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Nelsen, Roger B. "Concordance and Gini's measure of association". Journal of Nonparametric Statistics 9, n.º 3 (enero de 1998): 227–38. http://dx.doi.org/10.1080/10485259808832744.
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Burke, Daniel y P. Alex Linley. "Enhancing goal self-concordance through coaching". International Coaching Psychology Review 2, n.º 1 (marzo de 2007): 62–69. http://dx.doi.org/10.53841/bpsicpr.2007.2.1.62.
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Objectives:Research shows that self-concordant goals are more readily pursued, better achieved, and their attainment can lead to increases in well-being. This study assesses whether executive coaching in turn affects self-concordance.Design:We hypothesised that the heightened awareness produced by coaching leads to changes in self-concordance (type of motivation) and commitment (a measure of the amount of motivation). A single group design with repeated measures was used.Method:26 participants – all senior managers in business – identified three goals and then received a one-to-one coaching session focused on one goal, but received no coaching on the remaining goals.Results:The hypothesis was supported, with significant changes (increases) in self-concordance and commitment for the coached goal. There were also significant increases in self-concordance and commitment for some of the other non-coached goals.Conclusion:These results are discussed with reference to the goal attainment and coaching literature, and suggestions made for further research.
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Rocque, Gabrielle, Douglas W. Blayney, Mohammad Jahanzeb, August Knape, Merry Jennifer Markham, Trang Pham, Jeremy Shelton, Preeti Sudheendra y Tracey Evans. "Choosing Wisely in Oncology: Are We Ready For Value-Based Care?" Journal of Oncology Practice 13, n.º 11 (noviembre de 2017): e935-e943. http://dx.doi.org/10.1200/jop.2016.019281.
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Introduction: In 2012, ASCO created the Top Five Choosing Wisely (CW) list of low-value tests and procedures for which there is little evidence of benefit. ASCO’s Quality Oncology Practice Initiative, an oncologist-led practice-based quality assessment program, includes measures on the basis of these recommendations. Methods: CW test measures from spring and fall 2013, spring 2014, and spring 2015 were evaluated for concordance rates, change in the concordance over time, and variability by practice characteristics. Practice characteristics recorded included geographic location, academic affiliation, number of new cases, number of medical oncologists, and rounds of participation in Quality Oncology Practice Initiative. Medians, interquartile ranges, and percentages were calculated for concordance with recommendations and practice characteristics. Change in recommendation concordance over time was assessed using linear regression models. Results: From 2013 to 2015, 341 unique oncology practices abstracted the CW measures. Performance varied for specific recommendations. The median concordance was best for measure 1 (patients with low or undocumented performance status who received chemotherapy), where concordance ranged from 78.4% to 83.3%. The lowest concordance was for measure 3 (use of biomarkers or advanced imaging tests for surveillance in early breast cancer), where concordance ranged from 67.7% to 74.2%. Performance on CW measures varied markedly by individual practice. Variability over time and by practice characteristics was observed. Conclusion: Performance on ASCO’s CW demonstrates room for improvement. Concordance rates varied substantially by practice. Further education on CW measures is needed to improve patient care and enhance value.
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Rocque, Gabrielle B., Courtney P. Williams, Bradford E. Jackson, Audrey S. Wallace, Karina I. Halilova, Kelly M. Kenzik, Edward E. Partridge y Maria Pisu. "Choosing Wisely: Opportunities for Improving Value in Cancer Care Delivery?" Journal of Oncology Practice 13, n.º 1 (enero de 2017): e11-e21. http://dx.doi.org/10.1200/jop.2016.015396.
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Introduction: Patients, providers, and payers are striving to identify where value in cancer care can be increased. As part of the Choosing Wisely (CW) campaign, ASCO and the American Society for Therapeutic Radiology and Oncology have recommended against specific, yet commonly performed, treatments and procedures. Methods: We conducted a retrospective analysis of Medicare claims data to examine concordance with CW recommendations across 12 cancer centers in the southeastern United States. Variability for each measure was evaluated on the basis of patient characteristics and site of care. Hierarchical linear modeling was used to examine differences in average costs per patient by concordance status. Potential cost savings were estimated on the basis of a potential 95% adherence rate and average cost difference. Results: The analysis included 37,686 patients with cancer with Fee-for-Service Medicare insurance. Concordance varied by CW recommendation from 39% to 94%. Patient characteristics were similar for patients receiving concordant and nonconcordant care. Significant variability was noted across centers for all recommendations, with as much as an 89% difference. Nonconcordance was associated with higher costs for every measure. If concordance were to increase to 95% for all measures, we would estimate a $19 million difference in total cost of care per quarter. Conclusion: These results demonstrate ample room for reduction of low-value care and corresponding costs associated with the CW recommendations. Because variability in concordance was driven primarily by site of care, rather than by patient factors, continued education about these low-value services is needed to improve the value of cancer care.
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Rey, Sergio J. "Fast algorithms for a space-time concordance measure". Computational Statistics 29, n.º 3-4 (27 de octubre de 2013): 799–811. http://dx.doi.org/10.1007/s00180-013-0461-2.
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O’Neil, Daniel S., Wenlong Carl Chen, Oluwatosin Ayeni, Sarah Nietz, Ines Buccimazza, Urishka Singh, Sharon Čačala et al. "Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures". Journal of Global Oncology, n.º 5 (diciembre de 2019): 1–16. http://dx.doi.org/10.1200/jgo.19.00171.
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PURPOSE The quality of breast cancer care in sub-Saharan Africa contributes to the region’s dismal breast cancer mortality. ASCO has issued quality measures focusing on delivery of adjuvant chemotherapy, radiotherapy, and endocrine therapy. We applied these measures in five South African public hospitals and analyzed factors associated with care concordance. MATERIALS AND METHODS Among 1,736 women with breast cancer who were enrolled in the South African Breast Cancer and HIV Outcomes study over 24 months, we evaluated care using ASCO’s three measures. We also evaluated adjuvant chemotherapy receipt in 957 women with an indication. We used logistic regression to estimate associations between measure-concordant care and patient factors. RESULTS Of 235 women with hormone receptor–negative cancer, 173 (74%) began adjuvant chemotherapy within 120 days from diagnosis. Of 194 patients who received breast-conserving surgery, 73 (37%) began radiotherapy within 365 days from diagnosis. Of 999 women with hormone receptor–positive cancer, 719 (72%) initiated endocrine therapy within 365 days from diagnosis. Chemotherapy and radiotherapy measure-concordant care were more common among women residing < 20 km from the hospital (odds ratio [OR], 1.79; 95% CI, 1.32 to 2.44 and OR, 3.17; 95% CI, 1.57 to 6.42). Endocrine therapy measure-concordant care was more common among English-speaking women (OR, 2.12; 95% CI, 1.12 to 4.02). Participating hospitals varied in care concordance. HIV infection did not affect care quality. CONCLUSION More timely delivery of chemotherapy, radiotherapy, and endocrine therapy is needed in South Africa, particularly for women living > 20 km from the hospital or not speaking English. Focused quality improvement efforts could support that goal.
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Minh, Bui Quang, Matthew W. Hahn y Robert Lanfear. "New Methods to Calculate Concordance Factors for Phylogenomic Datasets". Molecular Biology and Evolution 37, n.º 9 (4 de mayo de 2020): 2727–33. http://dx.doi.org/10.1093/molbev/msaa106.
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Abstract We implement two measures for quantifying genealogical concordance in phylogenomic data sets: the gene concordance factor (gCF) and the novel site concordance factor (sCF). For every branch of a reference tree, gCF is defined as the percentage of “decisive” gene trees containing that branch. This measure is already in wide usage, but here we introduce a package that calculates it while accounting for variable taxon coverage among gene trees. sCF is a new measure defined as the percentage of decisive sites supporting a branch in the reference tree. gCF and sCF complement classical measures of branch support in phylogenetics by providing a full description of underlying disagreement among loci and sites. An easy to use implementation and tutorial is freely available in the IQ-TREE software package (http://www.iqtree.org/doc/Concordance-Factor, last accessed May 13, 2020).
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Cohen-Stavi, Chandra J., Calanit Key, Shmuel Giveon, Tchiya Molcho, Ran D. Balicer y Efrat Shadmi. "Assessing guideline-concordant care for patients with multimorbidity treated in a care management setting". Family Practice 37, n.º 4 (27 de marzo de 2020): 479–85. http://dx.doi.org/10.1093/fampra/cmaa024.
