Clinical Disagreement in Urology

Peter Campbell (2011). Clinical Disagreement in Urology MPhil Thesis, School of Medicine, The University of Queensland.

       
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Author Peter Campbell
Thesis Title Clinical Disagreement in Urology
School, Centre or Institute School of Medicine
Institution The University of Queensland
Publication date 2011-04
Thesis type MPhil Thesis
Supervisor Dr Peter Mactaggart
Total pages 73
Total colour pages 7
Total black and white pages 66
Language eng
Subjects 110312 Nephrology and Urology
110316 Pathology (excl. Oral Pathology)
Abstract/Summary Background: Clinical observation represents the process of gathering and processing information by both direct and indirect methods during the assessment and treatment of patients. Clinical disagreement represents inconsistencies between the observations of two clinicians or one clinician on separate occasions (inter-observer and intra-observer consistency). Accuracy is the closeness of a clinical observation to the true clinical state. For many clinical assessments there is no gold standard of accuracy. In these situations the best that one can strive for is consistency. Studies of clinical disagreement therefore represent surrogate measures of accuracy. Disagreement can be considered as occurring secondary to issues of interpretation or categorisation. Aims: To document the presence of clinical disagreement in the practice of urology and its potential sources. Methodology: Four separate studies were undertaken to document the presence of clinical disagreement in the practice of urology. Kappa statistics were used in two of these to assess agreement in the interpretation of histology and cytology specimens. Results: In studies of interstitial cystitis and urine cytology, disagreement was found secondary to issues of interpretation. In the studies of renal and urothelial lesions disagreement was due to issues of categorisation or classification. In both these circumstances the presence of clinical disagreement had implications for the clinical management of patients. Conclusion: Clinical disagreement occurs in Urology and is a potential source of error with implications for the diagnosis, treatment, and prognosis of our patients. Disagreement secondary to issues of interpretation can be addressed by using clearly defined diagnostic criteria applied in an environment of the ongoing professional education of clinicians. This can be supported by the use of clinical reviews in the setting of multi-disciplinary team meetings. Disagreement secondary to classification could be ameliorated by the use of preferably internationally adopted consensus criteria for diagnosis and staging. Tumour registries or other forms of centralised review or data collection might then assist in better analysing outcome data and allow thorough assessment of the impact of changes to classification systems on treatment and prognosis.
Keyword urology
Pathology
clinical disagreement, urology
Papillary neoplasm
Renal neoplasms
urine cytology
interstitial cystitis
Additional Notes Colour pages: 31, 45, 46, 49-51, 54 Landscape pages: 19, 42

 
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