PubMed · 15745213
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Roger Dyson. Team working.. https://doi.org/10.7861/clinmedicine.5-1-84a
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People with learning disabilities have high health needs and as a result will require access to all aspects of healthcare systems, including the emergency services. The evidence of the health needs experienced by this group is evolving and developing and they have a range of issues that will bring them into contact with general hospital and the emergency services. It is now apparent that they experience risks to their health when accessing general hospital care and action is required to identify and address their distinct health needs. Emergency services are often the first point of entry into the healthcare system and as a result they need to develop their knowledge and skills in meeting the health needs of this group. Partnership working with specialists in learning disability health and emergency care can help to improve care.
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OBJECTIVE: To determine variability in interpretation of chest radiographs among tuberculosis specialists, radiologists, and respiratory specialists. DESIGN: Observational study. SETTING: Tuberculosis and respiratory disease services, Samara region, Russian Federation. PARTICIPANTS: 101 clinicians involved in the diagnosis and management of pulmonary tuberculosis and respiratory diseases. MAIN OUTCOME MEASURES: Interobserver and intraobserver agreement on the interpretation of 50 digital chest radiographs, using a scale of poor to very good agreement (kappa coefficient: < or = 0.20 poor, 0.21-0.40 fair, 0.41-0.60 moderate, 0.61-0.80 good, and 0.81-1.00 very good). RESULTS: Agreement on the presence or absence of an abnormality was fair only (kappa = 0.380, 95% confidence interval 0.376 to 0.384), moderate for localisation of the abnormality (0.448, 0.444 to 0.452), and fair for a diagnosis of tuberculosis (0.387, 0.382 to 0.391). The highest levels of agreement were among radiologists. Level of experience (years of work in the specialty) influenced agreement on presence of abnormalities and cavities. Levels of intraobserver agreement were fair. CONCLUSIONS: Population screening for tuberculosis in Russia may be less than optimal owing to limited agreement on interpretation of chest radiographs, and may have implications for radiological screening programmes in other countries.