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Temporal artery biopsy (TAB) is the gold standard for diagnosing temporal arteritis; however, sensitivity is relatively poor (30‐40 per cent). The British Society of Rheumatology (BSR) guidelines state two major factors that can improve sensitivity: TAB specimen size >10mm; and pre‐biopsy steroid treatment <7 days. Owing to the low sensitivity, TA treatment is often commenced/continued despite negative histology. The purpose of this paper is to establish the extent to which TAB results influence clinical management and determine specimen adequacy regarding BSR guidelines.

In total, 55 patients underwent TAB between 2009‐2011. Patients' medical notes were analysed, specifically looking at biopsy specimen size, histology results and steroid therapy duration, pre‐ and post‐biopsy.

From 55 TABs, three (6 per cent) were positive, 47 (85 per cent) were negative and five (9 per cent) were “inadequate”. Of those patients with negative results, 18 (46 per cent) received > six months steroid treatment. From 50 “adequate” specimens, 31 (62 per cent) were <10 mm and 11 (28 per cent) received > seven days steroid treatment pre‐biopsy.

Despite negative results, many patients went on to receive long‐term steroids. Action must be taken to reduce false and true negative biopsies. False negatives may be reduced by improving adherence to BSR guidance (increased specimen size and early biopsy after commencing steroids). To reduce total true‐negative biopsies, the authors suggest implementing the American College of Rheumatology scoring system, designed to objectify the decision to perform TAB.

This article addresses a common problem seen in most UK hospitals. There is little literature discussing a plausible solution to reducing negative biopsies.

The purpose of this study is the generation of a thorough generic heart model optimized for direct 3D printing with silicone elastomers.

The base of the model design is segmentation of CT data, followed by a generic adaption and a constructive enhancement. The model is 3D printed with silicone. An evaluation of the physical model gives indications about its benefits and weaknesses.

The results show the feasibility of a generic design while maintaining anatomical correctness and the benefit of the generic approach to quickly derive a multiplicity of healthy and pathological versions from one single model. The material properties of the silicone model are sufficient for simulation, but the results of the evaluation indicate possible improvements, as for most anatomical features, the used silicone is too hard and too stretchable.

Previous developments mostly focus on patient-specific heart models. In contrast, this study sets out to explore the possibility and benefits of a generic approach. Standardized validated models would allow comparability in surgical simulation.

The full implementation of any intelligent system in health care, which is designed for decision support, has several stages, from initial problem identification through development and, finally, cost‐benefit analysis. Central to this is formal objectivist evaluation with its core component of inherent performance of the outputs from these systems. A Medline survey of one type of intelligent system is presented, which demonstrates that this issue is not being addressed adequately. Lack of criteria for dealing with the outputs from these “black box” systems to prescribe adequate levels of inherent performance may be preventing their being accepted by those in the health‐care domain and, thus, their being applied widely in the field.

The purpose of this paper is to better understand how and why adoption and implementation of healthcare IT innovations occur. The authors examine two IT applications, computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) at the meso and micro levels, within the context of the National Programme for IT in the English National Health Service (NHS).

To analyse these multi-level dynamics, the authors blend Rogers’ diffusion of innovations theory (DoIT) with Webster’s sociological critique of technological innovation in medicine and healthcare systems to illuminate a wider range of interacting factors. Qualitative data collected between 2004 and 2006 uses semi-structured, in-depth interviews with 72 stakeholders across four English NHS hospital trusts.

Overall, PACS was more successfully implemented (fully or partially in three out of four trusts) than CPOE (implemented in one trust only). Factors such as perceived benefit to users and attributes of the application – in particular speed, ease of use, reliability and flexibility and levels of readiness – were highly relevant but their influence was modulated through interaction with complex structural and relational issues.

Results reveal that combining contextual system level theories with DoIT increases understanding of real-life processes underpinning implementation of IT innovations within healthcare. They also highlight important drivers affecting success of implementation, including socio-political factors, the social body of practice and degree of “co-construction” between designers and end-users.

The originality of the study partly rests on its methodological innovativeness and its value on critical insights afforded into understanding complex IT implementation programmes.