Biomedical subjects
Publications and source records attributed to G R Hollingworth.
The incidence of tuberculosis is increasing in many regions of Canada and the world. Accurate and current knowledge of screening and prevention is of utmost importance for family physicians caring for patients who might be at risk. This article presents guidelines on screening, skin testing, interpretation of results, and preventive therapy.
This randomized, controlled trial tests the efficacy of a computerized prompting system for test ordering. The system, makes use of the sensitivity, specificity, positive and negative predictive values of tests. It was tested using clinical vignettes in an academic family medicine center with first and second year residents. We found that there was a 38% decrease in the numbers of tests ordered (p < .01) and a 12% decrease in the costs of tests ordered by using the prompting system. We suggest that when used at the point of the patient encounter, this system has the potential for promoting more appropriate test ordering and for saving considerable health care dollars.
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We have developed a computerized prompting system for test ordering which we feel will decrease the cost of investigations and at the same time promote an evidence based learning approach to test ordering. Prompting systems have been shown to be cost-effective but suffer from many disadvantages in the family practice setting. They tend to be difficult to modify by the user and contingent on an inflexible rule based structure. Many suggestions are ignored implying that they are not relevant. In family practice most conditions are of low prevalence. Prompting for test ordering where the pre-test likelihood of disease is small will result in a large number of false positives and many unnecessary repeat or confirmatory investigations and attendant anxiety unless the prompting system is specifically designed to be used in a low prevalence environment. PROMPTOR-FM (PRObabilistic Method of Prompting for Test ORdering in Family Medicine) was developed to overcome these perceived difficulties. It allows the physician to rapidly calculate the positive and negative predictive values of a test being considered based on the clinical index of suspicion. The physician is able to repeat the calculations and compare the results with previous calculations. By using PROMPTOR-FM repetitively, the clinician can learn to balance the risk of "missing" a rare but serious condition against the risk of falsely identifying disease with its downstream hazards and costs of further investigation. Prompting for test ordering is therefore uniquely tailored to each patient's situation.
There are unique features of family and general practice which lead to unique issues in medical informatics for family physicians. The nature of practice in office based community settings and the discipline of dealing with all ages, sexes, and health conditions over the lifetime of a patient and his/her family lead to models of the thinking that are different from those used in most other specialties. Research is urgently needed to verify the models of thinking that physicians use during patient care encounters and the associated nomenclatures and classifications which support them. User interfaces need to be optimized for accuracy and speed. Standards for medical records computing in family practice need testing and validation.
Seventy seven patients with soft tissue shoulder lesions including adhesive capsulitis and disorders of the rotator cuff and acromioclavicular joint were admitted to a trial comparing two different methods of corticosteroid injection with local anaesthetic in a randomly allocated double blind study. The method of anatomical injection after diagnosis by the technique of selective tissue tension gave 60% success compared with the method using tender or trigger point localisation, giving 20% success (p less than 0.001).