Search PubMed⌕ Search

Biomedical subjects

F T de Dombal

Publications and source records attributed to F T de Dombal.

At least 19 recordsLinked to original sources
PubMed1996

An information technology course in the medical curriculum.

This paper concerns the information technology course now running in year 1 of the undergraduate curriculum of the medical school of Leeds University. The background and objectives of the course are described, and the course content is outlined in terms of knowledge and practical skills. By the end of the course, 95% of students could successfully accomplish 95% of the skill tasks taught. As regards attitudes to IT, independent studies comparing two randomly selected groups suggested students who had taken the course (a) used IT more frequently, and (b) viewed IT more favourably than their counterparts.

Attitude↗
PubMed1996

On the value of clinical information. Is there a bridge between quantum theory and medical diagnosis?

This paper discusses the problems in assigning a precise value to an item (or group of items) of clinical information. Historical viewpoints are reviewed; the paper illustrates how determinist descriptive thinking has been overtaken by concepts of uncertainty and probability. Four equations are proposed outlining the factors which affect the value of clinical information. The validation of these equations and their implications is discussed. Parallels are drawn between the situation in theoretical physics a century ago and medical diagnostics today; and the central theme of uncertainty in both is emphasised. Finally, the need for further radical thinking is stressed.

Clinical Medicine↗
PubMed1996

Assigning value to clinical information--a major limiting factor in the implementation of decision-support systems.

This paper deals with a major difficulty and potential limiting factor in present-day decision support-that of assigning precise value to an item (or group of items) of clinical information. Historical determinist descriptive thinking has been challenged by current concepts of uncertainty and probability, but neither view is adequate. Four equations are proposed outlining factors which affect the value of clinical information, which explain some previously puzzling observations concerning decision support. It is suggested that without accommodation of these concepts, computer-aided decision support cannot progress further, but if they can be accommodated in future programs, the implications may be profound.

Decision Support Techniques↗
PubMed1995

[Diagnostic score for acute appendicitis].

Scoring systems seem to be ideal for supporting diagnosis of acute appendicitis because they are non invasive, require no special equipment and can be used in clinical routine. Several scores for appendicitis have been developed with good results in the original publications. Unfortunately these good results could not be reproduced on a German data base. Therefore we developed a new score using multivariate statistics and a quality controlled prospective data base. The score covers 8 variables: tenderness, rebound tenderness, micturition, type of pain, leucocytes, age, relocation of pain, rigidity. Independent evaluation of the score on a Dutch database resulted in a negative appendicectomy rate of 21% and a missing appendicitis rate of 2%. The results are encouraging, so that further testing and clinical application can be recommended.

Acute Disease↗
PubMed1994

Quality assurance in gastroenterology: the Telegastro project.

The goal of this Telegastro project is to improve standards of care in gastroenterology by establishing and circulating a 'consensus' view of several aspects of 'good practice' in specific areas of gastroenterology. The background for the study is described, followed by the detailed goals of the project and the modus operandi designed to achieve these goals. Finally, the problems of implementing such a package are discussed along with progress in the first 18 months and schedules for future activities.

Computer Communication Networks↗
PubMed1994

Acute abdominal pain in the elderly.

In this article, I review the diagnosis and immediate prognosis of acute abdominal pain in elderly patients. I draw on published work and on three major series of patients, one collected since 1976 by the World Organization of Gastroenterology (OMGE) Research Committee, one by the 1986 United Kingdom National Study of Human and Computer-Aided Diagnosis, and one by the European Community 1993 Concerted Action on Acute Abdominal Pain. These series include approximately 42,000 patients. Acute abdominal pain in the elderly patient presents a significant and challenging problem. Diagnostic accuracy is lower, and mortality far higher, than in younger patients. Reasons for these differences are multifactorial: the case mix is different, the evolution and prognosis of specific diseases are different, and the ways in which diseases present are also different in elderly patients. It is not difficult therefore to understand why serious problems in management occur. I conclude by discussing implications of existing studies and the literature that--if implemented--should significantly improve both management resource utilization and patient outcome.

Abdomen, Acute↗
PubMed1993

The hit and miss of ISS and TRISS. Yorkshire Trauma Audit Group.