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Abstract Background Disease-specific guidelines are not aligned with multimorbidity care complexity. Meeting all guideline-recommended care for multimorbid patients has been estimated but not demonstrated across multiple guidelines. Objective Measure guideline-concordant care for patients with multimorbidity; assess in what types of care and by whom (clinician or patient) deviation from guidelines occurs and evaluate whether patient characteristics are associated with concordance. Methods A retrospective cohort study of care received over 1 year, conducted across 11 primary care clinics within the context of multimorbidity-focused care management program. Patients were aged 45+ years with more than two common chronic conditions and were sampled based on either being new (≤6 months) or veteran to the program (≥1 year). Measures Three guideline concordance measures were calculated for each patient out of 44 potential guideline-recommended care processes for nine chronic conditions: overall score; referral score (proportion of guideline-recommended care referred) and patient-only score (proportion of referred care completed by patients). Guideline concordance was stratified by care type. Results 4386 care processes evaluated among 204 patients, mean age = 72.3 years (standard deviation = 9.7). Overall, 79.2% of care was guideline concordant, 87.6% was referred according to guidelines and patients followed 91.4% of referred care. Guideline-concordant care varied across care types. Age, morbidity burden and whether patients were new or veteran to the program were associated with guideline concordance. Conclusions Patients with multimorbidity do not receive ~20% of guideline recommendations, mostly due to clinicians not referring care. Determining the types of care for which the greatest deviation from guidelines exists can inform the tailoring of care for multimorbidity patients.
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Verbic, Miroslav y Franc Kuzmin. "Coefficient of structural concordance and an example of its application: Labour productivity and wages in Slovenia". Panoeconomicus 56, n.º 2 (2009): 227–40. http://dx.doi.org/10.2298/pan0902227v.
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The article presents the underlying principles, derivation and properties of a simple descriptive measure of concordance between two analogous rank structures that we call the coefficient of structural concordance. It is based upon the idea of Kendall's coefficient of concordance, which we extend to two rank structures. As the coefficient of structural concordance is a pure intergroup measure of concordance, it is designed to complement the Kendall's intragroup coefficient of concordance. We apply this descriptive measure by exploring the relationship between wages and labour productivity in Slovenia for the period 1998-2007. We are able to confirm the hypothesis of high concordance between wages and labour productivity, which indicates a stimulative role of wages in production of market traded goods and services.
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Dalessandro, Antonio y Gareth W. Peters. "Efficient and Accurate Evaluation Methods for Concordance Measures via Functional Tensor Characterizations of Copulas". Methodology and Computing in Applied Probability 22, n.º 3 (5 de diciembre de 2019): 1089–124. http://dx.doi.org/10.1007/s11009-019-09752-2.
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AbstractThere is now an increasingly large number of proposed concordance measures available to capture, measure and quantify different notions of dependence in stochastic processes. However, evaluation of concordance measures to quantify such types of dependence for different copula models can be challenging. In this work, we propose a class of new methods that involves a highly accurate and computationally efficient procedure to evaluate concordance measures for a given copula, applicable even when sampling from the copula is not easily achieved. In addition, this then allows us to reconstruct maps of concordance measures locally in all regions of the state space for any range of copula parameters. We believe this technique will be a valuable tool for practitioners to understand better the behaviour of copula models and associated concordance measures expressed in terms of these copula models.
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Susmaga, Robert y Izabela Szczęch. "Can Confirmation Measures Reflect Statistically Sound Dependencies in Data? The Concordance-based Assessment". Foundations of Computing and Decision Sciences 43, n.º 1 (1 de marzo de 2018): 41–66. http://dx.doi.org/10.1515/fcds-2018-0004.
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Abstract The paper considers particular interestingness measures, called confirmation measures (also known as Bayesian confirmation measures), used for the evaluation of “if evidence, then hypothesis” rules. The agreement of such measures with a statistically sound (significant) dependency between the evidence and the hypothesis in data is thoroughly investigated. The popular confirmation measures were not defined to possess such form of agreement. However, in error-prone environments, potential lack of agreement may lead to undesired effects, e.g. when a measure indicates either strong confirmation or strong disconfirmation, while in fact there is only weak dependency between the evidence and the hypothesis. In order to detect and prevent such situations, the paper employs a coefficient allowing to assess the level of dependency between the evidence and the hypothesis in data, and introduces a method of quantifying the level of agreement (referred to as a concordance) between this coefficient and the measure being analysed. The concordance is characterized and visualised using specialized histograms, scatter-plots, etc. Moreover, risk-related interpretations of the concordance are introduced. Using a set of 12 confirmation measures, the paper presents experiments designed to establish the actual concordance as well as other useful characteristics of the measures.
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Rios, Katrina Caridad, Arpitha Thakkalapally, Jacob Koskimaki, Mark Riffon, Robert S. Miller, George Anthony Komatsoulis y Danielle Potter. "Impact of curated data on electronic quality measure capture rates within CancerLinQ." Journal of Clinical Oncology 38, n.º 29_suppl (10 de octubre de 2020): 307. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.307.
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307 Background: Accurate calculation of key quality measures is critical for informing high-quality, value-based cancer care that is consistent with clinical guidelines. The American Society of Clinical Oncology (ASCO)’s CancerLinQ enables oncology organizations around the US to view near-real time quality measure dashboards sourced from structured electronic medical record (EMR) data; however, use of structured data in key fields is highly variable. Unstructured content, such as progress notes, contains important clinical information on treatment and disease status, which can then undergo curation. This process involves trained data abstractors searching for key data elements through a combination of manual review and natural language processing (NLP) to extract structured data from unstructured content. We hypothesize inclusion of curated data substantially augments structured data alone by more accurately representing the patient journey, thus improving validity of quality measures across EMRs. Methods: A total of 96,399 records across 57,232 patients from 4 EMRs vendors were analyzed from 2018-2019 across structured EMR and curated data. Each record represents 1 of 7 key data elements used to calculate the Staging Documented within One Month of First Office Visit quality measure. Structured documentation of these data elements determines if a patient is concordant with the measure, meaning they were staged within 31 days of their first visit after diagnosis, or non-concordant, meaning they were not staged within the appropriate window. Results: More than a quarter of records from patients concordant or non-concordant with the measure (28.85%) had key data elements sourced from curation. In total, 33% of all records among concordant patients were sourced from curation. Relying on structured data alone would show only 67% concordance versus 97.5% concordance among curated records. This demonstrates that appropriate care may often be delivered but documentation may be missing in a significant fraction of structured EMR data, thus limiting accurate reporting capabilities. Conclusions: NLP-assisted curation can meaningfully supplement structured EMR data by providing a more accurate picture of care rendered, which can have substantial impacts on clinical care, quality reporting, and business operations. [Table: see text]
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Zhang, Yilong y Yongzhao Shao. "Concordance measure and discriminatory accuracy in transformation cure models". Biostatistics 19, n.º 1 (5 de mayo de 2017): 14–26. http://dx.doi.org/10.1093/biostatistics/kxx016.
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Cardamone-Breen, Mairead C., Anthony F. Jorm, Katherine A. Lawrence, Andrew J. Mackinnon y Marie B. H. Yap. "The Parenting to Reduce Adolescent Depression and Anxiety Scale: Assessing parental concordance with parenting guidelines for the prevention of adolescent depression and anxiety disorders". PeerJ 5 (18 de septiembre de 2017): e3825. http://dx.doi.org/10.7717/peerj.3825.
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BackgroundDespite substantial evidence demonstrating numerous parental risk and protective factors for the development of adolescent depression and anxiety disorders, there is currently no single measure that assesses these parenting factors. To address this gap, we developed theParenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS)as a criterion-referenced measure of parental concordance with a set of evidence-based parenting guidelines for the prevention of adolescent depression and anxiety disorders. In this paper, we used a sample of Australian parents of adolescents to: (1) validate the PRADAS as a criterion-referenced measure; (2) examine parental concordance with the guidelines in the sample; and (3) examine correlates of parental concordance with the guidelines.MethodsSeven hundred eleven parents completed the PRADAS, as well as two established parenting measures, and parent-report measures of adolescent depression and anxiety symptoms. Six hundred sixty adolescent participants (aged 12–15) also completed the symptom measures. Concordance with the guidelines was assessed via nine subscale scores and a total score. Reliability of the scores was assessed with an estimate of the agreement coefficient, as well as 1-month test-retest reliability. Convergent validity was examined via correlations between the scale and two established parenting measures.ResultsOne proposed subscale was removed from the final version of the scale, resulting in a total of eight subscales. Reliability was high for the total score, and acceptable to high for seven of the eight subscales. One-month test-retest reliability was acceptable to high for the total score. Convergent validity was supported by moderate to high correlations with two established measures of parenting. Overall, rates of parental concordance with the guidelines were low in our sample. Higher scores were associated with being female and higher levels of parental education. Greater parental concordance with the guidelines was associated with fewer symptoms of depression and anxiety in adolescent participants.DiscussionThis initial validation study provides preliminary support for the reliability and validity of the PRADAS. The scale has potential for use in both clinical and research settings. It may be used to identify parents’ strengths and potential targets for intervention, and as an outcome measure in studies of preventive parenting interventions.
