The meaning of critical thinking in diagnostic radiography.

INTRODUCTION: The development and application of critical thinking skills is a requirement and expectation of higher education and clinical radiographic practice. There is a multitude of generic definitions of critical thinking, however, little is understood about what critical thinking means or how it develops through a course. Diagnostic radiography students struggle with demonstrating this skill to the desired expectation, and, in higher education it is assumed that students have an implicit understanding of what is required in relation to this expectation. This study explores radiography students' understanding and perceptions of the meaning of critical thinking in diagnostic radiography. METHODS: The research framework sits within the interpretive paradigm and was designed as a longitudinal study conducted over a three-year study period. Semi-structured face-to-face interviews were employed as the means of gathering context-rich information from diagnostic radiography students (n = 13) who were purposively selected to participate in the study. FINDINGS: Three themes were constructed following the analysis and interpretation of the interview data. The themes were logical thinking involving analysis and evaluation, the process of decision-making, and reflection and metacognition. CONCLUSION: As participants progressed from year one to year three, they recognised that critical thinking comprised not only of cognitive skills but affective skills too. They attributed their developing understanding of the meaning of critical thinking to clinical placement learning, understanding written feedback, and the expectations of professional practice. Based on these findings a definition of critical thinking applicable to diagnostic radiography was developed. IMPLICATIONS FOR RADIOGRAPHY EDUCATION AND PRACTICE: Understanding the meaning of critical thinking in relation to academic requirements and clinical placement learning is essential for diagnostic radiography students if they are to succeed in both settings.

Total joint arthroplasty in haemophilia.

In severely affected haemophilic patients arthropathy is a common problem which can lead to considerable pain and functional deficit. Surgical management, including total joint arthroplasty, can be undertaken if conservative management fails. A search of the literature showed that a number of studies describing the use of total knee arthroplasty (TKA) and total hip arthroplasty (THA) in haemophilia have been published, whereas shoulder, elbow and ankle arthroplasties are confined to case reports. This paper reviews the functional outcome of arthroplasty in the different joints, the postoperative and long-term complications, and the impact of HIV. Although complications are commonly described and the surgery is technically demanding, the results suggest that arthroplasty, particularly of the hip and knee, can be a valuable option in the management of severe haemophilic arthropathy.

Muscle rehabilitation in haemophilia.

Musculoskeletal dysfunction is a common manifestation of haemophilia. This dysfunction may be associated with imbalances between muscle groups. Evidence emerging from the literature suggests that the rehabilitation of this dysfunction is very relevant for the patient with musculoskeletal problems. Treatment of muscle imbalance may be linked with a reduction in recurrence of symptoms. Further research is needed to establish the relevance of this area in patients with haemophilia but the clinical evidence supports the developing work in this field.

Pathogenesis of upper cervical instability.

SUMMARY. The purpose of this article is to review the pathogenesis of upper cervical instability. Instability can arise from inflammatory, congenital and traumatic causes. The commonest causes of atlanto-axial dislocation are rheumatoid arthritis and Down's syndrome. The review revealed much less information about the relatively minor instabilities that are probably responsible for a number of chronic complaints of the type seen by manual therapists. The potential involvement of passive (ligamentous), active (musculotendinous) and neural control subsystems in maintaining the stability of the spine may go some way to explaining the spectrum of conditions included under the term clinical instability. Copyright 1996 Harcourt Publishers Ltd.

The effect of unilateral intercostal nerve transfer upon lung function.

Intercostal nerve transfer is a well-established technique in the treatment of some severe brachial plexus lesions in adults. There is, however, concern that in the presence of an ipsilateral phrenic nerve palsy it may lead to a significant compromise of respiratory function. 20 patients having intercostal nerve transfers had their lung function assessed pre-operatively and 6 weeks post-operatively. The patients were subsequently questioned about symptoms of respiratory dysfunction. There was no evidence that intercostal nerve transfer leads to a significant reduction in respiratory function in adults. It therefore appears safe to perform intercostal nerve transfers in adults following brachial plexus injuries even in the presence of an ipsilateral phrenic nerve palsy.