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Potential sources of variability were minimised through observer training and the use of standardised protocols and aid memoirs.
In contrast, specialty-qualified doctors expressed reservations about routine use of standardised protocols and were less likely to use the system than their more junior colleagues [ 16].
48 The strengths of this study include the large nationally representative sample of community-living adults which allows us to generalise our findings to the population in Ireland; the structured collection of interview data, including medication data; and the use of standardised protocols for measurements taken during the health assessment.
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In addition, use should be made of standardised protocols and central review to improve inter-observer variation for variables that are known to have prognostic value, but which have high levels of misclassification, such as tumour grade (Bueno-de-Mesquita et al, 2010).
Although the investigators recorded the frequency of use of the standardised protocols, it was difficult to assess overall adherence to the intervention because of its complexity and multifaceted nature.
The strengths of this study include the use of standardised imaging protocols and equipment on all cases of PCV.
However, the use of standardised interview protocols and locally tailored physical activity show-cards in all sites provided consistent guidance for field surveyors in conducting the interview.
22 Increasing clinician experience with patients attending the GP for an STI-related consultation and use of standardised (online) protocol sheets may help improve the quality of care, 23 24 as well as accessible and relevant continuing medical education.
Several sources of bias were minimised in this study because of the cohort study design, the extremely high attendance rate (conscription examinations were mandatory by law), the use of a standardised protocol for blood pressure and anthropometric measurements, and the use of official registries for assessment of socioeconomic status and of the outcome.
Despite the use of a standardised protocol, the overall level of reliability for the NET was poor, suggesting that this test is too unstable to be used to evaluate neck extensor muscle endurance.
A further strength is the use of a standardised protocol to obtain radiographs of both feet and a validated atlas and scoring system to grade features of OA at multiple foot joints.
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