PubMed Health⌕ Search

Biomedical subjects

D Shinar

Publications and source records attributed to D Shinar.

27 records · Page 2Linked to original sources
PubMed1986

Interobserver agreement in the diagnosis of stroke type.

Interobserver agreement is essential to the reliability of clinical data from cooperative studies and provides the foundation for applying research results to clinical practice. In the Stroke Data Bank, a large cooperative study of stroke, we sought to establish the reliability of a key aspect of stroke diagnosis: the mechanism of stroke. Seventeen patients were evaluated by six neurologists. Interobserver agreement was measured when diagnosis was based on patient history and neurologic examination only, as well as when it was based on results of a completed workup, including a computed tomographic scan. Initial clinical impressions, based solely on history and one neurologic examination, were fairly reliable in establishing the mechanism of stroke (ie, distinguishing among infarcts, subarachnoid hemorrhages, and parenchymatous hemorrhages). Classification into one of nine stroke subtypes was substantially reliable when diagnoses were based on a completed workup. Compared with previous findings for the same physicians and patients, the diagnosis of stroke type was generally more reliable than individual signs and symptoms. These results suggest that multicentered studies can rely on the independent diagnostic choices of several physicians when common definitions are employed and data from a completed workup are available. Furthermore, reliability may be less for individual measurements such as signs or symptoms than for more-complex judgments such as diagnoses.

Adult↗
PubMed1985

Interobserver variability in the assessment of neurologic history and examination in the Stroke Data Bank.

Interobserver reliability in obtaining neurologic histories and examinations was investigated among neurologists collaborating in the Stroke Data Bank (SDB). Seventeen in-hospital stroke patients were examined by six neurologists experienced in stroke over the course of three days. Patients were examined twice a day for two successive days, with each patient seen by four different neurologists. Data were recorded on SDB forms, according to definitions and procedures established for the SDB. Percent agreement and kappa coefficients were calculated to assess the levels of agreement for each item. Important differences in levels of agreement were found among items on both neurologic history and examination. Agreement among neurologists was higher for neurologic examination than for history. Patterns of agreement for items with low prevalence or with numerous unknown ratings are discussed. Improvement in interobserver agreement due to data editing for intra-observer consistency was shown.

Adult↗
PubMed1981

Symmetrical distribution and rapid transbilayer movement of cholesterol in Mycoplasma gallisepticum membranes.

The exchange of cholesterol between [14C]cholesterol-labeled Mycoplasma gallisepticum cells and an excess of sonicated egg phosphatidylcholine/cholesterol vesicles (molar ratio of 0.9) was measured. More than 90% of the radioactive cholesterol underwent transfer from intact cells to the vesicles. The kinetics of the transfer was biphasic. About 50% of the radioactive cholesterol was exchanged with a half-time of about 4 h. The residual was exchanged at a slower rate with a half-time of about 9 h at 37 degrees C. Bovine serum albumin had a pronounced effect in enhancing both the fast and slow rates of cholesterol exchange, but did not affect the pool sizes significantly. The half-time for equilibration of the two pools in the presence of 2% albumin, calculated using a reversible two-pool method of analysis, was 6.2 h. The effect of albumin was also obtained with isolated membrane preparations and with cells treated with growth inhibitors, suggesting that this effect is independent of albumin preservation of cell viability. The rate enhancement of albumin was concentration dependent with maximal effects observed with greater than or equal to 2%, where the rates of exchange of both the rapidly and slowly exchanging pools were twice as fast. The mechanism by which albumin may affect the exchange rates is discussed.

Cell Membrane↗
PubMedDate not supplied

Screening for depression in stroke patients: the reliability and validity of the Center for Epidemiologic Studies Depression Scale.

This study examined the inter-observer reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D) as a measure of depressive symptomatology in stroke patients, and its utility as a screening tool for depression in this population. The CES-D Scale is a brief questionnaire originally designed for use in community surveys. Twenty-seven non-aphasic patients enrolled in the Stroke Data Bank at the University of Maryland were interviewed by a research nurse using the CES-D. On the same day, each patient was independently evaluated by a research assistant using a psychiatric battery for depression and measures of cognitive, physical, and social functioning. Forty-one percent (11/27) of the patients were depressed according to clinical criteria for major or minor depression. With a cutpoint corresponding to the upper (most severe) 20% in community surveys, the CES-D Scale picked up 73% (8/11) of the depressed patients. In this sample no nondepressed patient scored over 16 on the CES-D (no false positives). The CES-D Scale scores correlated significantly with the other depression measures (r = .57 to r = .82, p less than .002) and did not correlate with the measures of cognitive, physical, or social functioning. Based on 24 patients who received a CES-D Scale score from both the nurse and the research assistant, inter-rater reliability was high (r = .76, p less than .001). Thus, the CES-D was found to be reliable and valid as a screening tool for assessing depression in stroke patients.

Adult↗