Clin Med
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The range of treatments for rheumatoid arthritis (RA) has increased significantly in recent years, with a parallel improvement in patient outcome. The development and assessment of new therapies and therapeutic strategies relies on the availability of valid and reliable outcome measures to assess the diverse impact of RA on the patient's life. ⋯ Some measures have been combined into composite indices which are useful for summarising the patient's current condition and as primary outcome measures for clinical trials. There is still a need for better and more relevant tools especially for imaging multiple joints and for assessing fatigue.
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Randomized Controlled Trial
A randomised trial of peer review: the UK National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project.
Peer review has been widely employed within the NHS to facilitate health quality improvement but has not been rigorously evaluated. This article reports the largest randomised trial of peer review ever conducted in the UK. The peer review intervention was a reciprocal supportive exercise that included clinicians, hospital management, commissioners and patients which focused on the quality of the provision of four specific evidence-based aspects of chronic obstructive pulmonary disease care. ⋯ Findings suggest peer review in this format is a positive experience for most participants but is ineffective in some situations. Its longer term benefits and cost effectiveness require further study. The generic findings of this study have potential implications for the application of peer review throughout the NHS.
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Diaphragm disease occurs in 2% of chronic non-steroidal anti-inflammatory drug users and occasionally may cause subacute small bowel obstruction.
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The doctor has a responsibility to develop and maintain an effective approach to ethical decision making and the skills to implement the correct moral action. At the heart of this process is the experience and knowledge of particular conditions and their outcomes, alongside excellence in communication skills and working with colleagues.