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Biomedical subjects

F T De Dombal

Publications and source records attributed to F T De Dombal.

At least 19 recordsLinked to original sources
PubMed1996

The endoscopic assessment of esophagitis: a progress report on observer agreement.

BACKGROUND & AIMS: The study and management of reflux esophagitis require an endoscopic classification system founded on esophageal lesions that can be reproducibly identified. The aim of this study was to investigate interobserver agreement for the identification of endoscopic lesions typical of reflux esophagitis. METHODS: Paired comparisons of observers' descriptions were obtained. Seventeen endoscopists assessed 100 still images, and 42 endoscopists, including 13 endoscopists in training, assessed 23 endoscopic video recordings. In a third, ancillary study, using a simpler evaluation sheet, 219 gastroenterologists recorded their assessments of 20 still images. RESULTS: The agreement between endoscopists was similar for still images and video recordings. Agreement between experienced endoscopists was acceptable to good for recognition of minimal changes (erythema, friability, mucosal edema; kappa = 0.46 to kappa = 0.8), mucosal breaks (discretely, demarcated areas of slough or erythema; kappa = 0.84), and complications (ulceration, kappa = 0.92; stricturing, kappa = 0.80; columnar metaplasia, kappa = 0.81), although there was poor agreement when the circumferential extent and number of mucosal breaks were assessed. However, total circumferential extent of the mucosal break had a kappa value of 0.59. Agreement between inexperienced endoscopists was poor for recognition of minimal changes but was good for recognition of complications (kappa, 0.70-0.90). CONCLUSIONS: Endoscopists can identify mucosal breaks confined to a mucosal fold and lesions that extend throughout the esophageal circumference. Complications of reflux disease can be reproducibly recorded. Criteria for assessing the number of mucosal breaks and their radial extent must be defined more clearly, as must the features of minimal change esophagitis.

Esophagitis↗
PubMed1991

The diagnosis of acute abdominal pain with computer assistance: worldwide perspective.

This presentation describes the use of computer aided decision support in acute abdominal pain. The development of such support and the feasability of providing it are described with reference to worldwide studies involving nearly 100,000 patients in the UK, the European Community and worldwide. This presentation will give an overview of the experienced gained in these and other studies. As a result of this experience, it will be suggested: a) The diagnosis of acute abdominal pain by inexperienced emergency surgeons remains a difficult problem. 2) Doctors who have been assisted by a computer have, in many instances, improved their diagnostic and decision-making performance. 3) This improvement has not been due to superior "artificial intelligence" of the computer--but due to the computer acting as an educational focus and a stimulus to good clinical practice. 4) On an international level, these studies have been immensely valuable. They have helped bring together different national groups and helped to develop common medical terminology--as well as foster collaborative "spin-off" in terms of research around the world.

Abdomen, Acute↗
PubMed1990

Computer-aided decision support in acute abdominal pain, with special reference to the EC concerted action.

This presentation describes the use of computer aided decision support in acute abdominal pain. The need for such support is explored and the feasability of providing support is described with reference to studies involving nearly 100,000 patients. It is argued that the provision of computer aided decision support can lead to substantial and practical benefit in clinical care--but this is mostly due to the constant stimulus towards "doing it right". This in turn depends upon the provision of a consensus view of "good medicine" in the area concerned; and on an international level strongly argues the case for multi-national cooperative studies to define good medicine and make it available. One such study (the European Community Concerted Action on Acute Abdominal Pain) is described.

Abdominal Pain↗
PubMed1990

Computer-aided decision support--glittering prospects, practical problems, and Pandora's box.

This chapter explores some of the prospects for and problems of computer-aided decision support in clinical medicine, with special reference to acute abdominal pain of both surgical and gynaecological origin. The need for such systems is argued, and it is further demonstrated that their provision is both feasible and (where implemented) associated with tangible improvements in performance by inexperienced hospital doctors. The problems of implementation are nevertheless formidable and these are discussed.

Attitude to Computers↗
PubMed1985

Can preliminary screening of dyspeptic patients allow more effective use of investigational techniques?

A total of 1041 patients with undiagnosed dyspepsia were interviewed to determine whether they required investigation for organic disease. The interviewer, a research assistant without medical qualifications, used a standard data sheet. The information obtained was analysed by computer, and, according to the results, patients were predicted to be at high, medium, or low risk. They were then followed up and the final diagnosis was compared with the risk predicted by computer. Patients predicted to be at low risk had a 10% chance of having ulcer disease and a 0.3% chance of having cancer, whereas patients predicted to be at high risk had a 20% chance of having ulcer disease and a 10% chance of having cancer. Appropriate preliminary screening of patients with acute dyspepsia can separate a group at low risk who will require investigation only if their symptoms do not resolve and a group at high risk requiring urgent outpatient consultation.

Duodenal Ulcer↗
PubMed1978

Clinical presentation of patients with "dyspepsia". Detailed symptomatic study of 360 patients.

This paper describes the clinical presentation of 360 patients suffering from "dyspepsia" at the time of their initial visit to two hospitals in Yorkshire. Disease categories studied were cholecystitis, duodenal ulcer, gastric ulcer, gastric cancer, and "functional" dyspepsia, with at least 50 patients in each category. The findings of this series are contrasted with "textbook" descriptions of these conditions. Some contrasts are quite surprising-for example, most of the 360 patients claimed that their pain was not aggravated by food. It is suggested that one reason for diagnostic error in this area of medicine is that clinicians have a faulty mental "database" of information with regard to the presentation of the various diseases concerned.

