Reliability and Initial Validation of the Ulcerative Colitis Endoscopic Index of Severity
John Radcliffe Hospital1, Medpace2, University of Miami3, University of Oxford4, University of Western Ontario5, University of Chicago6, University of Pennsylvania7, Medical University of Vienna8, Icahn School of Medicine at Mount Sinai9, University of Cincinnati10, Ohio State University11, Paris Diderot University12, University of California, San Diego13
TL;DR: The UCEIS and its components show satisfactory intrainvestigator and interinvestigator reliability and was unaffected by knowledge of clinical details when assessing the endoscopic severity of UC.
About: This article is published in Gastroenterology.The article was published on 2013-11-01 and is currently open access. It has received 337 citations till now.
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University of California, San Diego1, Icahn School of Medicine at Mount Sinai2, McMaster University3, Medical University of Vienna4, University of Amsterdam5, John Radcliffe Hospital6, Tel Aviv University7, University of Western Ontario8, University of Otago9, Columbia University10, Semmelweis University11, Mayo Clinic12, University of Copenhagen13, University of Toronto14, University of Calgary15, Université de Sherbrooke16, University of Chicago17, Dartmouth College18, University of Kiel19, Katholieke Universiteit Leuven20, University of Rennes21, Lille University of Science and Technology22, Northwestern University23
TL;DR: Evidence- and consensus-based recommendations for selecting the goals for treat-to-target strategies in patients with IBD are made available and future studies are needed to determine how these targets will change disease course and patients’ quality of life.
1,329 citations
Newcastle University1, Newcastle upon Tyne Hospitals NHS Foundation Trust2, University of Exeter3, University of Cambridge4, Chelsea and Westminster Hospital NHS Foundation Trust5, Imperial College London6, Royal Liverpool and Broadgreen University Hospital NHS Trust7, University of Manchester8, Pennine Acute Hospitals NHS Trust9, King's College London10, Guy's and St Thomas' NHS Foundation Trust11, Queen Mary University of London12, Barts Health NHS Trust13, University of Leeds14, Leeds Teaching Hospitals NHS Trust15, Royal College of Surgeons in Ireland16, University of Edinburgh17, Western General Hospital18, University Hospitals Bristol NHS Foundation Trust19, University of Glasgow20, Glasgow Royal Infirmary21, Queen Elizabeth Hospital Birmingham22, University of Birmingham23, University College London Hospitals NHS Foundation Trust24, University College London25, Brighton and Sussex Medical School26, Brighton and Sussex University Hospitals NHS Trust27, University of Wolverhampton28, University Hospital of Wales29
TL;DR: Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care.
Abstract: Ulcerative colitis and Crohn’s disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn’s and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn’s disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn’s disease, including patients, their families and friends.
1,140 citations
TL;DR: These guidelines indicate the preferred approach to the management of adults with UC and represent the official practice recommendations of the American College of Gastroenterology.
755 citations
Cites background from "Reliability and Initial Validation ..."
...The UCEIS demonstrated excellent correlation with disease severity (60) and good intra- and inter-observer reliability (60,61)....
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...Therefore, it is important to rely on objective clinical targets and use validated scores and instruments (including endoscopy) in confirming remission (60,76)....
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TL;DR: The development of guidelines is an expensive and time-consuming process, but this Consensus may help to avoid duplication of effort in the future and identify issues where the evidence is lacking and controlled studies are awaited.
671 citations
TL;DR: Although CRP, FC, and SL are useful biomarkers, their value in managing individual patients must be considered in specific clinical contexts.
421 citations
References
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TL;DR: Overall, incidence appeared to be on the rise worldwide and peak incidence occurred in the second to fourth decade of life, although a modest rise was also seen in later life, and no consistent difference was seen between the sexes.
Abstract: developing countries. It has been proposed that this is the result of improved hygiene and sanitation, which have led to reduced exposure to enteric infections and immaturity of the immune system. In a recent systematic review of population based studies, incidence varied from 0.6 to more than 20 people per 100 000 person years in Europe and North America, compared with 0.1 to 6.3 per 100 000 person years in Asia and the Middle East. Overall, incidence appeared to be on the rise worldwide. Peak incidence occurred in the second to fourth decade of life, although a modest rise was also seen in later life. Prevalence was estimated at 5-500 people per 100 000 worldwide. No consistent difference was seen between the sexes. Smoking protects against developing ulcerative colitis. Risk is eight times higher in first degree relatives of people with the disorder compared with first degree relatives of healthy controls, although this is not completely explained by known genetic risk factors.
3,187 citations
TL;DR: A subset of 'observers who demonstrate a high level of interobserver agreement can be identified by using pairwise agreement statistics betweeni each observer and the internal majority standard opinion on each subject.
Abstract: This paper presents a general statistical methodology for the anialysis of mnultivariate categorical data involving agreement among nmore than two observers Since these situations give rise to very large contingency tables in which mi0ost of the observed cell frequencies are zero, procedures based on indicator variables of the raw data for individual subjects are used to genierate first-order margins and main diagonal sums from the conceptual multidinmenisional contingency table From these quantities, estimates are generated to reflect the strenlgth of'an internlal mlajority decision on each subject Moreover, a subset of 'observers who demonstrate a high level of interobserver agreement can be identified by using pairwise agreement statistics betweeni each observer and the internal majority standard opinion on each subject These procedures are all illustrated within the context of'a clinical diagnosis examiiple involving seven pathologists
2,870 citations
TL;DR: The results were summarized in a draft manuscript by the primary authors (G.D. and W.J. as discussed by the authors ) and discussed at the annual IOIBD meetings in 2004 and 2005.
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01 Jan 1995
707 citations
"Reliability and Initial Validation ..." refers methods in this paper
...The sponsors paid for video image preparation, logistical support, statistical programming, and the time spent by independent gastroenterologists to evaluate the UCEIS....
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...Cronbach’s coefficient a, using partial correlation coefficients, was calculated for the overall UCEIS score and for the score with one-at-a-time descriptor deletion to evaluate internal consistency in the UCEIS.9 Intrainvestigator and interinvestigator agreements for descriptors and the overall UCEIS score were characterized by k statistics, qualitatively interpreted by Landis and Koch.10 The standard k summarizing the exact level of agreement was used for the descriptors....
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...Alternative methods for calculation of the UCEIS....
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...The reliability ratios for interinvestigator agreement were estimated using a model with terms for “investigator,” “video,” and “error”; additional terms for “investigator-by-video effects” were used to evaluate intrainvestigator agreement.(9) Correlation between the UCEIS and overall severity on the VAS, and all interobserver analyses avoided data from the second read of duplicate videos between investigators, and all those where clinical details were provided....
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...One-at-a-time deletion of descriptors resulted in slightly lower a coefficients (0.79–0.83), indicating that each descriptor contributed positively to the overall UCEIS....
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