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Edwards, H. H., P. Mikusiński y M. D. Taylor. "Measures of concordance determined byD4-invariant copulas". International Journal of Mathematics and Mathematical Sciences 2004, n.º 70 (2004): 3867–75. http://dx.doi.org/10.1155/s016117120440355x.
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A continuous random vector(X,Y)uniquely determines a copulaC:[0,1]2→[0,1]such that when the distribution functions ofXandYare properly composed intoC, the joint distribution function of(X,Y)results. A copula is said to beD4-invariant if its mass distribution is invariant with respect to the symmetries of the unit square. AD4-invariant copula leads naturally to a family of measures of concordance having a particular form, and all copulas generating this family areD4-invariant. The construction examined here includes Spearman’s rho and Gini’s measure of association as special cases.
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Mann, Sara Lauren, Willem Hardie Collier, Dominik Ose, Shane Brogan, Anna Catherine Beck y Jill E. Sindt. "Clinician versus patient: Who gets it right when assessing function in palliative care?" Journal of Clinical Oncology 36, n.º 34_suppl (1 de diciembre de 2018): 40. http://dx.doi.org/10.1200/jco.2018.36.34_suppl.40.
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40 Background: The Karnofsky Performance Score (KPS) is an important prognostic indicator in cancer care. Additionally, patient-reported outcomes are increasingly incorporated into clinical care and are validated in cancer patients with the NIH’s Patient-Reported Outcomes Measurement Information System (PROMIS). However, little is known about the concordance of the provider-rated KPS and patient-rated PROMIS measures. Methods: Retrospective review of patients with advanced cancer who underwent implantation of an intrathecal pump for refractory pain. We compared KPS and PROMIS scores recorded within 1 week of each other. PROMIS scores included an average score and 3 domains: physical function, fatigue, and pain interference. We divided each measure into 3 previously-described categories (Functionally Independent, Needs Limited Assistance, and Functionally Dependent) and assessed categorical concordance within each measure. The association of patient-related demographic and clinical characteristics were analyzed with KPS–PROMIS concordance using chi-square and Mann-Whitney U tests. Results: 47 patients were included. The provider-rated KPS score consistently indicated a higher functional status compared to the patient-rated PROMIS average score and across all PROMIS domain scores. 40% of patients were rated “Functionally Dependent” using the average PROMIS score, compared to just 19.1% using the KPS, a statistically significant difference (p=0.042). We noted categorical concordance of 55.3% for PROMIS average score, 57.5% for physical function, 44.7% for fatigue and 42.7% for pain interference compared to KPS. We found no statistically significant associations between concordance and patient demographics or characteristics. Conclusions: Our results revealed a notably low concordance in functional status in advanced cancer patients between provider-rated KPS and patient-rated PROMIS measures. Provider-rated scores consistently indicated a higher overall performance status, in particular with measures of the lowest functional status. Additional work is needed to better understand the reasons for this lack of concordance and its implications for ongoing clinical decision-making.
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E. Stahl, James, Mark A. Drew y Alexa Boer Kimball. "Patient-clinician concordance, face-time and access". International Journal of Health Care Quality Assurance 27, n.º 8 (7 de octubre de 2014): 664–71. http://dx.doi.org/10.1108/ijhcqa-04-2013-0048.
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Purpose – People in socially disadvantageous positions may receive less time with their clinicians and consequently reduced access to healthcare resources, potentially magnifying health disparities. Socio-cultural characteristics of clinicians and patients may influence the time spent together. The purpose of this paper is to explore the relationship between clinician/patient time and clinician and patient characteristics using real-time location systems (RTLS). Design/methodology/approach – In the MGH/MGPO Outpatient RFID (radio-frequency identification) project clinicians and patients wore RTLS tags during the workday to measure face-time (FT), the duration patients and clinicians are co-located, wait time (WT); i.e. from registration to clinical encounter and flow time (FLT) from registration to discharge. Demographic data were derived from the health system's electronic medical record (EMR). The RTLS and EMR data were synthesized and analyzed using standard structured-query language and statistical analytic methods. Findings – From January 1, 2009 to January 1, 2011, 1,593 clinical encounters were associated with RTLS measured FTs, which differed with socioeconomic status and gender: women and lower income people received greater FT. WT was significantly longer for lower socioeconomic patients and for patients seeing trainee clinicians, women or majority ethnic group clinicians (Caucasian). FLT was shortest for men, higher socioeconomic status and for attending physician patients. Demographic concordance between patient and clinician did not significantly affect process times. Research limitations/implications – The study demonstrates the feasibility of using RTLS to capture clinically relevant process measures and suggests that the clinical delivery system surrounding a clinical encounter may more significantly influence access to clinician time than individual patient and clinician characteristics. Originality/value – Applying RTLS to healthcare is coming. We can now successfully install and run these systems in healthcare settings and extract useful information from them. Interactions with the clinical delivery system are at least as important as interactions with clinicians for providing access to care: measure FT, WT and FLT with RTLS; link clinical behavior, e.g. FT, with patient characteristics; explore how individual characteristics interact with system behavior.
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Vassimon, Helena Siqueira, Jacqueline Pontes Monteiro, Alcyone Artioli Machado, Francisco José Albuquerque de Paula, Andressa Kutschenko y Alceu Afonso Jordão. "Which equation should be used to measure energy expenditure in HIV-infected patients?" Revista de Nutrição 26, n.º 2 (abril de 2013): 225–32. http://dx.doi.org/10.1590/s1415-52732013000200010.
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OBJECTIVE: In view of the practical need to use equations for the evaluation of energy expenditure in HIV-infected patients, the objective of the present study was to determine the concordance between the energy expenditure values obtained by indirect calorimetry as the gold standard and those obtained by predictive equations elaborated from data for the healthy population: Harris-Benedict, Schofield and Cunningham, and by equations elaborated from data for HIV-infected patients: Melchior (1991-1993). METHODS: The study was conducted at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto on 32 HIV-infected men under treatment with highly active antiretroviral therapy. Resting energy expenditure was measured by indirect calorimetry and estimated on the basis of measurement of O2 consumption and CO2 production. RESULTS: Statistical analysis revealed weak concordance for the Harris-Benedict (0.38) and Cunningham (0.34) equations and satisfactory concordance for the Schofield equation (0.47). Only the two Melchior equations (1991 and 1993) showed strong concordance with the values obtained by indirect calorimetry (0.63 and 0.66, respectively) and could be used in practice. CONCLUSION: The best equations seem to be population-specific, such as the Melchior equations elaborated for HIV-infected patients.
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Coren, Stanley. "Measurement of Handedness via Self-Report: The Relationship between Brief and Extended Inventories". Perceptual and Motor Skills 76, n.º 3 (junio de 1993): 1035–42. http://dx.doi.org/10.2466/pms.1993.76.3.1035.
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Three self-report measures of handedness were explored. For simple dichotomous classification into right- versus left-handed groups, a brief (4-item) and an extended (12-item) inventory produced 98.8% classification concordance in a sample of 250 subjects. When handedness was treated as a continuous variable, indexes based upon the short and expanded scales correlated highly ( r = 0.95). A single-item handedness measure was also created which produced handedness classifications which were better than 97% concordant with the brief and extended handedness scales for dichotomous classification. The methodological implications of these findings for handedness measurement are discussed.
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McNamara, Erica J., Andrew Stewart, E. Greer Gay, James Banasiak, Dmitry Eremin, Dennis Harman, Rafael Flores y Stephen B. Edge. "Beyond the performance rate: Understanding differences in treatment status using the Rapid Quality Reporting System (RQRS)." Journal of Clinical Oncology 30, n.º 15_suppl (20 de mayo de 2012): 6088. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.6088.
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6088 Background: RQRS is a cancer registry based tool for rapid case ascertainment and real-time care tracking using 5 National Quality Forum approved quality measures for breast (BC) and colon cancer (CC) and 1 American Society of Clinical Oncology, National Comprehensive Cancer Network and Commission on Cancer (CoC) endorsed rectal cancer (RC) measure. RQRS was introduced in 2009 for testing at selected CoC accredited programs. The purpose of this study was to evaluate the proportion of cases with treatment administered for 4 measures where care is concordant with treatment either “administered” or “considered but not administered” (CNA). Methods: Case information on 19,631 breast, colon and rectal cancer patients diagnosed from 2009 – 2010 submitted by 64 RQRS participating sites were reviewed for 4 measures: (1) hormone therapy within 1 year of diagnosis (dx) for AJCC T1c, N0M0, or stage II or II; hormone receptor positive BC (HT), (2) multi-agent chemotherapy within 4 months of dx; age < 70; hormone receptor negative BC (MAC), (3) adjuvant chemotherapy within 4 months of dx; age <80; AJCC Stage III CC (ACT), and (4) radiation therapy within 6 months of dx; age <80; AJCC T4N0M0 or stage III patients receiving surgical resection for RC (AdjRT). Treatment status was defined as concordant (administered or CNA) or non-concordant (NC – not part of planned first course therapy or received after required time frame). Patient demographics and Charlson-Deyo (CD) co-morbidity scores were compared by concordance status using Chi-square tests. Results: The aggregate concordance rate was 83.3%. Among these 889 (5.4%) were CNA. Co-morbidity score was > 0 for 15% of cases. Patients age > 70, with Medicare insurance, CD score > 0 were significantly more likely to be CNA compared to completed or NC. Patient choice was the most common reason for CNA (64%). Conclusions: Among patients treated at RQRS test sites for which RQRS measures applied and care was concordant, only 5% were CNA. Patients over age 70 or with CD > 0 were more likely to have treatment CNA. Inclusion of CNA as concordant care has a minor impact on concordance rates and provides cancer programs with important information for targeting care review and quality improvement programs.
