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Biomedical subjects

W B James

Publications and source records attributed to W B James.

9 recordsLinked to original sources

The use of information theory in evaluating the contribution of radiological and laboratory investigations to diagnosis and management.

Using information theory, the value of radiological and laboratory investigations has been assessed in the diagnosis and management of 67 patients suspected of having inflammatory polyarthritis. There were only three changes in diagnosis made as a result of the investigations. Both the radiological and laboratory tests supplied a small but significant amount of information in improving the physician's confidence in diagnosis. Changes in management occurred more frequently but the final management decision differed from the pre-investigation decision in only 17 of the 67 patients (25%). Radiological examination failed to decrease uncertainty using a simple 'change in uncertainty' measure. Both types of investigation supplied a limited bu significant amount of information towards the final management decision, although the contribution from radiology was only significant when view before the receipt of the results of the laboratory tests. In view of the limited value of the investigations - particularly radiology - in this study, it is important to fully asses present and future diagnostic procedures especially in relation to patient management.

Arthritis

Assessment of rheumatoid inflammation in the knee joint. A reappraisal.

Subjective pain score, clinical assessment, 99m technetium joint uptake, infrared thermography, and thermistor skin temperature measurements were evaluated and compared in patients with rheumatoid knee treated with intra-articular hydrocortisone. In 11 patients with definite and classical rheumatoid arthritis, 10 of whom had unilateral knee involvement, the affected knee joints were assessed by the above techniques before and at intervals after treatment of up to 14 days. The anti-inflammatory property of the steroid therapy was shown by all the assessment parameters, values having decreased significantly from the pretreatment values. However, the only parameter still showing a statistically significant decrease on the 14th post-treatment day was 99mTc joint uptake. Correlations were obtained between the two clinical measurements assessed by a physician i.e. pain score and index of joint inflammation. Both of these also correlated with the 99mTc joint uptake but not with skin temperature measurements. Using the clinical assessments as a yardstick, 99mTc joint uptake seemed to provide a useful index of changes in disease activity in the group as a whole. However, skin temperature measurements by infrared thermography and by the thermistor were of considerably less value.

Arthritis, Rheumatoid