International Journal of the Addictions
ISSN: 0020-773X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/isum19
Case-Note Abstraction: A Methodological Substudy as Cautionary Tale G. Edwards, N. H. Rathod, I. G. Thomson, E. Kyle & P. Nicholls To cite this article: G. Edwards, N. H. Rathod, I. G. Thomson, E. Kyle & P. Nicholls (1976) CaseNote Abstraction: A Methodological Substudy as Cautionary Tale, International Journal of the Addictions, 11:3, 409-416, DOI: 10.3109/10826087609056160 To link to this article: http://dx.doi.org/10.3109/10826087609056160
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The International Journal of the Addictions, ll(3). pp. 409-416, 1976
Case-Note Abstraction: A Methodological Substudy as Cautionary Tale G. Edwards
N. H. Rathod
I. G.Thomson E. Kyle
P. Nicholls Addiction Research Unit London. S.E.5., England
Abstract
A sample of 42 case notes of alcoholic patients were abstracted for 17 items by three different raters. Interrater agreement was generally rather low. Research based on case-note abstraction which does not report on abstraction reliabilities must therefore be viewed with some suspicion. It would be helpful if clinical material could more often be collected in a standardized manner. Alcoholism research has been based not infrequently on analysis of hospital case-files material. Rather little attention seems to have been given, however, to the methodological problem of abstractor reliability. We report here a small preliminary exercise bearing on this question. 409
Copyright 0 1976 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
EDWARDS ET AL.
410
Downloaded by [McMaster University] at 10:06 17 April 2016
METHOD In the major study, 935 case-notes of alcoholic patients have been examined, and patients followed-up by record search. Details of sampling, etc. have been given elsewhere (Edwards et al., 1974). For the present exercise, 46 case-notes were drawn as a subsample on the basis of four mental illness hospitals comprising the original sample and patient’s sex and social class. Two of the hospitals had a special interest in alcoholism treatment, one was an Observation Ward medically staffed by a postgraduate psychiatric teaching hospital, while the fourth provided a general service to its local community without a special emphasis on alcoholism. The three abstractors who cooperated in the study were all psychiatrists with specialized experience in the care of the alcoholic, they all had research experience in alcoholism, and they had all worked at the same postgraduate psychiatric institution. They each independently abstracted the same subsample of case notes using a structured precoded abstraction schedule. Written guidelines for interpretation of the schedule were provided. All 17 items considered here had to be given one or other of the forced-choked ratings yes/information equivocal/no/informationabsent.
RESULTS Four case-notes had to be rejected from consideration because of handwriting difficulties: therefore these notes will be excluded from further discussion and N may be taken as effectively reduced to 42. “Missing Data”
Set out in Table I are data on the frequency with which each of the three raters felt forced to make a “no information” entry on each of 17 abstraction items. Inconsistency. A complex pattern of disagreements between raters is revealed. Rater 3 generally had a much more optimistic view of the completeness of data than did his two colleagues, and inspection of the original data shows that this was largely because of his habit of recording a “negative” entry where the other two raters preferred “no information.” Raters 1 and 2 more closely resemble each other’s recording habits, with differences of not more than 5% in seven instances: in the remaining 10 instances, Rater 1 gave the higher estimate of “no information” on three items and Rater 2 on seven items.
e
e
4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17.
3.
1. 2.
Current drinking pattern suggesting addictive drinking Delirium tremens at any time Alcohol withdrawal fits at any time Alcoholic dementia (including Korsakoff‘s) Peptic ulceration at any time Peripheral neuritis at any time Head injury at any time Nonalcoholic epilepsy at any time Depressive illness at any time Pathological jealousy at any time Drug addiction at any time Suicidal gesture or attempt at any time Chronic adverse impact of drinking on family at any time Loss of job due to drinking at any time Total social disruption of skid-row type Alcohol-related criminality at any time Criminality other than alcohol related at any time
Item 13 51 71 2 90 80 63 68 56 93 76 65 46 56 5 68 85
Rater 1
3 12 17 12 85 73 93 15 15 12 20 20 2 5 15 54 66 71 90 80 100 78 49 66 54 68 21 54 48 46 51
12 17
0
Rater 3
Rater 2
% of entries by each rater given as “no information”
Seventeen Items Abstracted from Case Notes. Percentage of Entries for Each Item on Which Each of Three Raters Recorded That There Was “ N o Information” in the Case Notes. Range of N from 39 to 42
Table 1
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EDWARDS ET AL.
