Can diagnostic triage by general practitioners or rheumatology nurses improve the positive predictive value of referrals to early arthritis clinics?

Objectives: To determine whether diagnostic triage by general practitioners (GPs) or rheumatology nurses (RNs) can improve the positive predictive value of referrals to early arthritis clinics (EACs).

Methods: Four GPs and two RNs were trained in the assessment of early in?ammatory arthritis (IA) by four visits to an EAC supervised by hospital rheumatologists. Patients referred to one of three EACs were recruited for study and assessed independently by a GP, an RN and one of six rheumatologists. Each assessor was asked to record their clinical ?ndings and whether they considered the patient to have IA. Each was then asked to judge the appropriateness of the referral according to predetermined guidelines. The rheumatologists had been shown previously to have a satisfactory level of agreement in the assessment of IA.

Results: Ninety-six patients were approached and all consented to take part in the study. In 49 cases (51%), the rheumatologist judged that the patient had IA and that the referral was appropriate. The assessments of GPs and RNs were compared with those of the rheumatologists. Levels of agreement were measured using the kappa value, where 1.0 represents total unanimity. The kappa value was
0.77 for the GPs when compared with the rheumatologists and 0.79 for the RNs. Signi?cant stiffness in the morning or after rest and objective joint swelling were the most important clinical features enabling the GPs and RNs to discriminate between IA and non-IA conditions.

Conclusion: Diagnostic triage by GPs or RNs improved the positive predictive value of referrals to an EAC with a degree of accuracy approaching that of a group of experienced rheumatologists.

A study of the Type II-P supernova 2003gd in M74

We present photometric and spectroscopic data of the Type II-P supernova (SN II-P) 2003gd, which was discovered in M74 close to the end of its plateau phase. SN 2003gd is the first Type II supernova ( SN) to have a directly confirmed red supergiant ( RSG) progenitor. We compare SN 2003gd to SN 1999 em, a similar SN II-P, and estimate an explosion date of 2003 March 18. We determine a reddening towards the SN of E(B-V) = 0.14 +/- 0.06, using three different methods. We also calculate three new distances to M74 of 9.6 +/- 2.8, 7.7 +/- 1.7 and 9.6 +/- 2.2 Mpc. The former was estimated using the standard candle method (SCM), for Type II supernovae (SNe II), and the latter two using the brightest supergiants method (BSM). When combined with existing kinematic and BSM distance estimates, we derive a mean value of 9.3 +/- 1.8 Mpc. SN 2003gd was found to have a lower tail luminosity compared with other normal Type II-P supernovae ( SNe II-P) bringing into question the nature of this SN. We present a discussion concluding that this is a normal SN II-P, which is consistent with the observed progenitor mass of 8(-2)(+4) M-circle dot.

Dynamic Knowledge Creation Through Value Management Teams

With the intention of introducing unique and value-added products to the market, organizations have become more conscious of how to best create knowledge as reported by Ganesh Bhatt in 2000 in 'Information dynamics, learning and knowledge creation in organizations'. Knowledge creation is recognized as having an important role in generating and sustaining a competitive advantage as well as in meeting organizational goals, as reported by Aleda Roth and her colleagues in 1994 in 'The knowledge factory for accelerated learning practices.' One of the successful ingredients of value management (VM) is its utilization of diverse knowledge resources, drawing upon different organizational functions, professional disciplines, and stakeholders, in a facilitated team process. Multidisciplinary VM study teams are viewed as having high potential to innovate due to their heterogeneous nature. This paper looks at one of the VM workshop's major benefits, namely, knowledge creation. A case study approach was used to explore the nature, processes, and issues associated with fostering a dynamic knowledge creation capability within VM teams. The results indicate that the dynamic knowledge creating process is embedded in and influenced by managing team constellation, creating shared awareness, developing shared understanding, and producing aligned action. The catalysts that can speed up the processes are open dialogue and discussion among participants. This process is enhanced by the use of facilitators, skilled at extracting knowledge.