Adult↗
PubMed1977

Diagnosis of acute abdominal pain in the accident and emergency department.

This paper reports the findings in a study involving 1537 patients with 'acute abdominal pain' presenting over a 13-month period to the Accident and Emergency Department of the General Infirmary at Leeds. Of these, 341 patients who proved to have pain of greater duration than a week, pain incidental to some other identifiable condition or no pain at the time of their attendance were excluded. The remaining 1196 were diagnosed clinically (using a structured case sheet) and subsequently by a Bayesian computer system. Feedback of the results of clinical and computer systems was given to clinicians at regular intervals. Clinical diagnostic accuracy in patients with surgical disorders rose from 40 per cent before the study to 61 per cent. Computer accuracy in these patients was 69-9 per cent. The proportion of patients sent home without ill effects rose from 20 per cent to 39 per cent. In other areas (e.g. gynaecology) the effects were less marked. It is suggested that the introduction of a simple postgraduate educational service, aided by a small computer, might prove of practical benefit in this clinical situation.

Abdomen, Acute↗
PubMed1977

Computer-aided diagnosis of lower abdominal pain in women.

This paper describes the use of a system of computer aided diagnosis in an unselected, prospective survey of 393 women suffering from lower abdominal pain of less than 1 week's duration. An accurate diagnosis was made by clinicians at first patient contact in 68-5 per cent of the group of patients. The computer's diagnostic prediction (based on the same data) matched the final diagnosis in 81-6 per cent of the patients. During this survey a marked improvement in diagnostic accuracy was observed amongst the junior clinicians. It is suggested that this is because of the discipline of data collection imposed and the intermittent feedback received, and also that this educational aspect of computer usage may be of wider benefit.

Abdomen↗
PubMed1976

Transfer of computer-aided diagnosis of dyspepsia from one geographical area to another.

This paper reports a comparison in Airedale District General Hospital between computer-aided diagnosis of dyspepsia and endoscopy in a prospective unselected series of 165 patients. Patients were interviewed immediately before endoscopy and the findings analysed by a small desk-top computer-aided system. Each 'new' patient was compared by the computer with a group of 360 similar patients from Leeds (25 miles away). Overall, 83% of the positive lesions found at endoscopy were correctly predicted by the computer, including all but three of the 22 cases of gastric cancer. It is suggested (1) that there is little loss of accuracy in transferring the computer-aided system from one locality to another; and (2) that a computer-aided analysis of the patient interview may be of value in selecting 'high-risk' patients for intensive investigation.

Diagnosis, Computer-Assisted↗
PubMed1975

Histories obtained by two-stage questionnaire with automated transcript in specialist gynaecological practice.

A two-stage questionnaire which the patient completes at home has been developed for use by gynaecological outpatients. The first stage (root) identifies the patient's problem and obtains general background information. The second stage (branch) deals with the presenting problem in depth. The system has proved highly acceptable to patients. At the clinic a non-medical assistant uses a programmed typewriter to transcribe the data into a typewritten history which is handed to the doctor before he examines the patient. The transcript compares favourably with the conventional hand-written history in content, ease of assimilation, and cost. While the questionnaire itself is an excellent means of collecting information it becomes an efficient means of transmitting information to the clinician only when combined with the transcript facility. There is no storage of confidential information and no scope for unethical disclosure.

Adolescent↗
PubMed1975

Diagnosis of dyspepsia from data collected by a physician's assistant.

This paper presents a study of the diagnosis of "dyspepsia" in 154 patients based on data collected at their initial outpatient attendance via an interview with a non-medically qualified physician's assistant. The reactions of patients to this type of interview were favourable, and the data recorded were as reliable as those recorded by clinicians. We conclude (1) that the data recorded by the physician's assistant are valuable diagnostically; (2) where these cannot be collected by a qualified physician, this task may be delegated to a non-medically qualified person; but (3) this interview should augment and not replace the traditional clinical interview.

Diagnosis, Computer-Assisted↗
PubMed1975

Simplified computer-aided diagnosis of acute abdominal pain.

A simplified version of a system for computer-aided diagnosis of acute abdominal pain has been tested by "new" personnel unfamiliar with the previous system. After a two-month learning period the system proved more accurate in its diagnoses than the unaided clinician, and during the first five months of using the system the unaided clinicians' accuracy rose from 73% to 84%. When computer "feedback" was withdrawn the clinicians' diagnostic accuracy reverted towards the previous, "unaided" level. These findings further validate the concept of the computer as a potentially valuable diagnostic aid but indicate that a training period and computer feedback are important factors in its 4 use.

Abdomen, Acute↗
PubMed1975

A controlled clinical trial of three methods of closure of laparotomy wounds.

A controlled clinical trial was conducted of three methods of closing elective paramedian laparotomy wounds--catgut layer suture alone, catgut layer suture with tension sutures and wire sutures alone. Three hundred and twenty-four patients were entered in the trial. The combined incidence of wound dehiscence and subsequent incisional herniation in patients who did not manifest overt dehiscence in the immediate postoperative period was significantly higher after catgut layer suture alone (14 per cent) than after catgut layer suture with tension stitches (4-8 per cent) or wire sutures alone (0-9 per cent). There seemed to be more wound sespis and sinus formation associated with catgut layer suture and tension sutures than with either of the other methods of closure. In 4 patients a wire suture had to be extracted, because of sinus formation in 2 and on account of pain in 2.

Abdomen↗