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Biomedical subjects

D E Forsythe

Publications and source records attributed to D E Forsythe.

11 recordsLinked to original sources
PubMed1998

Using ethnography to investigate life scientists' information needs.

Designing information resources that actually meet the information needs of individuals requires detailed knowledge of these needs. This poses a challenge for developers. Because the meaning of particular terms can vary by field, professional knowledge differs to some extent in different disciplines, and the questions that people ask assume a certain amount of unarticulated background knowledge, understanding the information needs of life scientists is not a trivial undertaking. One source of help in meeting this challenge is ethnography, a set of research methods and an associated conceptual stance developed and used by anthropologists for investigating uncontrolled real-world settings. Drawing on the author's experience in using ethnographic techniques to study clinicians' information needs, this paper describes why such research is necessary, why it requires particular research methods, what an ethnographic perspective has added to the study of information needs, and what this broader approach has revealed about the types of information sought by clinicians in the course of their daily practice.

Anthropology, Cultural↗
PubMed1997

Implementing computers in ambulatory care: implications of physician practice patterns for system design.

This paper presents pre-implementation data from the internal medicine division of a large physician group practice scheduled to implement an electronic medical record (EMR). Data were gathered through short-term participant observation and interviews. Findings indicate that (1) most physicians anticipate enough benefits to be willing to use the system; (2) computers must be accessible, easy to log into, and provide for physician movement and interrupted sessions; (3) many physicians are concerned about losing eye contact with patients; (4) it is unrealistic to expect even good typists to enter their own long notes; (5) staged implementation, with order entry introduced first, may help physicians adapt gradually; and (6) training should include protected time for instructional sessions for physicians, simulated patient encounters to help physicians adapt their practice patterns, and tutors available to answer questions in the clinical setting.

Ambulatory Care↗
PubMed1996

New bottles, old wine: hidden cultural assumptions in a computerized explanation system for migraine sufferers.

Sophisticated computer programs known as "intelligent systems" have been developed for use in medical settings for over two decades. Such systems explicitly encode information about task domains, problem attributes, and problem-solving strategies. They also embody tacit assumptions held by those who build them, reflecting meanings taken for granted in particular cultural and disciplinary arenas. This article examines assumptions built into the design of a patient education system for migraine sufferers, drawing upon extended participant-observation of the development process. Its designers view the system as neutral, but observation reveals that it embodies a physician's point of view. While intended to support migraine patients by offering useful information not given them by physicians, the system in fact offers information characterized by the same assumptions and deletions as that provided by neurologists. Thus, although intended to empower migraine patients, this system may actually reinforce rather than reduce the power differential between doctor and patient.

Attitude to Health↗
PubMed1995

An intelligent interactive system for delivering individualized information to patients.

This paper is a report on the first phase of a long-term, interdisciplinary project whose goal is to increase the overall effectiveness of physicians' time, and thus the quality of health care, by improving the information exchange between physicians and patients in clinical settings. We are focusing on patients with long-term and chronic conditions, initially on migraine patients, who require periodic interaction with their physicians for effective management of their condition. We are using medical informatics to focus on the information needs of patients, as well as of physicians, and to address problems of information exchange. This requires understanding patients' concerns to design an appropriate system, and using state-of-the-art artificial intelligence techniques to build an interactive explanation system. In contrast to many other knowledge-based systems, our system's design is based on empirical data on actual information needs. We used ethnographic techniques to observe explanations actually given in clinic settings, and to conduct interviews with migraine sufferers and physicians. Our system has an extensive knowledge base that contains both general medical terminology and specific knowledge about migraine, such as common trigger factors and symptoms of migraine, the common therapies, and the most common effects and side effects of those therapies. The system consists of two main components: (a) an interactive history-taking module that collects information from patients prior to each visit, builds a patient model, and summarizes the patients' status for their physicians; and (b) an intelligent explanation module that produces an interactive information sheet containing explanations in everyday language that are tailored to individual patients, and responds intelligently to follow-up questions about topics covered in the information sheet.

Anthropology, Cultural↗
PubMed1995

Secretion of transforming growth factor-alpha (TGF alpha) by postnatal rabbit alveolar macrophages.

Transforming growth factor-alpha (TGF alpha) is a cytokine secreted by stimulated alveolar macrophages (AM) in vitro and after in vivo particulate or hyperoxia exposure and has been implicated in the processes of postnatal lung development. It is unknown if AM TGF alpha secretion changes during normal postnatal lung development. After sacrifice of New Zealand white rabbits on postnatal d 0-2, 5-7, 9-10, 14, 21, and 28 and > 4 mo (adult), AM were isolated by discontinuous density centrifugation and placed in culture in the presence or absence of concanavalin A (ConA) for 24 h. Media were collected, and the concentration and isoforms of TGF alpha in AM media samples were determined by an epidermal growth factor/TGF alpha radioreceptor assay and Western immunodetection, respectively. TGF alpha was present in media of AM from the 1.06 and 1.08 g/dL Percoll densities, but not in the 1.10 g/dL density. Statistically significant differences in TGF alpha secretion by unstimulated and ConA-stimulated AM at the various ages were not detected until d 14 (p < 0.02). Western blot analysis of unstimulated AM media samples from d 0-7 rabbits demonstrated the presence of TGF alpha isoforms at 46, 30, and 14.3 kD. At later postnatal ages (> or = d 9), a single 14.3-kD isoform was present. In contrast, analysis of ConA-stimulated AM media samples showed TGF alpha isoforms at 46, 30, and 14.3 kD for all ages; however, the 6-kD mature isoform was present only in juvenile (d 28) and adult media.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1995

Support for information management in critical care: a new approach to identify needs.

