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AASM scorer inter-reliabilty service
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jerzey devil
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Joined: 09 Jul 2007
Posts: 142
Location: New Jersey

PostPosted: Wed Jan 13, 2010 5:47 pm    Post subject: AASM scorer inter-reliabilty service Reply with quote

Just checked out the AASM's new scorer inter-reliabilty service at www.aasmnet.org/isr/ Even though there is a cost it would save SO much time not having to bug my medical director for his scoring of record samples.

Very Happy
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Neil
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Joined: 11 Jan 2007
Posts: 620
Location: Ottawa

PostPosted: Wed Jan 13, 2010 6:35 pm    Post subject: Reply with quote

free UNTIL MARCH. LOL, never miss an opportunity to rake in the $$$$$$$ those AASM folks, never ever miss the opportunity. Rolling Eyes

Neil
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somnonaut
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Joined: 11 Dec 2003
Posts: 13480
Location: http://tinyurl.com/righteousdude

PostPosted: Wed Jan 13, 2010 7:56 pm    Post subject: Reply with quote

Just registered. Will post back.
I hae been asking for this for about 15 years.

Here are instructions.

Taking Exams
In order to take an exam and contribute your results to your facility’s account, the center must have purchased credits available. If you are attempting to take an exam and your center does not have any available credits, please notify your center’s account administrator before attempting to take the exam.

Log in to your account and select the exam that you want to take from the list of available exams.
Select “Start”.
For each epoch, choose the appropriate:
Stage: Only one stage choice is allowed for each epoch. Use all of the information in the recording to score sleep stage. For example, score N2 for an epoch even if the epoch does not contain a single spindle or K complex if the previous epoch was scored as N2.
Respiratory Events: SCORE ALL EVENT TYPES FOR EACH EPOCH. Score any event that appears in an epoch, even if only a portion of an event is seen. For example, if an obstructive apnea starts in epoch 97 and ends in epoch 98, score OA for epochs 97 and 98. If there is an obstructive apnea and a central apnea in epoch 125, score OA and CA. If there are 2 obstructive apneas in epoch 36, score OA for the epoch. Use Rule 4.A. for scoring hypopneas. The criteria are a drop of 30% of the nasal pressure transducer signal and an oxygen desaturation of at least 4%.
Number of Limb Movements: Score all of the limb movements for each epoch. The limb movement may last from 0.5 to 10 seconds. There must be at least 5 seconds between limb movements. If limb movements occur in both legs they are scored as a single movement unless they are separated by at least 5 seconds. Do not score limb movements that occur 0.5 seconds before or after a respiratory event. Do not score limb movements that occur during a respiratory event. Score “none” if there are no limb movements in an epoch.
Number of Arousals: Score all of the arousals for each epoch. Arousals must last at least 3 seconds. Arousals must be preceded by at least 10 seconds of continuous sleep. Arousals during R must have an increase of chin EMG lasting at least 1 second. Arousals may occur during W and may occur with respiratory events. Score “none” if there are no arousals in an epoch.
If you wish to view a larger, high resolution picture of an epoch (that does not include the questions), click on the “View Original” link below the record image. To return to the exam and answer questions, click on “Return to Question”. You may also use the Magnifying Lens feature to enlarge only a portion of the epoch.
To save your answers, hit the “Save Answer” button.
If you are uncertain about the score for an epoch, you may click “Flag for review” above the picture of the epoch.
At any time during the test, you can click on the green “Review Exam” box at the upper right. The Review Exam page will give you a list of all of the questions you have completed, all those marked for review, and those remaining. Questions will not be marked as completed until all 4 questions have been answered. You may return to any of the questions by clicking on the number in the Review Exam screen.
When you have completed all of the questions, click on the red “Stop Exam” box at the upper right. To submit your results, you must type “yes” to confirm that you are finished with the exam.
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Stevo
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Joined: 20 Oct 2009
Posts: 98
Location: Lubbock, TX

PostPosted: Wed Jan 13, 2010 8:17 pm    Post subject: Reply with quote

Sweet... This will solve all of my ISR problems... Is it free to register?
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linuxgeek
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Joined: 23 Jan 2008
Posts: 1588

PostPosted: Wed Jan 13, 2010 11:04 pm    Post subject: Reply with quote

We've been using it for a few weeks and reporting back on its usability.
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tcr104
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Joined: 25 Aug 2008
Posts: 316

PostPosted: Thu Jan 14, 2010 12:02 pm    Post subject: Reply with quote

Used this yesterday. Here are some initial critiques;

My biggest complaint is that it is very slow to score an epoch (or 200 for that matter). You will likely make 4-5 mouse clicks per epoch. 1000 mouse clicks to score 200 epochs is tedious, and it took me about 90 minutes to complete.

Another thing is that the layout of the screen is not ideal. You actually have to scroll the window up and down after reviewing the screen and then to click your answer choices.

In the end, I think it's probably a worthwhile exercise because it affords the peace of mind of knowing you are using the AASM as gold standard. So, I'll likely put up with the tedium until they improve it.
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Amykr
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Joined: 06 Dec 2007
Posts: 850
Location: Orlando, Florida

PostPosted: Thu Jan 14, 2010 12:43 pm    Post subject: Reply with quote

it was long and tediuou. I wonder if we could get to use it for the school to teach scoring and if they would let us use it for free. This way we know that the new students are scoring to AASM criteria
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somnonaut
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Joined: 11 Dec 2003
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Location: http://tinyurl.com/righteousdude

PostPosted: Thu Jan 14, 2010 1:48 pm    Post subject: Reply with quote

Tedious is an understatement. It can easily be upgraded by programming the keypad to also enter in the values like a sleep system. map 1,2,3,5 for the specific stages' radio buttons and then use 4, for arousals, toggling up thru zero, one, two or three, and 6, for PLM (same toggling), and 7,8,9 for combos of resp events.