412
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Estimates of Incompleteness. The table shows that Rater 1 recorded 75% or greater availability of information (Lee, 25% incompleteness), for only three items, Rater 2 for only two items, but Rater 3 for 15 items. If 75% availability were taken as the arbitrary cut-off point to determine whether note abstraction could provide a satisfactory basis for further research analysis, then according to the results presented by the different raters the following very divergent conclusions might be reached: 1 . If Rater 1 is to be credited, only items 1 , 4, and 15 reach the necessary level. 2. If Rater 2 is to determine the matter, then only items 1 and 13 reach the 75% level. 3. If the criterion is that both Rater 1 and Rater 2 are simultaneously to be satisfied that the necessary level has been reached, then item 1 stands in isolation as alone attaining the required level of completeness. 4. However, with Rater 3 as arbiter, only items 5,6, and 7 (physical illness and accident) fail to reach the 75% level of completeness. Raters 1 and 2 : Detailed Examination of 4 Items
The data so far presented show that Rater 3 interpreted one aspect of the coding rules in a manner so different than did either of his colleagues as largely to obviate the usefulness of further a n d more detailed comparison between Rater 3 and Rater 1, or Rater 3 and Rater 2. Comparison between Rater 1 and Rater 2 on abstraction of four selected items is given below as illustration of the types and degrees of interrater differences which can occur between two note abstractors who are reasonably like-minded, at least in their interpretation of “no information” rules. The significance test used is the Kappa (K) coefficient of agreement compared with an estimate of its standard error. Kappa measures the proportion of agreement over and above that expected by chance and has been fully described by Everitt (1968), who also gave formulas for estimating the mean and variance. “Current Drinking Pattern Suggesting Addictive Drinking.” This is the one item on which Rater 1 and Rater 2 concurred in giving relatively low “no information” percentages. In 25/39 instances (64%) there was complete agreement, while in only two instances ( 5 % ) was there complete
413
CASE-NOTE ABSTRACTION Table 2 Rater 1 Versus Rater 2: Pattern of Drinking Suggesting Addiction. N = 41
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Rater 1 Rater 2
No information
No
Yes Equivocal No No information
1 1
-
1 2
-
2
-
Equivocal
Yes
2 2 2 1
21 1
-
3
disagreement with one rater entering “yes” and the other “no” (Table 2). The percentage agreement exceeds that to be expected by chance (K = .323, p < .05), and the position might be considered at least moderately satisfactory. Delirium Tremens at Any Time. This item, which one might have expected to find clearly recorded one way or the other in the majority of alcoholics’ notes, was in fact entered as “no information” in about half of all instances, both by Rater 1 and Rater 2 (see Table 1). Detailed crosstabulation gives a level of interrater agreement considerably exceeding chance (K = .743, p < .Ol), but Table 3 shows that this seeming agreement rests in quite large measure on the 17 agreements for “no information.” On the remaining 24 items there is complete agreement in only 13/ 24 (54%) of instances, but no instance of complete contradiction (“yes” for “no”). Depressive Illness. In 34% of cases (14/41) the two raters were in agreement that the notes contained no information which would permit a decision as to whether the patient had ever suffered from a depressive illness, while for the remaining 27 cases there was complete agreement in only Table 3 Rater 1 Versus Rater 2: Delirium Tremens at Any Time. N = 41 Rater 1 Rater 2
No information
No
Equivocal
Yes
Yes Equivocal No No information
1 3 17
6 4
1 -
7 1 1
EDWARDS ET AL.
414
Table 4 Rater 1 Versus Rater 2: Depressive Illness. N = 41
Rater 1 Rater 2
No information
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Yes Equivocal No No information
3
3 2 2
14
5
2 4
Equivocal
No
1
-
Yes 3 1
1
Table 5 Rater 1 Versus Rater 2: Chronic Adverse Impact of Drinking on Family. N = 39 Rater 1 Rater 2
No information
No
Equivocal
Yes
Yes Equivocal No No information
2 3 -
4
1
1
11 3 -
14
19% (5/27) cases (Table 4). The overall measure of agreement does not exceed that which might be expected by chance (K = .239, p > .05).
