I believe that the physiotherapy profession has an opportunity to lead on stopping the use of blind steroid injections in favour of ultrasound-guided injections.
Diagnostic ultrasound has been used for many years and its effectiveness as a non-invasive tool for diagnosis and injection therapy of joints and soft tissues is well documented. It is ludicrous that we all agree how effective it is in identifying the pathology, and yet come up with all sorts of reasons against using it to guide the injection.
We should be asking whether papers and arguments used for justifying the continued the use of blind injections were robust enough in their interpretation and understanding of the pathologies – for example, in cases of tendinosis/tendinopathy. There are many questions to be asked about the techniques or volume of injections used. But certainly the evidence now demonstrates that blind injections are hit-and-miss.
I am not surprised the injection guidelines are so restrictive on the volumes to be injected: nobody knows where the injection would end, so it’s best to avoid complications or adverse reactions by restricting the volumes and dosages.
We are not doing our patients justice, and I think it is wrong to continue with this practice. It does not have a place in modern medicine. And please do not respond by quoting papers with results that no one has managed to reproduce. I rest my case!
Tendayi Mutsopotsi, by email
All systems go
Now that the country has rejected the alternative vote (AV) option, will the CSP respect majority opinion and do the same regarding its own election processes?
The AV system was rejected because first-past-the-post was deemed by the majority of the population to be a better system. As a democratic organisation, I hope the CSP will respect this decision and follow suit. I would expect the CSP to make a strong case if it planned to continue with an AV system.
Graham Smith, by email
Phil Gray, chief executive, replies:
The CSP, in common with many other professional bodies and trade unions, uses the single transferable vote (STV) method in its elections to council and principal CSP groups and committees, and has done so since 1998 with no reported difficulties.
STV is a form of proportional representation that uses preferential voting in multi-member constituencies. Candidates do not need a majority of votes to be elected, just a known share of the votes, determined by the size of the electorate and the number of positions to be filled.
Each voter gets one vote, which can transfer from their first preference to their second preference. So if your preferred candidate has no chance of being elected or has enough votes already, your vote is transferred to another candidate in accordance with your instructions.
STV has been chosen because it puts most power in the hands of voters. Fewer votes are ‘wasted’ under this system. They are not cast for losing candidates or unnecessarily cast for the winner, which can happen in first-past-the-post, where only a small number of votes actually contribute to the result. In turn, STV encourages more members to put themselves forward for election.
All CSP elections are overseen by an independent scrutineer. This is currently Electoral Reform Services Ltd.
More information on how STV works can be obtained from the Chief Executive’s Office at the CSP.
I like the way you have put together the piece on senior negotiating officer Karen O’Dowd (Frontline 6 July 2011) like a scrapbook. It is easy to read, modern, eye-catching and made me really want to read the article. Well done!
Angela Brett (associate member), by email
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