Managing information is necessary to support clinical decision making and action in critical care. By understanding the nature of information management and its relationship to sound clinical practice, we should come to use technology more wisely. We demonstrated that a new approach inspired by ethnographic research methods could identify useful and unexpected findings about clinical information management. In this approach, a clinician experienced in a specific domain (critical care), with advice from a medical anthropologist, made short-term observations of information management in that domain. We identified 8 areas in a critical care Unit in which information management was seriously in need of better support. We also found interesting differences in how these needs were viewed by nurses and physicians. Our interest in this approach was at two levels: 1. Identify and describe representative instances of sub-optimal information management in a critical care Unit. 2. Investigate the effectiveness of such short-term observations by clinicians. Our long-range goal is to explore the use of this approach and the information it reveals to optimize the process of developing and selecting new information support tools, preparing for their introduction, and optimizing clinical outcomes.

Critical Care↗
PubMed1992

Expanding the concept of medical information: an observational study of physicians' information needs.

Obtaining and managing clinically relevant information constitutes a major problem for physicians, for which the development of automated tools is often proposed as a solution. However, designing and implementing appropriate automated solutions presumes knowledge of physicians' information needs. We describe an empirical study of information needs in four clinical settings in internal medicine in a university teaching hospital. In contrast to the retrospective data often used in previous studies, this research used ethnographic techniques to facilitate direct observation of communication about information needs. On the basis of this experience, we address two main issues: how to identify and interpret expressions of information needs in medicine and how to broaden our conception of "information needs" to account for the empirical data.

Computer Systems↗
PubMed1992

Using ethnography to build a working system: rethinking basic design assumptions.

The problem of user acceptance of knowledge-based systems is a current concern in medical informatics. User acceptance should increase when system-builders understand both the needs of potential users and the context in which a system will be used. Ethnography is one source of such understanding. This paper describes the contribution of ethnography (and an anthropological perspective) during the first year of a three-year interdisciplinary project to build a patient education system on migraine. Systematic fieldwork is producing extensive data on the information needs of migraineurs. These data call into question some of the assumptions on which the project was based. While it is not easy to rethink our assumptions and their implications for design, using ethnography has enabled us to undertake this process relatively early in the project at a time when redesign costs are low. This should greatly improve our chances of building a system that meets the needs of real users, thus avoiding the troublesome problem of user acceptance.

Anthropology, Cultural↗
PubMed1991

Physicians' information needs: analysis of questions posed during clinical teaching.

OBJECTIVE: To describe information requests expressed during clinical teaching. SETTING: Residents' work rounds, attending rounds, morning report, and interns' clinic in a university-based general medicine service. SUBJECTS: Attending physicians, medical house staff, and medical students in a general medicine training program. METHODS: An anthropologist observed communication among study subjects and recorded in field notes expressions of a need for information. We developed a coding scheme for describing information requests and applied the coding scheme to the data recorded. Based on assigned codes, we created a subset of strictly clinical requests. MEASUREMENTS: Five hundred nineteen information requests recorded during 17 hours of observed clinical activity were selected for detailed analysis. These requests related to the care of approximately 90 patients by 24 physicians and medical students. Sixty-five requests were excluded because they were not strictly clinical, leaving a subset of 454 clinical questions for analysis. MAIN RESULTS: On average, five clinical questions were raised for each patient discussed. Three hundred thirty-seven requests (74%) concerned patient care. Of these 337 questions, 175 (52%) requested a fact that could have been found in a medical record. Seventy-seven (23%) of these questions, motivated by the needs of patient care, were potentially answerable by a library, a textbook, a journal, or MEDLINE. Eighty-eight (26%) of the questions asked for patient care required synthesis of patient information and medical knowledge. CONCLUSIONS: Clinicians in the study settings requested information frequently. Many of these information needs required the synthesis of patient information and medical knowledge and thus were potentially difficult to satisfy. A typology is proposed that characterizes information needs as consciously recognized, unrecognized, and currently satisfied.

Education, Medical↗
PubMed1991

Broadening our approach to evaluating medical information systems.

Evaluation in medical informatics tends to follow the paradigm of controlled clinical trials. This model carries with it a number of assumptions whose implications for medical informatics deserve examination. In this paper, we describe the conventional wisdom on evaluation, pointing out some of its underlying assumptions and suggesting that these assumptions are problematic when applied to some aspects of evaluation. In particular, we believe that these assumptions contribute to the problem of user acceptance. We then suggest a broader approach to evaluation, offering some conceptual and methodological distinctions that we believe will be of use to the medical informatics community in rethinking this issue.

Bias↗