical Device Directive 2007/47/EC1 defines software with a medical purpose as a medical device. The implementation of health information technology suffers from patient safety problems that require effective post-market surveillance. The purpose of this study was to review, classify and discuss the incident data submitted to a nationwide database of the Finnish National Competent Authority with other forms of data. We analysed incident reports submitted to the authority database by users of electronic health records from 2010 to 2015. We identified 138 valid reports. Adverse events associated with electronic health record vulnerabilities, clustered around certain error types, cause serious harm and occur in all types of healthcare settings. The low rate of reported incidents raises questions about not only the challenges associated with medical software oversight but also the obstacles for reporting.
  • Hurri, Karoliina (2020)
    Developed countries, defined in the global climate negotiations as the Annex I countries, have been expected to take the lead in tackling climate change. However, given the severity of climate change, reducing China’s emissions is critical. China is a developing country with world’s highest emissions and a leader in the renewable sector. Hence, outside expectations for China’s climate action have been growing. Through constructivist role theory, the article researched what external expectations there are for China’s potential climate leadership role. The leadership ex-pectations of developed countries were examined from the UN climate conference high-level segment statements from 2016 to 2018. Results of the discourse analysis explain the expecta-tions in six storylines: 1) all parties are placed on the same line, 2) the dichotomy of developing and developed countries is deconstructed, 3) the position of developing countries is highlighted, 4) China has a greater responsibility than non-Annex or a regular party, 5) China is recognized as a climate actor, and 6) China is excluded as a major player. The expectations recognize China’s structural climate leadership but acknowledging China as a global climate leader might pose a role conflict for the developed countries. The conclusion suggests that this acknowledgement would require developed countries to rethink their own climate leadership and assign the role with China
  • Sternby, Hanna; Verdonk, Robert C.; Aguilar, Guadalupe; Dimova, Alexandra; Ignatavicius, Povilas; Ilzarbe, Lucas; Koiva, Peeter; Lantto, Eila; Loigom, Tonis; Penttilä, Anne; Regner, Sara; Rosendahl, Jonas; Strahinova, Vanya; Zackrisson, Sophia; Zviniene, Kristina; Bollen, Thomas L. (2016)
    Background: For consistent reporting and better comparison of data in research the revised Atlanta classification (RAC) proposes new computed tomography (CT) criteria to describe the morphology of acute pancreatitis (AP). The aim of this study was to analyse the interobserver agreement among radiologists in evaluating CT morphology by using the new RAC criteria in patients with AP. Methods: Patients with a first episode of AP who obtained a CT were identified and consecutively enrolled at six European centres backwards from January 2013 to January 2012. A local radiologist at each center and a central expert radiologist scored the Cfs separately using the RAC criteria. Center dependent and independent interobserver agreement was determined using Kappa statistics. Results: In total, 285 patients with 388 CTs were included. For most CT criteria, interobserver agreement was moderate to substantial. In four categories, the center independent kappa values were fair: extrapancreatic necrosis (EXPN) (0.326), type of pancreatitis (0.370), characteristics of collections (0.408), and appropriate term of collections (0.356). The fair kappa values relate to discrepancies in the identification of extrapancreatic necrotic material. The local radiologists diagnosed EXPN (33% versus 59%, P <0.0001) and non-homogeneous collections (35% versus 66%, P <0.0001) significantly less frequent than the central expert. Cases read by the central expert showed superior correlation with clinical outcome. Conclusion: Diagnosis of EXPN and recognition of non-homogeneous collections show only fair agreement potentially resulting in inconsistent reporting of morphologic findings. (C) 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.
