Referral Patterns for Dual-Energy Computed Tomography in Diagnosis and Management of Gout: Ten-Year Experience at a Canadian Institution

Purpose

To analyze the utilization, indications, and outcomes of dual-energy computed tomography (DECT) gout imaging in clinical practice.

Reliability of the hip examination in osteoarthritis: effect of standardization

OBJECTIVE: To assess the reliability of the physical examination of the hip in osteoarthritis (OA) among rheumatologists and orthopedic surgeons, and to evaluate the benefits of standardization. METHODS: Thirty-five physical signs and techniques were evaluated using a 6 x 6 Latin square design. Subjects with mild to severe hip OA, based on physical and radiographic signs, were examined in random order prior to and following standardization of physical examination techniques. For dichotomous signs, agreement was calculated as the prevalence-adjusted bias-adjusted kappa (PABAK), whereas for continuous and ordinal signs a reliability coefficient was calculated using analysis of variance. A PABAK >0.60 and a reliability coefficient >0.80 were considered to indicate adequate reliability. RESULTS: Adequate post-standardization reliability was achieved for 25 (71%) of 35 signs. The most highly reliable signs included true and apparent leg length discrepancy > or =1.5 cm; hip flexion, abduction, adduction, and extension strength; log roll test for hip pain; internal rotation and flexion range of motion; and Thomas test for flexion contracture. The standardization process was associated with substantial improvements in reliability for a number of physical signs, although minimal or no change was noted for some. Only 1 sign, Trendelenburg's sign, was highly unreliable post-standardization. CONCLUSION: With the exception of gait, a comprehensive hip examination can be performed with adequate reliability. Post-standardization reliability is improved compared with pre-standardization reliability for some physical signs. The application of these findings to future OA studies will contribute to improved outcome assessments in OA.     

Rheumatology health care providers’ views and practices on obesity and smoking cessation management in rheumatoid arthritis

Clinical Rheumatology - To assess rheumatology health care providers’ (HCPs) knowledge, beliefs, self-efficacy, practices, and perceived barriers pertaining to weight management and smoking...     

Evidence‐based medicine: A cornerstone for clinical care but not for quality improvement

Quality improvement (QI) as a clinical improvement science has been criticized for failing to deliver broad patient outcome improvement and for being a top‐down regulatory and compliance construct. These critics have argued that the focus of QI should be on increasing adherence to clinical practice guidelines (CPGs) and, as a result, should be consolidated into research structures with the science of evidence‐based medicine (EBM) at the helm. We argue that EBM often overestimates the role of knowledge as the root cause of quality problems and focuses almost exclusively on the effectiveness of care while often neglecting the domains of safety, efficiency, patient‐centredness, and equity. Successfully addressing quality problems requires a much broader, systems‐based view of health‐care delivery. Although essential to clinical decision‐making and practice, EBM cannot act as the cornerstone of health system improvement.