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Ponnet, Jolien, Robin Van Oirbeek y Tim Verdonck. "Concordance Probability for Insurance Pricing Models". Risks 9, n.º 10 (8 de octubre de 2021): 178. http://dx.doi.org/10.3390/risks9100178.
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The concordance probability, also called the C-index, is a popular measure to capture the discriminatory ability of a predictive model. In this article, the definition of this measure is adapted to the specific needs of the frequency and severity model, typically used during the technical pricing of a non-life insurance product. For the frequency model, the need of two different groups is tackled by defining three new types of the concordance probability. Secondly, these adapted definitions deal with the concept of exposure, which is the duration of a policy or insurance contract. Frequency data typically have a large sample size and therefore we present two fast and accurate estimation procedures for big data. Their good performance is illustrated on two real-life datasets. Upon these examples, we also estimate the concordance probability developed for severity models.
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Choi, Won Jae, Jin Kyung An, Jeong Joo Woo y Hee Yong Kwak. "Comparison of Diagnostic Performance in Mammography Assessment: Radiologist with Reference to Clinical Information Versus Standalone Artificial Intelligence Detection". Diagnostics 13, n.º 1 (30 de diciembre de 2022): 117. http://dx.doi.org/10.3390/diagnostics13010117.
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We compared diagnostic performances between radiologists with reference to clinical information and standalone artificial intelligence (AI) detection of breast cancer on digital mammography. This study included 392 women (average age: 57.3 ± 12.1 years, range: 30–94 years) diagnosed with malignancy between January 2010 and June 2021 who underwent digital mammography prior to biopsy. Two radiologists assessed mammographic findings based on clinical symptoms and prior mammography. All mammographies were analyzed via AI. Breast cancer detection performance was compared between radiologists and AI based on how the lesion location was concordant between each analysis method (radiologists or AI) and pathological results. Kappa coefficient was used to measure the concordance between radiologists or AI analysis and pathology results. Binominal logistic regression analysis was performed to identify factors influencing the concordance between radiologists’ analysis and pathology results. Overall, the concordance was higher in radiologists’ diagnosis than on AI analysis (kappa coefficient: 0.819 vs. 0.698). Impact of prior mammography (odds ratio (OR): 8.55, p < 0.001), clinical symptom (OR: 5.49, p < 0.001), and fatty breast density (OR: 5.18, p = 0.008) were important factors contributing to the concordance of lesion location between radiologists’ diagnosis and pathology results.
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Liang, Jun, Chuanhao Tang, Xiangyi Wang, Ziwei Guo, Jun Ni, Weiran Xu, Irene Dankwa-Mullan et al. "Impact of decision-support system and guideline treatment concordance on response rate in advanced lung cancer." Journal of Clinical Oncology 37, n.º 15_suppl (20 de mayo de 2019): e20006-e20006. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e20006.
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e20006 Background: Clinical decision-support systems (CDSS) provide up-to-date evidence to practitioners overwhelmed by the deluge of clinical findings. Few studies, however, have evaluated their impact on patient outcomes. This cross-sectional retrospective study was conducted to: 1) measure concordance of real-world clinical decisions with therapeutic options from the IBM Watson for Oncology (WfO) CDSS and the Chinese Society of Clinical Oncology (CSCO) guidelines, 2) the effect of concordance on objective response rate (ORR). Methods: Health records from patients receiving 1stline treatment at Peking University International Hospital Oncology Center in China between January 2016 and December 2018 (69 stage IV NSCLC, 30 with SCLC) with documented tumor progression after 2+ cycles of treatment, were reviewed to determine concordance of actual treatment with WfO therapeutic options and CSCO guidelines. Patients’ treatments were grouped as concordant with: WfO+CSCO, WFO only, CSCO only, or neither. ORR, defined as partial or complete response after 2+ treatment cycles (RECIST criteria)was determined for each group. Results: For NSCLC, ORR ranged from 21.4% for discordance with both WfO and CSCO to 100.0% for WfO only concordance. For SCLC, ORR ranged from 37.5% for CSCO only concordance to 73.3% for WfO+CSCO concordance (Table). The main reasons for discordance were: 1stgeneration TKIs like Gefitinib and Erlotinib (vs. Osimertinib) are standard of care for EGFR mutant patients in China, (2) Local CSCO guideline drugs like Lobaplatin and Icotinib are not included in WfO. Conclusions: This study provides preliminary evidence to suggest that treatment concordance with WfO may be associated with improved ORR in some cases of NSCLC (WfO only) and SCLC (WfO + CSCO). ORR in NSCLC patients who were discordant with both WFO and CSCO guidelines was the lowest at 21.4%. Larger studies are needed to understand the effect of guideline and WfO concordance on ORR. [Table: see text]
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Dziorny, Adam C., Robert B. Lindell, Julie C. Fitzgerald y Christopher P. Bonafide. "Variations among Electronic Health Record and Physiologic Streaming Vital Signs for Use in Predictive Algorithms in Pediatric Severe Sepsis". ACI Open 06, n.º 02 (julio de 2022): e76-e84. http://dx.doi.org/10.1055/s-0042-1755373.
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Abstract Objective This study sought to describe the similarities and differences among physiologic streaming vital signs (PSVSs) and electronic health record (EHR)-documented vital signs (EVSs) in pediatric sepsis. Methods In this retrospective cohort study, we identified sepsis patients admitted to the pediatric intensive care unit. We compared PSVS and EVS measures of heart rate (HR), respiratory rate, oxyhemoglobin saturation, and blood pressure (BP) across domains of completeness, concordance, plausibility, and currency. Results We report 1,095 epochs comprising vital sign data from 541 unique patients. While counts of PSVS measurements per epoch were substantially higher, increased missingness was observed compared with EVS. Concordance was highest among HR and lowest among BP measurements, with bias present in all measures. Percent of time above or below defined plausibility cutoffs significantly differed by measure. All EVS measures demonstrated a mean delay from time recorded at the patient to EHR entry. Conclusion We measured differences between vital sign sources across all data domains. Bias direction differed by measure, possibly related to bedside monitor measurement artifact. Plausibility differences may reflect the more granular nature of PSVS which can be critical in illness detection. Delays in EVS measure currency may impact real-time decision support systems. Technical limitations increased missingness in PSVS measures and reflect the importance of systems monitoring for data continuity. Both PSVS and EVS have advantages and disadvantages that must be weighed when making use of vital signs in decision support systems or as covariates in retrospective analyses.
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Underwood, Carol R., Lauren I. Dayton y Zoé Mistrale Hendrickson. "Concordance, communication, and shared decision-making about family planning among couples in Nepal: A qualitative and quantitative investigation". Journal of Social and Personal Relationships 37, n.º 2 (30 de julio de 2019): 357–76. http://dx.doi.org/10.1177/0265407519865619.
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Couple communication and joint decision-making are widely recommended in the family planning and reproductive health literature as vital aspects of fertility management. Yet, most studies continue to rely on women’s reports to measure couple concordance. Moreover, the association between communication and decision-making is often assumed and very rarely studied. Arguably, associations between dyadic communication and shared decision-making constitute a missing link in our understanding of how communication affects fertility-related practices. Informed by Carey’s notions of transmission and ritual communication, this study sought to address those gaps with two complementary studies in Nepal: a qualitative study of married men and women and a quantitative study of 737 couples. To assess spousal concordance on matters of family planning-related communication and decision-making in the quantitative study, responses from the couple were compared for each question of interest and matched responses were classified as concordant. Quantitative results found that more than one-third of couples reported spousal communication on all measured family planning-related topics. Nearly, 87% of couples reported joint decision-making on both family planning use and method type. Partner communication was significantly and positively associated with concordant family planning decision-making in both bivariate and multivariate models. Couples communicating about three family planning topics had more than twice the odds of concordant family planning decision-making than did those not reporting such communication. The qualitative findings provided insights into discordant as well as concordant interactions, revealing that decision-making, even when concordant, is not necessarily linear and is often complex.