  • Wu, Teddy Y.; Sobowale, Oluwaseun; Hurford, Robert; Sharma, Gagan; Christensen, Soren; Yassi, Nawaf; Tatlisumak, Turgut; Desmond, Patricia M.; Campbell, Bruce C. V.; Davis, Stephen M.; Parry-Jones, Adrian R.; Meretoja, Atte (2016)
    Haematoma and oedema size determines outcome after intracerebral haemorrhage (ICH), with each added 10 % volume increasing mortality by 5 %. We assessed the reliability of semi-automated computed tomography planimetry using Analyze and Osirix softwares. We randomly selected 100 scans from 1329 ICH patients from two centres. We used Hounsfield Unit thresholds of 5-33 for oedema and 44-100 for ICH. Three raters segmented all scans using both softwares and 20 scans repeated for intra-rater reliability and segmentation timing. Volumes reported by Analyze and Osirix were compared to volume estimates calculated using the best practice method, taking effective individual slice thickness, i.e. voxel depth, into account. There was excellent overall inter-rater, intra-rater and inter-software reliability, all intraclass correlation coefficients > 0.918. Analyze and Osirix produced similar haematoma (mean difference: Analyze -aEuroeOsirix = 1.5 +/- 5.2 mL, 6 %, p aecurrency signaEuroe0.001) and oedema volumes (-0.6 +/- 12.6 mL, -3 %, p = 0.377). Compared to a best practice approach to volume calculation, the automated haematoma volume output was 2.6 mL (-11 %) too small with Analyze and 4.0 mL (-18 %) too small with Osirix, whilst the oedema volumes were 2.5 mL (-12 %) and 5.5 mL (-25 %) too small, correspondingly. In scans with variable slice thickness, the volume underestimations were larger, -29%/-36 % for ICH and -29 %/-41 % for oedema. Mean segmentation times were 6:53 +/- 4:02 min with Analyze and 9:06 +/- 5:24 min with Osirix (p <0.001). Our results demonstrate that the method used to determine voxel depth can influence the final volume output markedly. Results of clinical and collaborative studies need to be considered in the context of these methodological differences.
  • Abdul-Rahim, Azmil H.; VISTA Collaborators; Kaste, M. (2019)
    BackgroundInter-observer variability in stroke aetiological classification may have an effect on trial power and estimation of treatment effect. We modelled the effect of misclassification on required sample size in a hypothetical cardioembolic (CE) stroke trial.MethodsWe performed a systematic review to quantify the reliability (inter-observer variability) of various stroke aetiological classification systems. We then modelled the effect of this misclassification in a hypothetical trial of anticoagulant in CE stroke contaminated by patients with non-cardioembolic (non-CE) stroke aetiology. Rates of misclassification were based on the summary reliability estimates from our systematic review. We randomly sampled data from previous acute trials in CE and non-CE participants, using the Virtual International Stroke Trials Archive. We used bootstrapping to model the effect of varying misclassification rates on sample size required to detect a between-group treatment effect across 5000 permutations. We described outcomes in terms of survival and stroke recurrence censored at 90days.ResultsFrom 4655 titles, we found 14 articles describing three stroke classification systems. The inter-observer reliability of the classification systems varied from fair' to very good' and suggested misclassification rates of 5% and 20% for our modelling. The hypothetical trial, with 80% power and alpha 0.05, was able to show a difference in survival between anticoagulant and antiplatelet in CE with a sample size of 198 in both trial arms. Contamination of both arms with 5% misclassified participants inflated the required sample size to 237 and with 20% misclassification inflated the required sample size to 352, for equivalent trial power. For an outcome of stroke recurrence using the same data, base-case estimated sample size for 80% power and alpha 0.05 was n=502 in each arm, increasing to 605 at 5% contamination and 973 at 20% contamination.ConclusionsStroke aetiological classification systems suffer from inter-observer variability, and the resulting misclassification may limit trial power.Trial registrationProtocol available at reviewregistry540.
  • Lampi, Jussi; Ung-Lanki, Sari; Santalahti, Päivi; Pekkanen, Juha (2018)
    Background: Questionnaires can be used to assess perceived indoor air quality and symptoms in schools. Questionnaires for primary school aged children have traditionally been parent-administered, but self-administered questionnaires would be easier to administer and may yield as good, if not better, information. Our aim was to compare the repeatability of self- and parent-administered indoor air questionnaires designed for primary school aged pupils. Methods: Indoor air questionnaire with questions on child's symptoms and perceived indoor air quality in schools was sent to parents of pupils aged 7-12 years in two schools and again after two weeks. Slightly modified version of the questionnaire was administered to pupils aged 9-12 years in another two schools and repeated after a week. 351 (52%) parents and 319 pupils (86%) answered both the first and the second questionnaire. Test-retest repeatability was assessed with intra-class correlation (ICC) and Cohen's kappa coefficients (k). Results: Test-retest repeatability was generally between 0.4-0.7 (ICC; k) in both self-and parent-administered questionnaire. In majority of the questions on symptoms and perceived indoor air quality test-retest repeatability was at the same level or slightly better in self-administered compared to parent-administered questionnaire. Agreement of self-and parent administered questionnaires was generally <0.4 (ICC; k) in reported symptoms and 0.4-0.6 (ICC; k) in perceived indoor air quality. Conclusions: Children aged 9-12 years can give as, or even more, repeatable information about their respiratory symptoms and perceived indoor air quality than their parents. Therefore, it may be possible to use self-administered questionnaires in future studies also with children.
