Inter-observer Reliability of Indicators and Decision of Pattern Identification Using Diagnostic Flowchart with Traditional Korean Medicine

Objective： To evaluate the consistency of patterns and pattern identification（PI）, and the improvement in the diagnosis of blood stasis after the standard operating procedures（SOPs） were enhanced by using a diagnostic flowchart. Methods： A total of 358 subjects who were admitted by the Jaseng Hospital of Korean Medicine between June 2013 and December 2014 were included in the study. Each patient was independently diagnosed by two experts from the same department. In 2014, the SOPs included the use of a diagnostic flowchart for each indicator. Inter-observer consistency was assessed by simple percent agreement and by the kappa and AC1 statistics. Results： The improvements in inter-observer agreement for the indicators（for al patients） and PI were greater in 2014 than in 2013. In 2013, the j-value measure of agreement between the two experts ranged from ＂poor＂（κ=–0.051） to ＂good＂（κ=0.968）. The AC1 measure of agreement between the experts was generally high for the indicators and ranged from –0.010 to 0.978. In most cases, agreement was considerably lower when it was assessed by the j-values compared with the AC1 values. In 2014, the j-value measure of agreement on the indicators（for the subjects） general y ranged from poor to good, with the values ranging from –0.007 to 0.994. Moreover, the AC1 measure of agreement between the experts was general y high for al of the indicators and ranged from ＂moderate＂（AC1=0.408） to ＂excel ent＂（AC1=0.996）. Conclusions： In four examinations, there was moderate agreement between the clinicians on the PI indicators of blood stasis. To improve clinician consistency（e.g., in the diagnostic criteria used）, it is necessary to analyse the reasons for inconsistency and to improve clinician training.（Trial registration No. KCT0000916）

Reliable identification of 'truly low' thromboembolic risk in patients initially diagnosed with 'lone' atrial fibrillation:The Belgrade atrial fibrillation study

Background The CHA 2 DS 2-VASc schema has recently been introduced to complement the CHADS2 score and improve the identification of atrial fibrillation （AF） patients at ＇truly low risk＇ for thromboembolism.We tested the predictive ability of the CHA 2 DS 2-VASc,CHADS2 and van Walraven risk stratification schemes in a cohort of ＇lone＇ AF patients with a 12-year follow-up.Methods and Results We conducted a registry-based,observational cohort study of 345 patients initially diagnosed with ＇lone＇ AF between 1992 and 2007.At baseline,all patients had the CHADS2 and van Walraven scores of 0,and 262 （75.9%） had a CHA 2 DS 2VASc score=0.During follow-up （or within a year prior to stroke）,228 （66.1%）,234 （67.8%） and 150 patients （43.5%） retained the CHADS2,van Walraven and CHA 2 DS 2VASc scores of 0,respectively.The overall rate of ischemic stroke was 0.19 （95%CI：0.18-0.20） per 100 patient-years.In the multivariable analysis,only the CHA 2 DS 2-VASc score of 0 was significantly related to the absence of stroke （OR 5.1,95%CI：1.5-16.8,P=0.008）.Only the CHA 2 DS 2-VASc score had a significant prediction ability （c-statistic 0.72 [0.61-0.84],P=0.031）.Conclusions The CHA 2 DS 2-VASc score reliably identified the ＇lone＇ AF patients who were at ＇truly low risk＇ for thromboembolism,and was the only tested risk stratification scheme with a significant predictive ability for thromboembolism amongst lone AF patients.