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Toutounji, Sandra, Ron Fung y Katherine Enright. "Improving anti-emetics in chemotherapy induced nausea and vomiting." Journal of Clinical Oncology 34, n.º 7_suppl (1 de marzo de 2016): 220. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.220.
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220 Background: Chemotherapy induced nausea and vomiting (CINV) remains one of the most feared treatment-related toxicities in cancer patients. CINV has been shown to decrease quality of life and to increase dose modifications and unplanned hospital visits. Cancer Care Ontario (CCO) and the American Society of Clinical Oncology (ASCO) updated their CINV guidelines in 2013. These changes included a reclassification of many regimens from moderate (MEC) to highly emetogenic (HEC) and a decrease in the duration of serotonin inhibitors (5HT3i). Uptake of the new guidelines at Trillium Health Partners has been slow. We aimed to improve CINV by increasing the percentage of patients who received guideline concordant anti-emetics with their first cycle of HEC/MEC chemotherapy. Methods: The first 25 patients started on MEC/HEC chemotherapy during 3 time periods (pre-guidelines, 6 months post guidelines, 1.5 years post guidelines) were identified. The primary measure of interest was the percentage of patients receiving MEC/HEC who were treated in concordance with the updated CINV guidelines. Secondary measures included the percentage of MEC/HEC patients who experienced grade 2+ CINV. The collected data was used with quality improvement techniques to guide the development of interventions to improve guideline concordance. Results: The concordance of anti-emetics on the day of chemotherapy improved over time, but post-chemotherapy concordance remained at 0% (table). The primary driver for concordance was the use of NK1inhibitors on chemotherapy day, and the duration of 5HT3i post-chemotherapy. Using quality improvement methodology, the highest impact intervention was identified as changing the default settings in the computerized order entry system (CPOE) to reflect the updated guidelines. These changes are currently in progress and a test of this change will be presented. Conclusions: Concordance with CINV guidelines improved over time resulting in lower CINV and less need for reactive CINV interventions. Further work to target duration of 5HT3i is ongoing. [Table: see text]
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Marasini, Donata, Piero Quatto y Enrico Ripamonti. "A Measure of Ordinal Concordance for the Evaluation of University Courses". Procedia Economics and Finance 17 (2014): 39–46. http://dx.doi.org/10.1016/s2212-5671(14)00876-4.
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Teles, Júlia. "Concordance coefficients to measure the agreement among several sets of ranks". Journal of Applied Statistics 39, n.º 8 (agosto de 2012): 1749–64. http://dx.doi.org/10.1080/02664763.2012.681460.
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Shams, Soheil, Alina Keomanee, Raja Kashavan, Megan Roytman, Daniel Saul y Christopher Lum. "119. Concordance of integrated analysis approaches to measure HRD genomic instability". Cancer Genetics 268-269 (noviembre de 2022): 38. http://dx.doi.org/10.1016/j.cancergen.2022.10.122.
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Thomson, Allison, Simon Morgan, Amanda Tapley, Mike Van Driel, Kim Henderson, Chris Oldmeadow, Jean Ball et al. "Prevalence and associations of gender concordance in general practice consultations: a cross-sectional analysis." European Journal for Person Centered Healthcare 3, n.º 4 (1 de diciembre de 2015): 470. http://dx.doi.org/10.5750/ejpch.v3i4.1016.
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Rationale, aims and objectives: Gender effects on physician-patient interactions are well-established and gender concordance of the physician-patient dyad influences consultation dynamics, person-centeredness and outcomes. We aimed to establish the prevalence and associations of gender-concordant and gender-discordant consultations of general practice (family medicine) trainees and to compare outcomes of gender-concordant and gender-discordant consultations.Method: A cross-sectional analysis from an ongoing cohort study. The outcome measure was whether a consultation included a gender concordant (female-female, male-male) or discordant (male-female, female-male) physician-patient dyad. Independent variables related to patient, physician (registrar), practice, consultation content and consultation outcome.Results: Five hundred and ninety-two general practice (GP) registrars (trainees) in 4 of Australia’s 17 regional training programs provided data on 56,234 individual consultations. Sixty-two point nine percent of consultations were gender-concordant (73.5% female-female, 26.5% male-male) and 37.1% were gender-discordant (47.0% male physician-female patient, 53% female physician-male patient). Associations of having a gender-concordant consultation were patient female gender and younger age (<55), the patient not being new to the registrar and the registrar being part-time, younger and having worked at the practice previously. Addressing a reproductive/contraceptive/ genital problem was associated with gender concordance. Gender-concordant consultations were ‘complex’: significantly longer than gender-discordant consultations, addressed a greater number of problems, resulted in more pathology ordered, more follow-up organised and more learning goals generated.Conclusions: Gender-concordant consultations may be more complex and gender-concordance is ‘sought’ by patients rather than being random. Thus, efforts could be made in general practice to provide access to both male and female GPs, especially for female patients or groups or patients with particular needs.
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Islam, Fakir M. Amirul, Jahar Bhowmik, Donny M. Camera, Ralph Maddison y Gavin W. Lambert. "Concordance between Different Criteria for Self-Reported Physical Activity Levels and Risk Factors in People with High Blood Pressure in a Rural District in Bangladesh". International Journal of Environmental Research and Public Health 18, n.º 19 (6 de octubre de 2021): 10487. http://dx.doi.org/10.3390/ijerph181910487.
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Self-reported assessment of physical activity (PA) is commonly used in public health research. The present study investigated the concordance of self-reported PA assessed using the global physical activity questionnaire (GPAQ) and two different measurement approaches. Participants (n = 307, aged 30–75 years with hypertension) were recruited from a rural area in Bangladesh. We analyzed the difference between the World Health Organization (WHO) recommendations of more than 600 metabolic-equivalent time-minutes (MET-min) and the self-reported active hours, at least 2.5 h per week. Tests of sensitivity and specificity were conducted to determine concordance between the two measures. According to the WHO criteria, 255 (83%) participants were active more than 600 MET-min per week and 172 (56%) people were physically active 2.5 h or more per week, indicating a 27% difference in self-reported PA. The sensitivity, specificity, positive and negative predictive values and concordance between the two measures were 64%, 92%, 98%, 34% and 70%, respectively. Considering the WHO MET-min as the appropriate measure, 89 (35%) were false negative (FN). Older age, professionals and businesspersons were associated with a higher proportion of FN. There is a gap between self-reported PA, thus a better estimate of PA may result from combining two criteria to measure PA levels.
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Barros, Mauro V. G., Maria Alice A. de Assis, Mário C. Pires, Suely Grossemann, Francisco de Assis G. de Vasconcelos, Maria Elizabeth Peixoto Luna y Simone S. Honda Barros. "Validity of physical activity and food consumption questionnaire for children aged seven to ten years old". Revista Brasileira de Saúde Materno Infantil 7, n.º 4 (diciembre de 2007): 437–48. http://dx.doi.org/10.1590/s1519-38292007000400011.
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OBJECTIVES: assess reproducibility and concurrent validity of the questionnaire focusing on a typical physical activity and food intake day (DAFA) to measure physical activity and food intake in children between seven and ten years old. METHODS: sixty nine children recruited in a public school located in Florianópolis, Santa Catarina participated of the survey. Reproducibility was determined by comparing measures of two DAFA applications in a two week interval while concurrent validity of physical activity was assessed by comparing DAFA with a questionnaire filled by parents/teachers. As for food intake, the reference method was a 24 hour recordatory. Analysis included concordance coefficient determination, intraclass correlation, adjusted kappa coefficient and Wilcoxon and Kruskal-Wallis tests. RESULTS: concordance coefficient was of 88% (school commuting) and 68% (physical activity related attitude) while intraclass correlation was of 0.85 for the general measure for physical activity. Using the report of parents/teachers, the children were broken into three groups of physical activities (low/medium/high), it should be considered that DAFA scores differed significantly. As for food intake measuring, 80% of concordance was determined between DAFA applications. Interinstrument convergence was substantial/moderate in relation to 17 food items. CONCLUSIONS: DAFA allows for physical activity and food intake measures in children with good reproducibility and moderate validation evidence.
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Dean, Christina L., Alexander Duncan, Ann Ingle, Jeannette Guarner, John D. Roback, Harold C. Sullivan y Cheryl Maier. "A Sticky Situation: Poor Correlation Between Platelet Inhibition Assays". American Journal of Clinical Pathology 152, Supplement_1 (11 de septiembre de 2019): S5—S6. http://dx.doi.org/10.1093/ajcp/aqz112.010.
