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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
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↗
PubMed1990

Twelve years' experience of computer-aided diagnosis in a district general hospital.

This paper describes experience in a modern district general hospital with a small desktop system for computer-aided diagnosis of acute abdominal pain, over a 12-year period involving 5512 cases. When compared with a baseline year (1973) in which unaided performance was monitored, during an initial study period (1974-76) the diagnostic accuracy of junior staff rose by between 10 and 15%. This higher performance level was then maintained for a decade (1976-86) despite changes in staff. The perforation rate among appendicitis cases fell from 27% to 12.5%, accompanied by a smaller fall in negative laparotomy rates. The saving in surgical bednights devoted to acute abdominal pain was approximately 15%, and the notional cost of resources saved during the first 6 years of operation was 120,000 pounds. Other hospitals have shown--in the short term--benefits similar to those obtained at Airedale District General Hospital. The long-term benefits of the system at Airedale reinforce the conclusions of the earlier short-term trials that a comparable system should probably be offered to all DGHs in the UK, not as an exercise in 'artificial intelligence' but as an effective continuing stimulus to good clinical practice.

Abdominal Pain↗
PubMed1989

Computer-aided decision support in clinical medicine.

This paper reviews the problems and prospects involved in providing computer-aided decision support in clinical medicine. First, the evaluation of medical innovation is discussed. It is suggested that there are three criteria by which an innovation may be judged, namely (1) a need for the innovation, (2) the ability of the innovation to fulfil that need and (3) the ability to do so without transgressing practical, ethical or legal boundaries. These problems are addressed in turn. The paper suggests, taking one area of clinical medicine as an example (acute abdominal pain) there is a clear need for decision support--since the area is not handled well by doctors in current practice. Evidence is adduced to suggest that the computer can provide decision support and do so without transgressing professional, ethical or legal boundaries. The obstacles to progress, which stand in the way of widespread implementation are briefly discussed. These are lack of medical terminology, poor man-machine interface and above all a lack of co-ordination. Finally, it is suggested that the most valuable facet of current systems is the discipline and precision in data collection they impose upon practicing doctors.

Attitude to Computers↗
PubMed1989

Acute abdominal pain and appendicitis in north east Thailand.

In a survey of emergency admissions to hospital in rural Thailand, acute appendicitis was the commonest cause of acute abdominal pain. Estimates of the incidence of appendicitis, in two series comprising a total of 356 patients, at 3.2 and 3.7 per 10,000 population per year, were relatively high compared with reports from other warm climate countries. In comparison with 1825 cases in studies sponsored by the Organisation Mondiale de Gastroenterologie (OMGE), Thai patients with acute appendicitis were older, presented late and experienced more complications than those in 14 other countries. In Khon Kaen only 2-3% of the cases were children aged 0-9 years, compared with 9-26% in the OMGE series. In patients admitted to hospital with acute abdominal pain in Thailand, acute appendicitis was diagnosed more often than non-specific abdominal pain. The converse was true in the OMGE series. This may reflect the longer distances travelled to hospital by many patients and delays between onset of symptoms and admission to hospital. Acute appendicitis was the commonest definitive diagnosis in both series. This survey indicates that relatively high rates of acute appendicitis may occur in populations eating traditional diets. The results are consistent with the recently described hypothesis of an infective aetiology and increases in appendicitis rates may be expected in people born since the introduction of improvements in environmental sanitation. Further studies are needed to examine trends in the incidence of appendicitis in populations eating traditional diets with both high and low fibre content and to investigate the significance of changing social and environmental factors.

Abdomen, Acute↗
PubMed1988

Retrospective study of 1000 deaths from injury in England and Wales.

One thousand consecutive deaths from injury in 11 coroner's districts in England and Wales were reviewed by four independent assessors, who studied necropsy reports to identify deaths in hospital that might have been preventable. Of 514 patients admitted to hospital alive, 102 deaths (20%) were judged by all four assessors to have been potentially preventable. When those cases in which three out of four assessors considered that the death was preventable were added the total rose to 170 (33%). Nearly two thirds of all non-central nervous system deaths were judged to have been preventable. The median age of the 170 patients whose deaths were preventable was 41, and the mean Injury Severity Score was 29. Further analysis suggested that the preventable deaths were principally the result of failure to stop bleeding and prevent hypoxia and the absence of, or delay in, surgical treatment. The results closely parallel those from similar studies from the United States and suggest that there are serious deficiencies in the services for managing severe injury in England and Wales. Debate is needed now on how to correct these deficiencies. In particular, the place of trauma centres must be considered.

Adolescent↗
PubMed1988

The OMGE acute abdominal pain survey. Progress report, 1986.

By 1986 the central analysis team of this on-going multinational survey had received a total of 10,682 cases for analysis and had accepted 10,320. In all, some 26 centres in 17 countries, involving over 200 doctors, had participated in this survey. A common protocol was used for data collection; around 98% of all possible data was recorded (using precirculated definitions) and analysed via a computer-aided system in Leeds, England. The construction and format of a series of computer-aided decision-support and teaching programs has been described in an earlier (1982) report. These programs are currently available/in use in 10 countries. The present report concentrates upon an update of current material collated for the survey, some demographic trends, and special subreports (as with IBD survey) concerning acute abdominal pain in children and elderly patients, together with some preliminary data on the value of leucocyte count in patients with suspected appendicitis.

Abdomen, Acute↗
PubMed1988

Acute abdominal pain in children.

This preliminary communication describes the initial results of a further special study investigating the disease spectrum and clinical presentation in a total of 1080 children admitted to hospital with acute abdominal pain (677 from the Children's Hospital, Sheffield, England, and the remaining 403 from hospitals in Paris, Oslo, Copenhagen, and Deventer). The disease spectrum in children differs radically from that in adults, well over 90% of cases being due to either acute appendicitis or non-specific abdominal pain (NSAP). The clinical presentation of both appendicitis and NSAP was found to differ from that in older age groups. These findings imply clearly that the use of the existing OMGE database for computer-aided diagnosis--using data drawn from cases of all ages--may not be optimal in children. A fresh database (using only children's data) was therefore created and tested. Its sensitivity for appendicitis was equivalent to that of inexperienced clinicians (79.6% versus 77.3%). The computer's specificity (over 70%) was higher than that of clinicians (52.7%). The findings also re-emphasise the value of disciplined data collection, and the implications for teaching are discussed.

Abdomen, Acute↗
PubMed1988

Do the stigmata of recent haemorrhage have additional prognostic value in patients with bleeding duodenal ulcer?

To assess the additional prognostic value of endoscopic stigmata of recent haemorrhage (SRH) in addition to clinical data, a pilot study was conducted on 207 duodenal ulcer patients from the OMGE survey. The incidence of SRH was compared in 145 patients who settled and 62 who re-bled. Only active bleeding emerged as significantly commoner in the latter group. Two computer-assisted predictions of further bleeding (before and after addition of the stigmata to a clinical database) were compared with the final outcome. Little improvement, in terms of prognosis for further bleeding, was obtained when SRH data were added. Similar findings were observed in a smaller series from Marburg, FRG.

Diagnosis, Computer-Assisted↗