Objective：Compared to research conducted under a controlled system such as a clinical trial, differences in characteristics among observers (medical care providers) can be an issue when conducting observational research in general or research using RWD in particular. In particular, systematic differences in observational behaviors (attitudes) by department may cause confusion in interpreting study results, so we aimed to quantify the differences in behaviors toward patient observation by department. Design：Descriptive aggregation using “Millennium medical record” Database. Basic statistics such as median values for the number of characters in the clinical summary, which is a free entry column, are obtained for each department. Based on the purpose of this study, it was judged that it was appropriate to omit the description after hospitalization because the number of characters described in the part of the clinical course up to hospitalization in the clinical summary was included in the character count. Results：The median number of letters in internal medicine was 503. The ratios of the median number of letters to the median number of letters in various departments were surgery (0.55), ophthalmology (0.57), psychiatry/psychosomatic medicine (2.85), pediatrics (1.19), obstetrics/gynecology (1.04), and dermatology, orthopedic surgery/plastic surgery (0.41), respectively. Conclusion：There are characteristic differences in the number of letters in the free entry items depending on the medical department.

OBJECTIVE: To investigate the clinical feasibility of dual energy subtraction (DES) imaging to improve the delineation of the vocal cord and diagnostic accuracy of vocal cord paralysis as compared with the anterior-posterior view of flat panel detector (FPD) neck radiography. MATERIALS AND METHODS: For 122 consecutive patients who underwent both a flexible laryngoscopy and conventional/DES FPD radiography, three blinded readers retrospectively graded the radiographs during phonation and inspiration on a scale of 1 (poor) to 5 (excellent) for the delineation of the vocal cord, and in consensus, reviewed the diagnostic accuracy of vocal cord paralysis employing the laryngoscopy as the reference. We compared vocal cord delineation scores and accuracy of vocal cord paralysis diagnosis by both conventional and DES techniques using kappa statistics and assessing the area under the receiver operating characteristic curve (AUC). RESULTS: Vocal cord delineation scores by DES (mean, 4.2 +/- 0.4) were significantly higher than those by conventional imaging (mean, 3.3 +/- 0.5) (p < 0.0001). Sensitivity for diagnosing vocal cord paralysis by the conventional technique was 25%, whereas the specificity was 94%. Sensitivity by DES was 75%, whereas the specificity was 96%. The diagnostic accuracy by DES was significantly superior (kappa = 0.60, AUC = 0.909) to that by conventional technique (kappa = 0.18, AUC = 0.852) (p = 0.038). CONCLUSION: Dual energy subtraction is a superior method compared to the conventional FPD radiography for delineating the vocal cord and accurately diagnosing vocal cord paralysis.
Absorptiometry, Photon/*instrumentation/*methods ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Observer Variation ; Reproducibility of Results ; Sensitivity and Specificity ; Subtraction Technique ; Vocal Cord Paralysis/*radiography ; Vocal Cords/radiography ; *X-Ray Intensifying Screens ; Young Adult