OBJECTIVE: To measure interobserver variation in recording injury from case notes and its effect on calculating injury severity scores (ISS) from identical data and predicting probabilities of survival by using the combined trauma and injury severity score (TRISS). DESIGN: Observer variation study using injury severity scoring and subsequent calculation of probability of survival based on combined trauma and injury severity scores. SUBJECTS: 16 patients with a range of injury severity scores, and 15 observers. RESULTS: There was a wide variation in recorded injury severity scores, the probability of two observers agreeing on the score being 0.28 (28%). The probability of any two observers agreeing over which severity band the patient should be in was 0.5 (50%). Observer variation was independent of the training and type of observer. Survival probability (calculated by combined trauma and injury severity scoring methodology from individual observers' scores) varied by over 0.2 in six of the 16 patients and by over 0.5 in three. CONCLUSIONS: There is wide observer variation in injury severity scoring, which highlights a potential fallibility in its use for trauma audit. The use of combined trauma and injury severity scoring for individual prediction of survival is potentially inaccurate except at the extremes of probabilities. The use of the 0.5 survival line on a combined trauma and injury severity score "pre-chart" is statistically and clinically inappropriate.

Emergency Service, Hospital↗
PubMed1992

Collecting, communicating and using information: the educational issues. A report from the Royal College of Physicians Committee on Medical Information Technology.

Few of the major advances in information science and technology have yet been successfully introduced in health care. Their implementation could improve both quality of care and the working environment of clinicians, but this will not be achieved by investing in hardware and software alone. Investment in education is also required.

Attitude to Computers↗
PubMed1991

Can computer aided teaching packages improve clinical care in patients with acute abdominal pain?

OBJECTIVE: To compare three methods of support for inexperienced staff in their diagnosis and management of patients with acute abdominal pain--namely, with (a) structured data collection forms, (b) real time computer aided decision support, and (c) computer based teaching packages. DESIGN: Prospective assessment of effects of methods of support on groups of doctors in one urban hospital and one rural hospital. SETTING: Accident and emergency department at Whipps Cross Hospital, London, and surgical wards of Airedale General Hospital, West Yorkshire. PATIENTS: Consecutive prospective series of all patients presenting to each hospital in specified time periods with acute abdominal pain; total patients in the various periods were 12,506. MAIN OUTCOME MEASURES: Diagnostic accuracy of participating doctors, admission rates of patients with non-specific abdominal pain, perforation rates in patients with appendicitis, negative laparotomy rates. RESULTS: Use of any one modality resulted in improved diagnostic accuracy and decision making performance. Use of structured forms plus computer feedback resulted in better performance than use of forms alone. Use of structured forms plus a computer teaching package gave results at least as good as those with direct feedback by computer. CONCLUSIONS: The results confirm earlier studies in suggesting that the use of computer aided decision support improves diagnostic and decision making performance when dealing with patients suffering from acute abdominal pain. That use of the computer for teaching gave results at least as good as with its use for direct feedback may be highly relevant for those who are apprehensive about the real time use of diagnostic computers in a clinical setting.

Abdominal Pain↗
PubMed1990

The British Society of Gastroenterology early gastric cancer/dysplasia survey: an interim report.

This presentation describes interim findings in a series of 319 patients referred from 41 hospitals on the basis of histopathological findings of 'early gastric cancer', 'dysplasia', or 'worrying mucosal appearances'. Data were recorded using a predefined proforma, and histopathological material circulated amongst a 'panel' of three further pathologists. After this process, 132 patients were classified as having early gastric cancer and 63 as dysplasia. There was good agreement between pathologists as to whether the cases had cancer or dysplasia - but 39 cases said by referring pathologists to have early gastric cancer were classified by the panel as having more extensive disease. Most early gastric cancer cases were diagnosed only after histopathological examination. Cancer or 'possible cancer' was only mentioned after 36% of the radiological investigations and 40.5% of the endoscopies. Computer aided analysis of the patients' symptoms placed 91.3% of the early gastric cancer cases into a 'high risk' group - but was unable to distinguish between early gastric cancer and dysplasia. The five year survival rate of the cases agreed to be early gastric cancer by the panel was well over 90%, but the four year survival rate of cases registered as 'early gastric cancer' but said by the panel to have more advanced disease was under 75%. These findings may account for some of the differences between series, and emphasise the need for precise, widely agreed criteria for the diagnosis of early gastric cancer and gastric dysplasia.

Follow-Up Studies↗