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Abstract Monitoring antiplatelet therapy is critical in patients undergoing cardiac or neurologic stent placement to ensure adequate platelet suppression and prevent thrombosis. Light transmission aggregometry (LTA) using platelet-rich plasma (PRP) is the gold standard to assess platelet responsiveness to aspirin (ASA) and P2Y12 inhibitors (P2Y12-I). Other platforms for antiplatelet therapy monitoring employ whole-blood aggregometry (WBA) via electrical impedance (EA) or ELISA-based detection of urinary metabolites. The goal of this study was to evaluate the concordance of four antiplatelet therapy monitoring platforms. Blood and urine samples from 20 patients receiving antiplatelet therapy prior to neurologic stent placement were prospectively collected. Blood samples were analyzed by LTA using PRP on the Helena AggRAM and by WBA-EA using the Chrono-log Lumi-aggregometer to assess ASA and P2Y12-I response. For the LTA, the maximum amplitude (MA) of the platelet aggregation curve was determined using high-dose (HD) and low-dose (LD) ADP agonist for measuring P2Y12-I response and with arachidonic acid (AA) for ASA response. For the WBA, resistance (ohms) was measured with ADP for P2Y12-I response and with HD and LD collagen for ASA response. Whole-blood samples were also analyzed with the VerifyNow PRUTest to assess platelet response to P2Y12-I. Urine samples were analyzed with AspirinWorks. Concordance of antiplatelet response based on predefined cutoff values (eg, concordant = optimal/optimal, discordant = optimal/suboptimal), as well as correlation between actual units of measure, was determined. When comparing P2Y12-I response determined by LTA and WBA, overall concordance was 55% (correlation was r = 0.75 and 0.65 for HD and LD ADP, respectively). VerifyNow was concordant with LTA in 70% (r = 0.86 and 0.75 for HD and LD ADP, respectively) and with WBA in 45% (r = 0.57) of samples. When comparing ASA response between LTA and WBA, overall concordance was 70% (r = 0.09 and 0.19 for HD and LD collagen, respectively). AspirinWorks was concordant with LTA and WBA in 60% of samples (r = 0.32 for LTA; r = 0.08 LD collagen, r = 0.02 for HD collagen on WBA). In summary, concordance varied between 45% and 70% on the four antiplatelet therapy monitoring platforms. Testing of P2Y12 inhibition showed the best correlation between LTA HD ADP and VerifyNow (r = 0.86). When comparing WBA vs LTA, the strongest correlation was between LD ADP LTA and WBA (r = 0.75). Correlation with ASA inhibition was overall poor between the various assays (r ranging between 0.02 and 0.58). The results from this correlation study support the continued use of LTA with HD and LD ADP and AA; other testing methods can be used as adjuncts when LTA proves difficult to interpret.
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O’Connor, Sydney G., Wangjing Ke, Eldin Dzubur, Susan Schembre y Genevieve F. Dunton. "Concordance and predictors of concordance of children’s dietary intake as reported via ecological momentary assessment and 24 h recall". Public Health Nutrition 21, n.º 6 (21 de enero de 2018): 1019–27. http://dx.doi.org/10.1017/s1368980017003780.
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AbstractObjectiveTo provide preliminary evidence in support of using ecological momentary assessment (EMA), a real-time data capture method involving repeated assessments, to measure dietary intake in children by examining the concordance of children’s dietary reports through EMA and 24 h recall.DesignChildren completed eight days of EMA surveys, reporting on recent dietary intake of four pre-specified food categories (‘Fruits or Vegetables’, ‘Chips or Fries’, ‘Pastries or Sweets’, ‘Soda or Energy Drinks’), and completed two 24 h recalls during the same period. Concordance of children’s reports of intake during matched two-hour time windows from EMA and 24 h dietary recall was assessed using cross-tabulation. Multilevel logistic regression examined potential person-level (i.e. sex, age, ethnicity and BMI category) predictors of concordance.SettingChildren in Los Angeles County, USA, enrolled in the Mothers’ and Their Children’s Health (MATCH) study.SubjectsOne hundred and forty-four 144 children (53 % female; mean age 9·6 (sd 0·9) years; 34·0 % overweight/obese).ResultsTwo-hour concordance varied by food category, ranging from 64·9 % for ‘Fruits/Vegetables’ to 89·9 % for ‘Soda/Energy Drinks’. In multilevel models, overweight/obese (v. lean) was associated with greater odds (OR; 95 % CI) of concordant reporting for ‘Soda/Energy Drinks’ (2·01; 1·06, 4·04) and ‘Pastries/Sweets’ (1·61; 1·03, 2·52). Odds of concordant reporting were higher for Hispanic (v. non-Hispanic) children for ‘Pastries/Sweets’ (1·55; 1·02, 2·36) and for girls (v. boys) for ‘Fruits/Vegetables’ (1·36; 1·01, 1·83).ConclusionsConcordance differed by food category as well as by person-level characteristics. Future research should continue to explore use of EMA to facilitate dietary assessment in children.
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Rozmahel, Petr y Nikola Najman. "The Concordance Index of the Business Cycles in the Czech Republic and other selected Central and Eastern Europen Countries and the Eurozone". Acta Universitatis Agriculturae et Silviculturae Mendelianae Brunensis 58, n.º 6 (2010): 407–14. http://dx.doi.org/10.11118/actaun201058060407.
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The paper deals with the evaluation of the preparedness of the Czech Republic and other candidate countries to join the Eurozone. The main goal is to asses the level of business cycle similarity in the selected Eurozone member and candidate countries using the Concordance index. Business cycle similarity belongs among the criteria defined within the theory of optimum currency areas. The first order differencing procedure, Hodrick-Prescott filter and Christiano-Fitzgerald band pass filter were used to identify the classical and growth GDP cycles. The results show that the Czech Republic belongs among the states with relatively high level of concordance comparing to the other Eurozone member and candidate countries. Accordingly, the measure of business cycle concordance should not serve as an argument for slowing down of the monetary integration process in the Czech Republic. The resultant concordance measures also give an evidence of relatively low level of the business cycle similarity of Slovak economy and the Eurozone, which might imply a possibly higher risk of the asymmetric shock occurrence in Slovakia.
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van Klaveren, David, Mithat Gönen, Ewout W. Steyerberg y Yvonne Vergouwe. "A new concordance measure for risk prediction models in external validation settings". Statistics in Medicine 35, n.º 23 (1 de junio de 2016): 4136–52. http://dx.doi.org/10.1002/sim.6997.
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Fang, Zhaoben, Taizhong Hu y Harry Joe. "On the Decrease in Dependence with Lag for Stationary Markov Chains". Probability in the Engineering and Informational Sciences 8, n.º 3 (julio de 1994): 385–401. http://dx.doi.org/10.1017/s026996480000348x.
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Results and conditions that quantify the decrease in dependence with lag for stationary Markov chains are obtained. Notions of dependence that are used are the concordance or positive quadrant dependence ordering, measures of dependence based on ψ-divergences such as the relative entropy measure of dependence, and the Goodman-Kruskal measure of association. The general results are mainly for first-order Markov chains, but there are also some results for higher order Markov chains.
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Kanas, Michel, Marcio Squassoni Leite, Renato Hiroshi Salvioni Ueta, David Del Curto, Délio Eulálio Martins, Marcelo Wajchenberg y Eduardo Barros Puertas. "Comparison of Farfan modified and Frobin methods to evaluate the intervertebral disc height". Coluna/Columna 13, n.º 1 (marzo de 2014): 31–34. http://dx.doi.org/10.1590/s1808-18512014130100313.
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OBJECTIVE: To evaluate the reliability and reproducibility of Farfan modified and Frobin methods to measure the intervertebral disc height in radiographs with inter- and intraobserver comparison. METHOD: Six radiographs of different patients treated for low back pain have been collected and digitized, and five lumbar disc of each patient were evaluated by six examiners with different levels of experience. The measures were done in Image Pro Plus 6.0 software. RESULTS: When compared, both methods showed more than 95% concordance. In intraexaminer analysis, both also shown to be reliable and reproducible, with a high level of concordance. By comparing the correlation between classes of examiners, the higher the level of experience, the greater the agreement for both methods. CONCLUSION: Farfan modified and Frobin are reliable methods to measure the disc height in the lateral radiographs. The higher level of experience of the examiner, the higher was the correlation between measurements.
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Brentnall, Adam R. y Jack Cuzick. "Use of the concordance index for predictors of censored survival data". Statistical Methods in Medical Research 27, n.º 8 (29 de diciembre de 2016): 2359–73. http://dx.doi.org/10.1177/0962280216680245.
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The concordance index is often used to measure how well a biomarker predicts the time to an event. Estimators of the concordance index for predictors of right-censored data are reviewed, including those based on censored pairs, inverse probability weighting and a proportional-hazards model. Predictive and prognostic biomarkers often lose strength with time, and in this case the aforementioned statistics depend on the length of follow up. A semi-parametric estimator of the concordance index is developed that accommodates converging hazards through a single parameter in a Pareto model. Concordance index estimators are assessed through simulations, which demonstrate substantial bias of classical censored-pairs and proportional-hazards model estimators. Prognostic biomarkers in a cohort of women diagnosed with breast cancer are evaluated using new and classical estimators of the concordance index.
