Department of Clinical Sciences, Ophthalmology, Malmö, Lund University, Sweden.
BMC Ophthalmol. 2011 May 19;11:12. doi: 10.1186/1471-2415-11-12.
To evaluate the effect of one lesson of continuing medical education (CME) of subjective assessment of optic nerve head appearance on sensitivity and specificity for the diagnosis of glaucoma.
Ophthalmologists and residents in ophthalmology attending an international glaucoma meeting arranged at Malmö University Hospital, Malmö, Sweden, were asked to grade optic nerve head (ONH) photographs of healthy and glaucomatous subjects at two sessions separated by a lecture on glaucoma diagnosis by ONH assessment. Each grader had access to an individual portfolio of 50 ONH photographs randomly selected from a web-based data bank including ONH photographs of 73 glaucoma patients and 123 healthy subjects. The individual portfolio of photographs was graded before and after the lecture, but in different randomized order.
Ninety-six doctors, 91% of all attending the meeting, completed both assessment sessions. The number of correct classifications increased from 69 to 72% on the average. Diagnostic sensitivity increased significantly (p < 0.0001) from 70% to 80%, and the number of photographs classified as uncertain decreased significantly (p < 0.0001) from 22% to 13%. Specificity remained at 68%, and intra-grader agreement decreased.
CME had only a small effect on the assessment of ONH for the glaucoma diagnosis. Sensitivity increased and the amount of uncertain classifications decreased, while specificity was unchanged.
评估单次继续医学教育课程（CME）对主观评估视盘外观在诊断青光眼的敏感性和特异性的影响。
在瑞典马尔默大学医院举行的一次国际青光眼会议上，邀请眼科医生和眼科住院医师参加，他们被要求在两次会议上对健康和青光眼患者的视神经头（ONH）照片进行评分，两次会议之间有一次关于通过 ONH 评估诊断青光眼的讲座。每位评分者都可以访问一个由 50 张 ONH 照片组成的个人资料，这些照片是从一个基于网络的数据库中随机选择的，其中包括 73 名青光眼患者和 123 名健康受试者的 ONH 照片。个人资料中的照片在讲座前后进行评分，但顺序不同。
96 名医生，占所有参加会议的医生的 91%，完成了两次评估。平均而言，正确分类的数量从 69%增加到 72%。诊断敏感性显著增加（p<0.0001），从 70%增加到 80%，不确定分类的照片数量显著减少（p<0.0001），从 22%减少到 13%。特异性保持在 68%，且评分者间的一致性降低。
CME 仅对视盘评估对青光眼诊断的影响较小。敏感性增加，不确定分类的数量减少，而特异性保持不变。