  • Stevenson, Nathan J.; Lauronen, Leena; Vanhatalo, Sampsa (2018)
    Objectives: To measure changes in the visual interpretation of the EEG by the human expert for neonatal seizure detection when reducing the number of recording electrodes. Methods: EEGs were recorded from 45 infants admitted to the neonatal intensive care unit (NICU). Three experts annotated seizures in EEG montages derived from 19, 8 and 4 electrodes. Differences between annotations were assessed by comparing intra-montage with inter-montage agreement (K). Results: Three experts annotated 4464 seizures across all infants and montages. The inter-expert agreement was not significantly altered by the number of electrodes in the montage (p = 0.685, n = 43). Reducing the number of EEG electrodes altered the seizure annotation for all experts. Agreement between the 19-electrode montage (K-19,K-19 = 0.832) was significantly higher than the agreement between 19 and 8-electrode montages (dK = 0.114; p <0.001, n = 42) or 19 and 4-electrode montages (dK = 0.113, p <0.001, n = 43). Seizure burden and number were significantly underestimated by the 4 and 8-electrode montage (p <0.001). No significant difference in agreement was found between 8 and 4-electrode montages (dK = 0.002; p = 0.07, n = 42). Conclusions: Reducing the number of EEG electrodes from 19 electrodes resulted in slight but significant changes in seizure detection. (C) 2017 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
  • Holopainen, Saila; Rautala, Elina; Lilja-Maula, Liisa; Lohi, Hannes; Rajamaki, Minna M.; Lappalainen, Anu K. (2019)
    Canine idiopathic pulmonary fibrosis is a chronic, progressive interstitial lung disease particularly prevalent in West Highland White Terriers. In the present prospective pilot study, we evaluated the feasibility of modified VetMousetrap (TM) device in high resolution CT to detect idiopathic pulmonary fibrosis in West Highland White Terriers. Twelve awake West Highland White Terriers with canine idiopathic pulmonary fibrosis and 24 clinically healthy West Highland White Terriers were scanned using a helical dual slice scanner utilizing VetMousetrap (TM) device without or with minimal chemical restraint with butorphanol. Three evaluators blindly assessed the images for image quality and the presence of canine idiopathic pulmonary fibrosis related imaging findings such as ground glass opacity and reticular opacities. Additionally, the attenuation of the lung was quantified with ImageJ software using histogram analysis of density over the lung fields. Computed tomography was successfully completed and motion artifact ranked in statistical analysis barely noticeable to mild in all dogs. The agreement between imaging findings and clinical status was very good with overall kappa value 0.91 and percentage of agreement of 94%. There was also very good intraobserver (kappa(range) = 0.79-0.91) and interobserver agreement (kappa = 0.94). Moderate to severe ground glass opacity was present in all affected dogs. In the ImageJ analysis, a significant difference in lung attenuation between the study groups was observed. We conclude that modified VetMousetrap (TM) device is applicable in diagnosing canine idiopathic pulmonary fibrosis in awake West Highland White Terriers avoiding anesthetic risk in these often severely hypoxic patients.
  • Tapani, Karoliina T.; Vanhatalo, Sampsa; Stevenson, Nathan J. (2019)
    The aim of this study was to develop methods for detecting the nonstationary periodic characteristics of neonatal electroencephalographic (EEG) seizures by adapting estimates of the correlation both in the time (spike correlation; SC) and time-frequency domain (time-frequency correlation; TFC). These measures were incorporated into a seizure detection algorithm (SDA) based on a support vector machine to detect periods of seizure and nonseizure. The performance of these nonstationary correlation measures was evaluated using EEG recordings from 79 term neonates annotated by three human experts. The proposed measures were highly discriminative for seizure detection (median AUC(SC): 0.933 IQR: 0.821-0.975, median AUC(TFC): 0.883 IQR: 0.707-0.931). The resultant SDA applied to multi-channel recordings had a median AUC of 0.988 (IQR: 0.931-0.998) when compared to consensus annotations, outperformed two state-of-the-art SDAs (p <0.001) and was noninferior to the human expert for 73/79 of neonates.