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Gordon, Amber S., Ashly C. Westrick, Michael I. Falola, Chevis N. Shannon, Beverly C. Walters y Winfield S. Fisher. "Reliability of postoperative photographs in assessment of facial nerve function after vestibular schwannoma resection". Journal of Neurosurgery 117, n.º 5 (noviembre de 2012): 860–63. http://dx.doi.org/10.3171/2012.8.jns12158.
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Object This study was undertaken to assess the reliability of observations of postoperative photographs in assigning House-Brackmann scores as outcome measures for patients following resection of vestibular schwannomas. Methods Forty pictures of differing facial expressions typically elicited from patients for assigning House-Brackmann scores were individually evaluated by neurosurgery residents and faculty members at the University of Alabama at Birmingham; a score was assigned to each picture by the individual raters. The interrater reliability was measured using the Spearman correlation coefficient, Kendall coefficient of concordance, and kappa statistic; internal consistency was calculated using the Cronbach alpha reliability estimate. Results The Spearman correlation coefficients showed strong positive association among raters, with a range of values of 0.66 to 0.90. Internal consistency measured by the Cronbach alpha coefficient was excellent (α = 0.97). The Kendall coefficient of concordance for the ordinal grades suggested a substantial degree of agreement among the raters (w = 0.76, p < 0.001). Conclusions Static postoperative photographs are a reliable outcome measure for determining facial nerve function after vestibular schwannoma resection and may serve as a surrogate for the dynamic patient interview.
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Loth, Katie A., Angela Fertig, Amanda Trofholz, Lisa Harnack, Ross Crosby, Dianne Neumark-Sztainer y Jerica M. Berge. "Concordance of children’s intake of selected food groups as reported by parents via 24-h dietary recall and ecological momentary assessment". Public Health Nutrition 24, n.º 1 (24 de junio de 2020): 22–33. http://dx.doi.org/10.1017/s1368980020001111.
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AbstractObjective:To understand how dietary intake data collected via a brief ecological momentary assessment (EMA) measure compares to that of data collected via interviewer-administered 24-h dietary recalls, and explore differences in level of concordance between these two assessment types by individual- and meal-level characteristics.Design:Parents completed three 24-h dietary recalls and 8 d of brief EMA surveys on behalf of their child; in total, there were 185 d where dietary intake data from both EMA and 24-h recall were available. The EMA measure asked parents to indicate whether (yes/no) their child had consumed any of the nine total food items (e.g. fruit, vegetable, etc.) at eating occasions where both the child and parent were present.Setting:Twenty-four-hour dietary recalls were completed in person in the study participant’s home; participants completed EMA surveys using a study provided in iPad or their personal cell phone.Participants:A diverse, population-based sample of parent–child dyads (n 150).Results:Among meals reported in both the EMA and dietary recalls, concordance of reporting of specific types of food ranged from moderate agreement for meat (kappa = 0·55); fair agreement for sweets (kappa = 0·38), beans/nuts (kappa = 0·37), dairy (kappa = 0·31), fruit (kappa = 0·31) and vegetables (kappa = 0·27); and little to no agreement for refined grains, whole grains and sweetened beverages (73 % overall agreement; kappa = 0·14). Concordance of reporting was highest for breakfast and snacks, as compared with other eating occasions. Higher concordance was observed between the two measures if the meal occurred at home.Conclusions:Data suggest that among meals reported in both the EMA and dietary recalls, concordance in reporting was reasonably good for some types of food but only fair or poor for others.
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L. Thompson, Hannah, Marie-Claire Reville, Anna Price, Laura Reynolds, Lauren Rodgers y Tamsin Ford. "The Quality of Life Scale for Children (QoL-C)". Journal of Children's Services 9, n.º 1 (12 de marzo de 2014): 4–17. http://dx.doi.org/10.1108/jcs-05-2013-0019.
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Purpose – There is a lack of valid and reliable generic measures of Health-Related Quality of Life (HRQoL) for children under eight. The purpose of this paper is to assess the psychometric properties of the newly formulated Quality of Life Scale for Children (QoL-C), which uses a pictorial response format. Design/methodology/approach – In total, 335 primary school children completed the QoL-C on two occasions, two weeks apart. Children aged four to seven were interviewed one-to-one while children aged eight to nine completed the measure as a class activity. Test-re-test reliability, convergent validity and child-parent concordance were assessed. Findings – Only one child refused to complete the QoL-C, which suggests the measure is user-friendly. Test-re-test reliability was moderate for the measure's total score (intraclass correlation coefficient =0.48, 95 percent CI 0.39, 0.57) but low to fair for individual items (K from 0.13 to 0.37). Internal consistency was moderate (α=0.42 time one, 0.53 time two). A small significant correlation was found between the QoL-C and Child Health Meter in the expected direction (r=−0.32), suggesting convergent validity. There was low concordance between the children's QoL-C responses and parent's responses (r=0.19) to a parallel measure. Research limitations/implications – The results suggest that further development of this measure is needed. However, the findings indicate that one-to-one support increases the reliability of very young children's responses. The use of pictures, emoticons and minimal text used in the QoL-C should be investigated further. Originality/value – Low parent-child concordance underscores the importance of younger children getting the opportunity to share their views about their HRQoL.
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Aerts, Marc, Adelino JC Juga y Niel Hens. "Measures for concordance and discordance with applications in disease control and prevention". Statistical Methods in Medical Research 28, n.º 10-11 (3 de septiembre de 2018): 3086–99. http://dx.doi.org/10.1177/0962280218796252.
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Bivariate binary response data appear in many applications. Interest goes most often to a parameterization of the joint probabilities in terms of the marginal success probabilities in combination with a measure for association, most often being the odds ratio. Using, for example, the bivariate Dale model, these parameters can be modelled as function of covariates. But the odds ratio and other measures for association are not always measuring the (joint) characteristic of interest. Agreement, concordance, and synchrony are in general facets of the joint distribution distinct from association, and the odds ratio as in the bivariate Dale model can be replaced by such an alternative measure. Here, we focus on the so-called conditional synchrony measure. But, as indicated by several authors, such a switch of parameter might lead to a parameterization that does not always lead to a permissible joint bivariate distribution. In this contribution, we propose a new parameterization in which the marginal success probabilities are replaced by other conditional probabilities as well. The new parameters, one homogeneity parameter and two synchrony/discordance parameters, guarantee that the joint distribution is always permissible. Moreover, having a very natural interpretation, they are of interest on their own. The applicability and interpretation of the new parameterization is shown for three interesting settings: quantifying HIV serodiscordance among couples in Mozambique, concordance in the infection status of two related viruses, and the diagnostic performance of an index test in the field of major depression disorders.
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Wade, Alisha N., Nigel J. Crowther, Shafika Abrahams-Gessel, Lisa Berkman, Jaya A. George, F. Xavier Gómez-Olivé, Jennifer Manne-Goehler et al. "Concordance between fasting plasma glucose and HbA1c in the diagnosis of diabetes in black South African adults: a cross-sectional study". BMJ Open 11, n.º 6 (junio de 2021): e046060. http://dx.doi.org/10.1136/bmjopen-2020-046060.
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ObjectivesWe investigated concordance between haemoglobin A1c (HbA1c)-defined diabetes and fasting plasma glucose (FPG)-defined diabetes in a black South African population with a high prevalence of obesity.DesignCross-sectional study.SettingRural South African population-based cohort.Participants765 black individuals aged 40–70 years and with no history of diabetes.Primary and secondary outcome measuresThe primary outcome measure was concordance between HbA1c-defined diabetes and FPG-defined diabetes. Secondary outcome measures were differences in anthropometric characteristics, fat distribution and insulin resistance (measured using Homoeostatic Model Assessment of Insulin Resistance (HOMA-IR)) between those with concordant and discordant HbA1c/FPG classifications and predictors of HbA1c variance.ResultsThe prevalence of HbA1c-defined diabetes was four times the prevalence of FPG-defined diabetes (17.5% vs 4.2%). Classification was discordant in 15.7% of participants, with 111 individuals (14.5%) having HbA1c-only diabetes (kappa 0.23; 95% CI 0.14 to 0.31). Median body mass index, waist and hip circumference, waist-to-hip ratio, subcutaneous adipose tissue and HOMA-IR in participants with HbA1c-only diabetes were similar to those in participants who were normoglycaemic by both biomarkers and significantly lower than in participants with diabetes by both biomarkers (p<0.05). HOMA-IR and fat distribution explained additional HbA1c variance beyond glucose and age only in women.ConclusionsConcordance was poor between HbA1c and FPG in diagnosis of diabetes in black South Africans, and participants with HbA1c-only diabetes phenotypically resembled normoglycaemic participants. Further work is necessary to determine which of these parameters better predicts diabetes-related morbidities in this population and whether a population-specific HbA1c threshold is necessary.
