"Bottom line" thinking in health care can have dire consequences.
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Delivery of Health Care↗
Biomedical subjects
E Williams
Publications and source records attributed to E Williams.
Inflammatory sacroiliac joint pathology: evaluation of radiologic assessment techniques.
Recognition of sacroiliac disease has been integral to arthritis diagnostic approaches. However, intra- and inter-observer variation have been recognized as limiting factors in radiologic assessment of the sacroiliac joint. The assumption that such irregularly shaped joints can be radiologically assessed of the sacroiliac joint. The assumption that such irregularly shaped joints can be radiologically assessed has not actually been rigorously evaluated. Direct arthroscopic visualization of the joints was therefore used as a standard against which to assess the validity of routine radiologic views, stereo-radiology, tomography and computed tomography, in the analysis of a group of sacroiliac joints drawn from the Todd Collection (Cleveland Museum of Natural History). The most sensitive techniques for the recognition of erosions or fusion are 15 degree angulation and stereo, but the frequency of false positives makes the technique of questionable clinical utility. While sensitivity for joint space narrowing is high with several techniques (30 degree anterior-posterior or posterior-anterior projections and tomograms), specificity is still poor, with a high rate of false positives. Fulfillment of the New York Criteria for sacroiliac disease is especially insensitive and non-specific. Radiologic techniques therefore have major limitations for the assessment of sacroiliac disease and greater reliance on clinical acumen is required for patient categorization.
False Positive Reactions↗
Assessing the future.
Awareness of the importance of wound assessment and management appears to be increasing, and centres of excellence are emerging. Nurses have a responsibility to provide effective research-based care for patients, but require knowledge and training to do this. Research-based practice is important, but there is a case for more nurses being involved in research in this area. Nurses realise that, where disagreement in wound management arises between themselves and other professions, one way to overcome this is by demonstrating that they are skilled, proficient and knowledgeable practitioners in wound care. In this way, autonomy may be promoted and nurses can continue to push forward the boundaries of wound management, questioning rituals and promoting innovation. Good documentation is also important and the use of a wound assessment tool may assist in this. The challenge now is for nurses to demand adequate training in order to help them become the skilled, proficient and knowledgeable practitioners they strive to be.
Clinical Competence↗