Background

Multi-source feedback (MSF) has become the accepted mechanism of ensuring the appropriate professional behaviour of doctors. It is part of the mandatory assessment of doctors in training and is to be utilized as part of the revalidation of trained doctors. There is significant variation in the models of MSF currently used within the National Health Service and new models of MSF are being designed by various specialties. No single model has been recognized as the 'gold standard'. However, there is a large published literature concerning MSF, both in the context of health systems and, more extensively, within industry. This published literature is reviewed, drawing attention to aspects of MSF systems in which there is consensus on effective approaches as well as other aspects in which there is doubt about the optimum approach. In the light of the review 10 principles key in the development of effective MSF models have been produced.

Objective. To test the hypothesis that genetic characterization of patients at the time they present with inflammatory arthritis can predict subsequent destructive disease.Methods. We evaluated 177 patients with early arthritis. Patients were serologically tested for rheumatoid factor (RF) and were DNA oligotyped for the presence of conserved base sequences in the third hypervariable region (HVR3) of the DRBl gene, previously shown to be associated with severe rheumatoid arthritis (RA). Homozygosity in the patient's genotype was confirmed usiiig restriction fragment length polymorphism analysis. The main outcome measure was radiologic erosions at 1 year.Results. At presentation, 120 patients fulfilled the American College of Rheumatology 1987 criteria for RA, 64% of whom possessed the conserved base sequences, compared with 45% of 347 healthy controls (P < 0.001) and with 56% of 57 patients with other inflammatory arthritis (P not significant). Within the RA population, the frequency of Dw4/Dw14 compound heterozygotes was disproportionately increased. The presence of either HVR3 or RF had a relative risk of 13.49 for erosions, with a sensitivity of 95% (specificity 39%); the presence of both HVR3 and RF had a relative risk of 8.13, with a specificity of 88% (sensitivity 53%).