Chronic Adverse Impact of Drinking on Family (or on with Whom Living). Both raters agreed that in 14/39 (36%) cases “no information” had to be entered: they agreed on a positive entry for 11/39 (28%) cases, and did not in any instance disagree absolutely (Table 5). Here K = S76, p < .05.
DISCUSSION The Limits of Extrapolation
To extrapolate from the case-note study reported here to any general statements as to the reliability or unreliability of case-note studies would be unwise. It is possible that the three raters who cooperated in this study were in some ways egregious, and possible too that the original standard of case recording in these 10 to 15 year-old files represents a level which would today be bettered. That the three raters had a background of training and experience which might be expected to lead to a uniformity of
CASE-NOTE ABSTRACTION
415
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approach, and that two of the four hospitals might be expected to set a particularly high standard of alcoholism case recording, has, however, already been noted in the introduction. If it is rash to extrapolate these findings too incautiously to case-note research in general, it would equally be over-sanguine to dismiss this tale as totally unworrying. It is then more proper and more constructive to see the study as probably suggesting the need for a few simple and clearly delineated ground rules which might govern the use of this type of material in research. Two Suggested Ground Rules 1. The value of case-note material for alcoholism research (or any other studies) would be enhanced if the initial note-taking were done within the framework of a uniform structured caserecording scheme. There might well be a place here for national and international cooperation in the design of schedules for general use, at least in clinical centers specializingin alcoholism research. Too much confidence should, of course, not even then be placed in the value of such seemingly “uniform” material, for factors related both to the unreliability of data provided by the paitent and factors of bias introduced by the particular clinician’s interviewing and note-taking habits and personal interpretations will ensure that the ink-mark on the case papers is seldom more than a rather uncertain reflection of actuality. Unless a structured schedule is employed, there will always be uncertainty as to whether “no information” indicates the failure to ask a question or the failure to record a (negative) answer. 2. Any study which is based on case-note abstracting should report interrater reliability on a subsample, with at least two independent abstractors. The operational rules for abstraction should be clearly written, and in the event of low interrater reliability the whole procedure should be carefully gone into, the reasons for disagreement identified, and rules for abstraction where indicated revised. Items where good agreement cannot be obtained should be discarded. Case Notes as Sociological Raw Material Robinson (1973) has argued that case notes have a meaning beyond their overt content: the entries made by the interviewer are not only
EDWARDS ET AL.
Downloaded by [McMaster University] at 10:06 17 April 2016
416
overt indications of what that interviewer believed to be the patient’s history and condition, but are covert indications of the interviewer’s attitudes toward his patient and sometimes toward other agencies. The notes, whether complete or incomplete,. accurate or inaccurate, have a reality of their own and are potentially valuable material for sociological research which sees the doctor, as much as the patient, as objects of study. The present report would suggest that the value of this type of research also will be enhanced if the interrater question is explored. Only the most concrete “front sheet” information should be immune from the methodological demands, and even here it is likely that a subsample should be checked for any unsuspected idiosyncracies of the abstractor. ACKNOWLEDGMENTS
We would like to thank the hospital authorities concerned for permission to study these case notes and record officers for their assistance. Mrs. Julia Polglaze undertook all the secretarial work. REFERENCES
EDWARDS, G., KYLE, E., and NICHOLLS, P. A study of alcoholics admitted to four hospitals: I . Social class and the interaction of the alcoholic with the treatment system. Q. J. Stud. Alcohol. 1974. Awaiting publication. EVERITT, B.S. Moments of the statistic kappa and weighted kappa. Br. J. Math. Stat. PsJ&o~. 21: 97-103, 1968.
ROBINSON, D. Alcoholism as a social fact: Notes on the sociologist’s viewpoint in relation to a proposed study of referral behaviour. Br. J. Addict. 2: 91-98, 1973.
ISSN: 0020-773X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/isum19
Case-Note Abstraction: A Methodological Substudy as Cautionary Tale G. Edwards, N. H. Rathod, I. G. Thomson, E. Kyle & P. Nicholls To cite this article: G. Edwards, N. H. Rathod, I. G. Thomson, E. Kyle & P. Nicholls (1976) CaseNote Abstraction: A Methodological Substudy as Cautionary Tale, International Journal of the Addictions, 11:3, 409-416, DOI: 10.3109/10826087609056160 To link to this article: http://dx.doi.org/10.3109/10826087609056160
Published online: 03 Jul 2009.
Submit your article to this journal
Article views: 2
View related articles
Citing articles: 3 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=isum19 Download by: [McMaster University]
Date: 17 April 2016, At: 10:06
Downloaded by [McMaster University] at 10:06 17 April 2016
The International Journal of the Addictions, ll(3). pp. 409-416, 1976
Case-Note Abstraction: A Methodological Substudy as Cautionary Tale G. Edwards
N. H. Rathod
I. G.Thomson E. Kyle
P. Nicholls Addiction Research Unit London. S.E.5., England
Abstract
A sample of 42 case notes of alcoholic patients were abstracted for 17 items by three different raters. Interrater agreement was generally rather low. Research based on case-note abstraction which does not report on abstraction reliabilities must therefore be viewed with some suspicion. It would be helpful if clinical material could more often be collected in a standardized manner. Alcoholism research has been based not infrequently on analysis of hospital case-files material. Rather little attention seems to have been given, however, to the methodological problem of abstractor reliability. We report here a small preliminary exercise bearing on this question. 409
Copyright 0 1976 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
EDWARDS ET AL.
410
Downloaded by [McMaster University] at 10:06 17 April 2016
METHOD In the major study, 935 case-notes of alcoholic patients have been examined, and patients followed-up by record search. Details of sampling, etc. have been given elsewhere (Edwards et al., 1974). For the present exercise, 46 case-notes were drawn as a subsample on the basis of four mental illness hospitals comprising the original sample and patient’s sex and social class. Two of the hospitals had a special interest in alcoholism treatment, one was an Observation Ward medically staffed by a postgraduate psychiatric teaching hospital, while the fourth provided a general service to its local community without a special emphasis on alcoholism. The three abstractors who cooperated in the study were all psychiatrists with specialized experience in the care of the alcoholic, they all had research experience in alcoholism, and they had all worked at the same postgraduate psychiatric institution. They each independently abstracted the same subsample of case notes using a structured precoded abstraction schedule. Written guidelines for interpretation of the schedule were provided. All 17 items considered here had to be given one or other of the forced-choked ratings yes/information equivocal/no/informationabsent.
RESULTS Four case-notes had to be rejected from consideration because of handwriting difficulties: therefore these notes will be excluded from further discussion and N may be taken as effectively reduced to 42. “Missing Data”
Set out in Table I are data on the frequency with which each of the three raters felt forced to make a “no information” entry on each of 17 abstraction items. Inconsistency. A complex pattern of disagreements between raters is revealed. Rater 3 generally had a much more optimistic view of the completeness of data than did his two colleagues, and inspection of the original data shows that this was largely because of his habit of recording a “negative” entry where the other two raters preferred “no information.” Raters 1 and 2 more closely resemble each other’s recording habits, with differences of not more than 5% in seven instances: in the remaining 10 instances, Rater 1 gave the higher estimate of “no information” on three items and Rater 2 on seven items.
e
e
4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17.
3.
1. 2.
Current drinking pattern suggesting addictive drinking Delirium tremens at any time Alcohol withdrawal fits at any time Alcoholic dementia (including Korsakoff‘s) Peptic ulceration at any time Peripheral neuritis at any time Head injury at any time Nonalcoholic epilepsy at any time Depressive illness at any time Pathological jealousy at any time Drug addiction at any time Suicidal gesture or attempt at any time Chronic adverse impact of drinking on family at any time Loss of job due to drinking at any time Total social disruption of skid-row type Alcohol-related criminality at any time Criminality other than alcohol related at any time
Item 13 51 71 2 90 80 63 68 56 93 76 65 46 56 5 68 85
Rater 1
3 12 17 12 85 73 93 15 15 12 20 20 2 5 15 54 66 71 90 80 100 78 49 66 54 68 21 54 48 46 51
12 17
0
Rater 3
Rater 2
% of entries by each rater given as “no information”
Seventeen Items Abstracted from Case Notes. Percentage of Entries for Each Item on Which Each of Three Raters Recorded That There Was “ N o Information” in the Case Notes. Range of N from 39 to 42
Table 1
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EDWARDS ET AL.
412
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Estimates of Incompleteness. The table shows that Rater 1 recorded 75% or greater availability of information (Lee, 25% incompleteness), for only three items, Rater 2 for only two items, but Rater 3 for 15 items. If 75% availability were taken as the arbitrary cut-off point to determine whether note abstraction could provide a satisfactory basis for further research analysis, then according to the results presented by the different raters the following very divergent conclusions might be reached: 1 . If Rater 1 is to be credited, only items 1 , 4, and 15 reach the necessary level. 2. If Rater 2 is to determine the matter, then only items 1 and 13 reach the 75% level. 3. If the criterion is that both Rater 1 and Rater 2 are simultaneously to be satisfied that the necessary level has been reached, then item 1 stands in isolation as alone attaining the required level of completeness. 4. However, with Rater 3 as arbiter, only items 5,6, and 7 (physical illness and accident) fail to reach the 75% level of completeness. Raters 1 and 2 : Detailed Examination of 4 Items
The data so far presented show that Rater 3 interpreted one aspect of the coding rules in a manner so different than did either of his colleagues as largely to obviate the usefulness of further a n d more detailed comparison between Rater 3 and Rater 1, or Rater 3 and Rater 2. Comparison between Rater 1 and Rater 2 on abstraction of four selected items is given below as illustration of the types and degrees of interrater differences which can occur between two note abstractors who are reasonably like-minded, at least in their interpretation of “no information” rules. The significance test used is the Kappa (K) coefficient of agreement compared with an estimate of its standard error. Kappa measures the proportion of agreement over and above that expected by chance and has been fully described by Everitt (1968), who also gave formulas for estimating the mean and variance. “Current Drinking Pattern Suggesting Addictive Drinking.” This is the one item on which Rater 1 and Rater 2 concurred in giving relatively low “no information” percentages. In 25/39 instances (64%) there was complete agreement, while in only two instances ( 5 % ) was there complete
413
CASE-NOTE ABSTRACTION Table 2 Rater 1 Versus Rater 2: Pattern of Drinking Suggesting Addiction. N = 41
Downloaded by [McMaster University] at 10:06 17 April 2016
Rater 1 Rater 2
No information
No
Yes Equivocal No No information
1 1
-
1 2
-
2
-
Equivocal
Yes
2 2 2 1
21 1
-
3
disagreement with one rater entering “yes” and the other “no” (Table 2). The percentage agreement exceeds that to be expected by chance (K = .323, p < .05), and the position might be considered at least moderately satisfactory. Delirium Tremens at Any Time. This item, which one might have expected to find clearly recorded one way or the other in the majority of alcoholics’ notes, was in fact entered as “no information” in about half of all instances, both by Rater 1 and Rater 2 (see Table 1). Detailed crosstabulation gives a level of interrater agreement considerably exceeding chance (K = .743, p < .Ol), but Table 3 shows that this seeming agreement rests in quite large measure on the 17 agreements for “no information.” On the remaining 24 items there is complete agreement in only 13/ 24 (54%) of instances, but no instance of complete contradiction (“yes” for “no”). Depressive Illness. In 34% of cases (14/41) the two raters were in agreement that the notes contained no information which would permit a decision as to whether the patient had ever suffered from a depressive illness, while for the remaining 27 cases there was complete agreement in only Table 3 Rater 1 Versus Rater 2: Delirium Tremens at Any Time. N = 41 Rater 1 Rater 2
No information
No
Equivocal
Yes
Yes Equivocal No No information
1 3 17
6 4
1 -
7 1 1
EDWARDS ET AL.
414
Table 4 Rater 1 Versus Rater 2: Depressive Illness. N = 41
Rater 1 Rater 2
No information
Downloaded by [McMaster University] at 10:06 17 April 2016
Yes Equivocal No No information
3
3 2 2
14
5
2 4
Equivocal
No
1
-
Yes 3 1
1
Table 5 Rater 1 Versus Rater 2: Chronic Adverse Impact of Drinking on Family. N = 39 Rater 1 Rater 2
No information
No
Equivocal
Yes
Yes Equivocal No No information
2 3 -
4
1
1
11 3 -
14
19% (5/27) cases (Table 4). The overall measure of agreement does not exceed that which might be expected by chance (K = .239, p > .05).
