title: Observer variability in the process of medical care for amebic liver abscess.
abstract: The objectives of this study were to evaluate the degree of concordance between specialists (physicians) in relation to the process of medical care of patients with amebic liver abscess and to elaborate a model that contains the minimum elements considered as indispensable for the diagnosis, treatment and follow-up of an illness, based on the consensus of physicians that usually treat these patients. The design of the study was a comparative survey. Twenty eight specialists (physicians) were interviewed (nine infectologists, two gastroenterologists, six internists and eleven general surgeons) affiliated with second and third level hospitals (medical centers) of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security) located in the southern part of Mexico City. A three-part structured questionnaire was applied: the first part consisting of 57 questions focused on the diagnosis, the second corresponded to treatment and consisted of 16 questions and the third part referred to follow-up and included five questions. The agreement among the internists for the overall process (diagnosis+treatment) was the highest (kappa (k) = 0.64), followed by the surgeons (k = 0.63) and the infectologists (k = 0.49); the difference among these three groups of specialists was considered statistically significant (p = 0.001). When the therapeutic process was analyzed in separated form, this same statistical difference was sustained, which on the other hand was not identified for the diagnosis and follow-up processes. When comparing each group, the degree of agreement obtained from the members of each group did not express statistically significant differences.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Unidad de Investigación en Epidemiología Clínica, Hospital de Pediatría, CMN Siglo XXI, IMSS, México, D.F.
authors.forename: W A
authors.initials: WA
authors.lastname: Reyes
authors.forename: M C
authors.initials: MC
authors.lastname: Martinez
authors.forename: J
authors.initials: J
authors.lastname: Garduño
authors.forename: M L
authors.initials: ML
authors.lastname: Cuevas
authors.forename: A
authors.initials: A
authors.lastname: Fajardo
authors.forename: D M
authors.initials: DM
authors.lastname: Hernandez
authors.forename: O
authors.initials: O
authors.lastname: Muñoz
mesh_terms: D000328:Adult; D005260:Female; D005762:Gastroenterology; D013502:General Surgery; D006801:Humans; D007388:Internal Medicine; D008101:Liver Abscess, Amebic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008962:Models, Theoretical; D015588:Observer Variation; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires