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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.

Osteoporosis demands systematic management for optimum use of resources. Guidelines from the Primary Care Rheumatology Society (PCRS) aim to improve its diagnosis and treatment. We identified all admissions over three months to a district general hospital of patients with fracture of femur, vertebra, or distal forearm and of women who underwent oophorectomy or hysterectomy. We audited their care using the criteria that the diagnosis and risk of osteoporosis should be recorded; that management should follow PCRS guidelines; and that this information should be communicated to general practitioners. An ideal standard of 100% compliance with these criteria was chosen. Overwhelmingly these audit criteria were not met, the only one that was met being the prescription of hormone replacement therapy after oophorectomy. Potential for prevention of 35% of hip and distal forearm fractures was identified, the commonest risk factor being long‐term corticosteroid therapy. Identification of high risk patients is feasible by simple methods and their management needs improvement. We suggest that a ‘long‐term corticosteroid therapy register’ and a dedicated ‘osteoporosis service’ would facilitate this.

The purpose of this paper is to investigate the effect of different levels of place understanding (primarily typo-morphological analysis) on the nature of interventions within historic urban setting and buildings within the City of Amman.

The research methodology depended on an extensive thematic survey and analysis. The typo-morphological analysis addressed several of Amman's residential hills and their connections with the downtown area. The thematic place survey tool included different units of analysis (e.g. buildings, public spaces, streets and sloped lands between streets) and addressed the values of these various buildings and spaces, their typology, typo-morphology and relation to the urban context, nature of change and transformations over time to mention a few. The extensive survey also included semi-structured interviews about these buildings addressing their emergence, historic context and values.

The paper presents an architectural typology for Amman's architecture and its relationship with the city's morphology stressing the specificity of Amman's historic core and residential hills. The paper also discusses the effect of this level of place understanding on the nature and levels of interventions within historic settings and buildings.

This level of place understanding (typo-morphological analysis) can have a positive impact on the practice of architectural and urban conservation by informing the nature of interventions within historic urban setting and buildings within the city. More specifically, this level of place understanding can, first, inform the development of urban and heritage guidelines within conservation areas in one of Amman's residential neighborhoods (Weibdeh) and, second, inform the nature of interventions to existing historic buildings based on respect of building typology.

This paper contributes to the disciplines of architectural and urban conservation illustrating how place understanding can inform practices of heritage conservation and future policies and strategies concerning new intervention within such heritage places.

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.