Chronic Adverse Impact of Drinking on Family (or on with Whom Living). Both raters agreed that in 14/39 (36%) cases “no information” had to be entered: they agreed on a positive entry for 11/39 (28%) cases, and did not in any instance disagree absolutely (Table 5). Here K = S76, p < .05.
DISCUSSION The Limits of Extrapolation
To extrapolate from the case-note study reported here to any general statements as to the reliability or unreliability of case-note studies would be unwise. It is possible that the three raters who cooperated in this study were in some ways egregious, and possible too that the original standard of case recording in these 10 to 15 year-old files represents a level which would today be bettered. That the three raters had a background of training and experience which might be expected to lead to a uniformity of
CASE-NOTE ABSTRACTION
415
Downloaded by [McMaster University] at 10:06 17 April 2016
approach, and that two of the four hospitals might be expected to set a particularly high standard of alcoholism case recording, has, however, already been noted in the introduction. If it is rash to extrapolate these findings too incautiously to case-note research in general, it would equally be over-sanguine to dismiss this tale as totally unworrying. It is then more proper and more constructive to see the study as probably suggesting the need for a few simple and clearly delineated ground rules which might govern the use of this type of material in research. Two Suggested Ground Rules 1. The value of case-note material for alcoholism research (or any other studies) would be enhanced if the initial note-taking were done within the framework of a uniform structured caserecording scheme. There might well be a place here for national and international cooperation in the design of schedules for general use, at least in clinical centers specializingin alcoholism research. Too much confidence should, of course, not even then be placed in the value of such seemingly “uniform” material, for factors related both to the unreliability of data provided by the paitent and factors of bias introduced by the particular clinician’s interviewing and note-taking habits and personal interpretations will ensure that the ink-mark on the case papers is seldom more than a rather uncertain reflection of actuality. Unless a structured schedule is employed, there will always be uncertainty as to whether “no information” indicates the failure to ask a question or the failure to record a (negative) answer. 2. Any study which is based on case-note abstracting should report interrater reliability on a subsample, with at least two independent abstractors. The operational rules for abstraction should be clearly written, and in the event of low interrater reliability the whole procedure should be carefully gone into, the reasons for disagreement identified, and rules for abstraction where indicated revised. Items where good agreement cannot be obtained should be discarded. Case Notes as Sociological Raw Material Robinson (1973) has argued that case notes have a meaning beyond their overt content: the entries made by the interviewer are not only
EDWARDS ET AL.
Downloaded by [McMaster University] at 10:06 17 April 2016
416
overt indications of what that interviewer believed to be the patient’s history and condition, but are covert indications of the interviewer’s attitudes toward his patient and sometimes toward other agencies. The notes, whether complete or incomplete,. accurate or inaccurate, have a reality of their own and are potentially valuable material for sociological research which sees the doctor, as much as the patient, as objects of study. The present report would suggest that the value of this type of research also will be enhanced if the interrater question is explored. Only the most concrete “front sheet” information should be immune from the methodological demands, and even here it is likely that a subsample should be checked for any unsuspected idiosyncracies of the abstractor. ACKNOWLEDGMENTS
We would like to thank the hospital authorities concerned for permission to study these case notes and record officers for their assistance. Mrs. Julia Polglaze undertook all the secretarial work. REFERENCES
EDWARDS, G., KYLE, E., and NICHOLLS, P. A study of alcoholics admitted to four hospitals: I . Social class and the interaction of the alcoholic with the treatment system. Q. J. Stud. Alcohol. 1974. Awaiting publication. EVERITT, B.S. Moments of the statistic kappa and weighted kappa. Br. J. Math. Stat. PsJ&o~. 21: 97-103, 1968.
ROBINSON, D. Alcoholism as a social fact: Notes on the sociologist’s viewpoint in relation to a proposed study of referral behaviour. Br. J. Addict. 2: 91-98, 1973.
