title: Agreements among traditional Chinese medicine practitioners in the diagnosis and treatment of irritable bowel syndrome.
abstract: BACKGROUND
  Traditional Chinese Medicine was frequently used by patients with irritable bowel syndrome.
  
  
  OBJECTIVE
  To evaluate the agreement on diagnoses and prescription of irritable bowel syndrome among Traditional Chinese Medicine practitioners.
  
  
  METHODS
  Consecutive irritable bowel syndrome patients were interviewed independently by four Traditional Chinese Medicine practitioners. The study was divided into three phases: (i) blinded individual assessment, (ii) discussion to achieve consensus on diagnosis and treatment, (iii) individual assessment based on consensual diagnostic criteria. Patients with other causes of diarrhoea were recruited as controls in phase (iii). Percentage agreement and kappa-value in diagnosis, treatment principle and regime were determined.
  
  
  RESULTS
  Thirty-nine irritable bowel syndrome patients were assessed in phase (i) whereas 65 irritable bowel syndrome patients and 17 non-irritable bowel syndrome controls were studied in phase (iii). The mean agreement rates in diagnosis, treatment principle and regimen were: 57, 58 and 52% for phase (i) and 80, 81 and 80% for phase (iii) (P = 0.002). Accordingly, there was significant improvement in the mean kappa-values in diagnosis (0.11-0.34, P = 0.015) and treatment principle (0.16-0.37, P = 0.002) but not in treatment regime.
  
  
  CONCLUSIONS
  Variations in diagnosis and treatment principles do exist among Traditional Chinese Medicine practitioners. Concordant diagnosis can be reached by mutual understanding and converging opinion among Traditional Chinese Medicine practitioners.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong. joesung@cuhk.edu.hk
authors.forename: J J Y
authors.initials: JJ
authors.lastname: Sung
authors.forename: W K
authors.initials: WK
authors.lastname: Leung
authors.forename: J Y L
authors.initials: JY
authors.lastname: Ching
authors.forename: L
authors.initials: L
authors.lastname: Lao
authors.forename: G
authors.initials: G
authors.lastname: Zhang
authors.forename: J C Y
authors.initials: JC
authors.lastname: Wu
authors.forename: S M
authors.initials: SM
authors.lastname: Liang
authors.forename: H
authors.initials: H
authors.lastname: Xie
authors.forename: Y P
authors.initials: YP
authors.lastname: Ho
authors.forename: L S
authors.initials: LS
authors.lastname: Chan
authors.forename: B
authors.initials: B
authors.lastname: Berman
authors.forename: F K L
authors.initials: FK
authors.lastname: Chan
mesh_terms: D000328:Adult; D000488:Allied Health Personnel / Q000592:standards*; D032921:Consensus; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008516:Medicine, Chinese Traditional / Q000592:standards*; D008875:Middle Aged; D015588:Observer Variation; D010808:Physical Examination