I find it odd that there is no voltage scale for the LM channels, after all the hoopla of the new rules.
And does this now set a new standard for for-profit Inter scoring reliability undertakings, all you need is one gold scorer and two consensus over-readers like they do, and voila' you've got a product? Otherwise the AASM is the provider of the standard mandating inter-scoring reliability and yet is the only "sanctioned" provider of said ISR. Hmmm, what is wrong with that picture?

Oh, there is a free webinar Feb 3, @ 12PM CST AASM is giving on this program.
http://www.aasmnet.org/SleepEdEvent.aspx?id=293
[No CMEs]
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ZZs4iowa
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Joined: 13 Aug 2008
Posts: 94

PostPosted: Thu Jan 14, 2010 3:49 pm    Post subject: Details? Reply with quote

Now, you all got me very excited about this - until I found that it is only for Accredited Centers, which we are in the process of doing. But we could really take advantage of this now as our Medical Director is a very busy guy (aren't they all!)
Anyway, I also cannot find out the cost of this without being able to register - can someone give me a figure, for future reference?
Thanks!
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somnonaut
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PostPosted: Thu Jan 14, 2010 6:25 pm    Post subject: Reply with quote

Just finished december. But their scoring is screwed up in that they average all of the components, even though there might have only been 15 arousals during the whole recording, and maybe I missed 1, which skews my score on arousals, and therefore "averages" into my average unequally.

Arousals 88%
Limb Movement(s) 99%
Respiratory 95%
Stage 89%

And the average of these is 92.75...though my score was 92.25, eh must be due to rounding.
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somnonaut
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Joined: 11 Dec 2003
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Location: http://tinyurl.com/righteousdude

PostPosted: Thu Jan 14, 2010 6:26 pm    Post subject: Re: Details? Reply with quote

ZZs4iowa wrote:
Now, you all got me very excited about this - until I found that it is only for Accredited Centers, which we are in the process of doing. But we could really take advantage of this now as our Medical Director is a very busy guy (aren't they all!)
Anyway, I also cannot find out the cost of this without being able to register - can someone give me a figure, for future reference?
Thanks!


No need to login for pricing.
http://www.aasmnet.org/ISR/Pricing.aspx
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ZZs4iowa
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Posts: 94

PostPosted: Thu Jan 14, 2010 7:50 pm    Post subject: Thanks Reply with quote

Thanks Somnonaut, guess I didn't dive into the website enough.

In case someone else is wondering - the answer to my other question is here:

Q: My center is not accredited by the AASM but would like to use this program. How do we register?
A: At this time, the AASM Inter-scorer Reliability testing program is available to accredited centers only (during the free trial period). Following the free trial period, non-accredited centers will have the ability to register for the program.
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Stevo
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Joined: 20 Oct 2009
Posts: 98
Location: Lubbock, TX

PostPosted: Thu Jan 14, 2010 8:42 pm    Post subject: Re: Details? Reply with quote

ZZs4iowa wrote:
Now, you all got me very excited about this - until I found that it is only for Accredited Centers, which we are in the process of doing.


Sorry I found out about this yesterday and was too busy to post about it. Your center has to be actively accredited. We are accepted for a site visit but we still can't register just yet. Thanks for the pricing page Somno... I didn't notice the menu bar at the top Laughing

$25 per credit isn't too bad and well worth the time it will save and hopefully by the time we are accredited or April (whichever comes first Laughing ) it will be easier to use judging from everybody's experiences so far.
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ZZs4iowa
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Joined: 13 Aug 2008
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PostPosted: Thu Jan 14, 2010 9:26 pm    Post subject: I can wait til March Reply with quote

It looks like everyone is welcome to use this service in March, after the free trial period, accredited or not. I suspect that they want to give the accredited centers a chance to give their opinions for improvement before setting it free. Good idea.
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RPSGT88athome
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Joined: 15 Jul 2007
Posts: 2863

PostPosted: Tue Jan 19, 2010 1:42 am    Post subject: Reply with quote

I can't see how this saves time. It took me 40 minutes to score 50 epochs can you imagine how much that will cost to have all the hourly people do the whole thing? 2 hours 40 minutes to score 200 epochs. Let's say tech A makes $25/hr. 2hr 40 min = $66.50 to score their record. Than you have to PAY AASM $25 per credit? How does this help us?

My techs do their concordance and event scoring of 200 epochs in about 20 minutes = 6 seconds per epoch. That speed translates into 1hr 20 minutes for an 800 epoch moderately to severely abnormal record.

The worse problem is the resolution is far too low. The magnifying glass is not helpful in any size. AASM technical specifications require a resolution of "at least 1600X1200." The test resolution is far below that and I'm having a real problem seeing the waveforms. All of my monitors are 1600X1200. You would think they would provide the proper resolution as per their own specifications considering this is the most important scoring activity we are doing. I am also not sure the study was recorded at 256 hz or higher. The waveforms look so terrible.

Why do this at all? Why risk my techs failing the concordance because they can't see the waveforms? Why should Somno make an 89 on concordance? I dare say its not because he needs to learn how to score. Why did AASM choose those terrible epochs?

Sometimes I just don't know what those guys are thinking.


RPSGT88
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