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Webster, Dan E., Meghasyam Tummalacherla, Michael Higgins, David Wing, Euan Ashley, Valerie E. Kelly, Michael V. McConnell et al. "Smartphone-Based VO2max Measurement With Heart Snapshot in Clinical and Real-world Settings With a Diverse Population: Validation Study". JMIR mHealth and uHealth 9, n.º 6 (4 de junio de 2021): e26006. http://dx.doi.org/10.2196/26006.
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Background Maximal oxygen consumption (VO2max) is one of the most predictive biometrics for cardiovascular health and overall mortality. However, VO2max is rarely measured in large-scale research studies or routine clinical care because of the high cost, participant burden, and requirement for specialized equipment and staff. Objective To overcome the limitations of clinical VO2max measurement, we aim to develop a digital VO2max estimation protocol that can be self-administered remotely using only the sensors within a smartphone. We also aim to validate this measure within a broadly representative population across a spectrum of smartphone devices. Methods Two smartphone-based VO2max estimation protocols were developed: a 12-minute run test (12-MRT) based on distance measured by GPS and a 3-minute step test (3-MST) based on heart rate recovery measured by a camera. In a 101-person cohort, balanced across age deciles and sex, participants completed a gold standard treadmill-based VO2max measurement, two silver standard clinical protocols, and the smartphone-based 12-MRT and 3-MST protocols in the clinic and at home. In a separate 120-participant cohort, the video-based heart rate measurement underlying the 3-MST was measured for accuracy in individuals across the spectrum skin tones while using 8 different smartphones ranging in cost from US $99 to US $999. Results When compared with gold standard VO2max testing, Lin concordance was pc=0.66 for 12-MRT and pc=0.61 for 3-MST. However, in remote settings, the 12-MRT was significantly less concordant with the gold standard (pc=0.25) compared with the 3-MST (pc=0.61), although both had high test-retest reliability (12-MRT intraclass correlation coefficient=0.88; 3-MST intraclass correlation coefficient=0.86). On the basis of the finding that 3-MST concordance was generalizable to remote settings whereas 12-MRT was not, the video-based heart rate measure within the 3-MST was selected for further investigation. Heart rate measurements in any of the combinations of the six Fitzpatrick skin tones and 8 smartphones resulted in a concordance of pc≥0.81. Performance did not correlate with device cost, with all phones selling under US $200 performing better than pc>0.92. Conclusions These findings demonstrate the importance of validating mobile health measures in the real world across a diverse cohort and spectrum of hardware. The 3-MST protocol, termed as heart snapshot, measured VO2max with similar accuracy to supervised in-clinic tests such as the Tecumseh (pc=0.94) protocol, while also generalizing to remote and unsupervised measurements. Heart snapshot measurements demonstrated fidelity across demographic variation in age and sex, across diverse skin pigmentation, and between various iOS and Android phone configurations. This software is freely available for all validation data and analysis code.
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Durieux, Brigitte N., Anna Berrier, Hannah Z. Catzen, Tamryn Gray, James A. Tulsky y Justin J. Sanders. "“I think that she would have wanted...”: Caregiver reflections on goal-concordant care for patients with cancer at the end of life." Journal of Clinical Oncology 39, n.º 28_suppl (1 de octubre de 2021): 163. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.163.
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163 Background: Experts recognize goal-concordant care (GCC) as among the most important outcomes for those with advanced cancer. Despite a conceptual understanding about ways to measure goal-concordant care, we know little about what patient experiences align perceptions of goal concordance. Caregivers’ close proximity to patients give them a unique perspective on what factors contribute to perceived goal concordance. Methods: We conducted semi-structured interviews with 19 recently bereaved family caregivers of those with cancer to understand their experience of care, the extent to which they felt it was goal-concordant, and the factors of care which contextualized their experience. Caregivers were interviewed using a semi-structured guide based on the end-of-life planning module in Round 2 of the National Health and Aging Trends Survey (NHATS). We used template analysis to identify themes across the 19 interviews. Results: Most caregivers reported goal-concordant care when prompted, though many also recalled moments of goal discordance. Three high-level themes characterized their care perceptions: communication, relationships and humanistic care, and care transitions. Sub-themes of communication included clinician communication quality, prognostic communication, and information gaps. First, clear and transparent clinician communication facilitated GCC and high-quality care. Prognostic communication that did not align to patient preferences or consider patient hope was seen as harmful. Information gaps inhibited high-quality care as well as caregivers’ confidence that decisions were goal concordant. Second, relationships between patients and their clinicians enriched care, and humanistic care was seen as higher-quality. Lastly, logistical barriers, the need for relationship rebuilding, uncertain information communication, and a general lack of coordination characterized perceptions around care transitions and goal discordance. In particular, several caregivers noted issues and inter-specialty tensions around transitions specifically involving hospice. Conclusions: Caregivers consistently rated care as goal-concordant while also identifying areas of disappointing and low-quality care. Measures that capture goal-concordant care may be subject to psychological bias and may not clearly align with or predict other measures of care quality. Communication, relationships and humanistic care, and care transitions are all modifiable targets for quality improvement and deserve clear attention for patients with advanced cancer.
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Zhao, Cao y Yong Ji. "Recurrence in mean for group actions". Stochastics and Dynamics 20, n.º 01 (17 de junio de 2019): 2050006. http://dx.doi.org/10.1142/s0219493720500069.
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In this paper, the mean values of the recurrence are computed for general group actions. Let [Formula: see text] be a metric space with a finite measure [Formula: see text] and [Formula: see text] be a countable group acting on [Formula: see text]. Let [Formula: see text] be a sequence of subsets of [Formula: see text] with [Formula: see text] and put [Formula: see text]. If the Hausdorff measure [Formula: see text] is finite on [Formula: see text] and [Formula: see text] is [Formula: see text]-invariant. We assume that [Formula: see text] and [Formula: see text] are concordant. Then the function [Formula: see text] is [Formula: see text]-integrable and for any [Formula: see text]-measurable set [Formula: see text] we have [Formula: see text] If moreover, [Formula: see text] then [Formula: see text] without the concordance condition for the measure [Formula: see text] and [Formula: see text]
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Eagen‐Torkko, Meghan. "Concordance as a Person‐Centered Measure of Breastfeeding Success: From Adequacy to Agency". Journal of Midwifery & Women's Health 64, n.º 6 (30 de septiembre de 2019): 749–53. http://dx.doi.org/10.1111/jmwh.13036.
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Schooling, C. Mary. "Concordance with known causal effects is a potential validity measure for observational studies". Journal of Clinical Epidemiology 74 (junio de 2016): 4–6. http://dx.doi.org/10.1016/j.jclinepi.2016.01.016.
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Ingleby, Fiona C., Aurélien Belot, Iain Atherton, Matthew Baker, Lucy Elliss-Brookes y Laura M. Woods. "Assessment of the concordance between individual-level and area-level measures of socio-economic deprivation in a cancer patient cohort in England and Wales". BMJ Open 10, n.º 11 (noviembre de 2020): e041714. http://dx.doi.org/10.1136/bmjopen-2020-041714.
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ObjectivesMost research on health inequalities uses aggregated deprivation scores assigned to the small area where the patient lives; however, the concordance between aggregate area-level deprivation measures and personal deprivation experienced by individuals living in the area is poorly understood. Our objective was to examine the agreement between individual and ecological deprivation. We tested the concordance between metrics of income, occupation and education at individual and area levels, and assessed the reliability of area-based deprivation measures to predict individual deprivation circumstances.SettingEngland and Wales.ParticipantsA cancer patient cohort of 9547 individuals extracted from the Office for National Statistics Longitudinal Study.OutcomesWe quantified the concordance between measures of income, occupation and education at individual and area level. In addition, we used ROC (receiver operating characteristic) curves and the area under the curve (AUC) to assess the reliability of area-based deprivation measures to predict individual deprivation circumstances.ResultsWe found low concordance between individual-level and area-level indicators of deprivation (Cramer’s V statistics range between 0.07 and 0.20). The most commonly used indicator in health inequalities research, area-based income deprivation, was a poor predictor of individual income status (AUC between 0.56 and 0.59), whereas education and occupation were slightly better predictors (AUC between 0.62 and 0.65). The results were consistent across sexes and across six major cancer types.ConclusionsOur results indicate that ecological deprivation measures capture only part of the relationship between deprivation and health outcomes, especially with respect to income measurement. This has important implications for our understanding of the relationship between deprivation and health, and, as a consequence, healthcare policy. The results have a wide-reaching impact for the way in which we measure and monitor inequalities, and in turn, fund and organise current UK healthcare policy aimed at reducing them.