The detection and assessment of clinical uncertainties could serve many purposes: First, we believe that the clinical community, clinicians and patients, should be aware that different options are indeed being offered for the management of similar patients, if only to provide other options. Second, the detection of insecurity may be the first important step towards a true science of medical practice, as this can encourage community members to organize and prepare for the work at hand: accept the uncertainty revealed by the study and pursue clinical research that addresses this uncertainty. But no type of research will do that. This guide is intended to assist clinicians, industry, and FDA staff in interpreting and complying with the rules regarding financial disclosure through clinical trials, 21 CFR Part 54. The purpose of these guidelines is to outline the FDA`s expectations and make recommendations for the evaluation and reporting of age, race, and ethnicity data in clinical trials of medical devices. The primary intention of these recommendations is to improve the quality, consistency and transparency of data on the performance of medical devices across certain age groups, races and ethnic groups. There are many statistical approaches to measuring reliability and compliance, depending on the type of data (categorical, ordinal, continuous), sampling method and error handling . The reliability of treatment recommendations (categories) is most frequently analyzed with statistics similar to kappa. There are different types of Kappa statistics and a discussion of the proper use of one or the other goes beyond the scope of this article. A statistician should be involved in the preparation of the study at an early stage. The problem is more delicate in intra-rate studies. These can be very instructive, but they are rarely performed [31, 40, 41].
Better concordance can be expected if the same clinician responds twice to the same set of cases (usually weeks apart in patients presented in a different order to ensure independence between judgments), but the risk is that the clinician will reveal their own inconsistencies in decision-making. In the case of diagnostic tests, a mismatch among evaluators (beyond several evaluators) is evidence of unreliability of the score/measure/diagnostic categories and a strong indication that the scale or categories should be changed . We see no reason to conclude differently in management decisions: if the same question is asked twice, a clinician`s inconsistencies in recommending options opposed to that same patient only confirm a high degree of uncertainty about the clinical dilemma being studied. Participation in these intra-rate trials can be a humiliating experience, but one that can convince the participant that a clinical trial may be correct. Farzin B, Gentric JC, Pham M, Tremblay-Paquet S, Brosseau L, Roy C, Jamali S, Chagnon M, Darsaut TE, Guilbert F, Naggara O, Raymond J. Correspondence studies in radiology. . . .