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Biomedical subjects

J C Wyatt

Publications and source records attributed to J C Wyatt.

At least 19 recordsLinked to original sources
PubMed1998

Opportunities for and challenges of computerisation.

Information technology offers many potential advantages over paper for the storage and retrieval of patients' data. Enthusiasts predict that soon all records will be stored and viewed on computer, but others are more sceptical. The failure of some computer-based records may be due to poor information design. This paper explores how computers broaden the range of design options but points out that more attention to design is required for computer-based than for paper-based records.

Attitude to Computers↗
PubMed1998

How to limit clinical errors in interpretation of data.

We all assume that we can understand and correctly interpret what we read. However, interpretation is a collection of subtle processes that are easily influenced by poor presentation or wording of information. This article examines how evidence-based principles of information design can be applied to medical records to enhance clinical understanding and accuracy in interpretation of the detailed data that they contain.

Attention↗
PubMed1998

Helping clinicians to find data and avoid delays.

One major criticism of paper medical records is the time and effort required to find data items or to gain an overview. Computerisation does not necessarily help. To help clinicians find data faster and with less effort, everyone designing and writing in records needs to understand how and why we search records and the design features that make searching easier. This paper describes how clinicians search medical records and how to improve record design, whether on paper or computer, to help clinicians find all the data they need without delay.

Documentation↗
PubMed1998

Design should help use of patients' data.

Checklists and other tools help doctors to use published evidence in clinical practice. Two other important sources of evidence, however, are the patient and his or her medical record. This series aims to advance the practice of evidence-based medicine by helping in redesign of medical records, drawing on insights from psychology, information design, and medical informatics; and by promoting changes analogous to those occurring in the medical literature. The four papers look at: the uses of medical records and importance of organising them so doctors can use the data they contain; different methods doctors use to search for data and how design of records can help or hinder these approaches; how we interpret data once found, and how record formatting assists this process; and the issues raised by computerisation of records.

Evidence-Based Medicine↗
PubMed1998

The origin, content, and workload of e-mail consultations.

CONTEXT: Despite the common use of e-mail, little beyond anecdote or impressions has been published on patient-clinician e-mail consultation. OBJECTIVE: To report our experiences with free-of-charge e-mail consultations. DESIGN: Retrospective review of all e-mail consultation requests received between November 1, 1995, and June 31, 1998. SETTING AND PARTICIPANTS: Consecutive e-mail consultation requests sent to the Division of Pediatric Gastroenterology at the Children's Medical Center of the University of Virginia in Charlottesville. MAIN OUTCOME MEASURES: Number of consultation requests per month, time required to respond, who initiated the request and their geographic origin, and the kind of information requested in the consultation. RESULTS: During the 33-month period studied, we received 1239 requests, an average (SD) of 37.6 (15.9) each month. A total of 1001 consultation requests (81%) were initiated by parents, relatives, or guardians, 126 (10%) by physicians, and 112 (9%) by other health care professionals. Consultation requests were received from 39 states and 37 other countries. In 855 requests (69%), there was a specific question about the cause of a particular child's symptoms, diagnostic tests, and/or therapeutic interventions. In 112 (9%), the requester sought a second opinion about diagnosis or treatment for a particular child, and 272 consultations (22%) requested general information concerning a disorder, treatment, or medication without reference to a particular child. A total of 1078 requests (87%) were answered within 48 hours of the initial request. On average, reading and responding to each e-mail took slightly less than 4 minutes. CONCLUSION: E-mail provides a means for parents, guardians, and health care professionals to obtain patient and disease-specific information from selected medical consultants in a timely manner.

Communication↗
PubMed1998

Randomised trial of educational visits to enhance use of systematic reviews in 25 obstetric units.

OBJECTIVE: To evaluate the effectiveness of an educational visit to help obstetricians and midwives select and use evidence from a Cochrane database containing 600 systematic reviews. DESIGN: Randomised single blind controlled trial with obstetric units allocated to an educational visit or control group. SETTING: 25 of the 26 district general obstetric units in two former NHS regions. SUBJECTS: The senior obstetrician and midwife from each intervention unit participated in educational visits. Clinical practices of all staff were assessed in 4508 pregnancies. INTERVENTION: Single informal educational visit by a respected obstetrician including discussion of evidence based obstetrics, guidance on implementation, and donation of Cochrane database and other materials. MAIN OUTCOME MEASURES: Rates of perineal suturing with polyglycolic acid, ventouse delivery, prophylactic antibiotics in caesarean section, and steroids in preterm delivery, before and 9 months after visits, and concordance of guidelines with review evidence for same marker practices before and after visits. RESULTS: Rates varied greatly, but the overall baseline mean of 43% (986/2312) increased to 54% (1189/2196) 9 months later. Rates of ventouse delivery increased significantly in intervention units but not in control units; there was no difference between the two types of units in uptake of other practices. Pooling rates from all 25 units, use of antibiotics in caesarean section and use of polyglycolic acid sutures increased significantly over the period, but use of steroids in preterm delivery was unchanged. Labour ward guidelines seldom agreed with evidence at baseline; this hardly improved after visits. Educational visits cost pound860 each (at 1995 prices). CONCLUSIONS: There was considerable uptake of evidence into practice in both control and intervention units between 1994 and 1995. Our educational visits added little to this, despite the informal setting, targeting of senior staff from two disciplines, and donation of educational materials. Further work is needed to define cost effective methods to enhance the uptake of evidence from systematic reviews and to clarify leadership and roles of senior obstetric staff in implementing the evidence.

Costs and Cost Analysis↗
PubMed1995

Hospital information management: the need for clinical leadership.

On 12 July the Audit Commission published For Your Information, a well researched report about information and its management in acute hospitals in Britain, how and why it is failing, and steps that clinicians, managers, and the NHS should take to correct this. This article discusses why information management matters to clinicians and considers the problems identified by the Audit Commission--most of which will strike chords with doctors--and possible remedies. Finally, it describes possible routes to administer these remedies and the proposal, recently supported by the BMA Council, for a national centre for health informatics with the goals of educating and enthusing clinicians about informatics, empowering them to participate in local and national information management decisions; exploring how information can be used to improve patient care and outcomes; and evaluating clinical information systems and helping to realise their benefits.

Communication↗
PubMed1995

Uptake of meta-analytical overviews of effective care in English obstetric units.

OBJECTIVE: To establish the current availability of meta-analytical overviews of effective care in perinatal medicine, in the form of Effective Care in Pregnancy and Childbirth and the Oxford Database of Perinatal Trials, in English obstetric units and to find out how obstetricians without either one keep up to date. DESIGN: Standardised telephone questionnaire. SUBJECTS: The consultant obstetrician deemed to be the Royal College of Obstetricians and Gynaecologists' administrative contact in each of the 24 teaching hospitals, and in 74 of 173 (43%) district general hospitals in England. MAIN OUTCOME MEASURES: Knowledge and use of Effective Care and the Oxford Database in the obstetric unit. RESULTS: Thirty-seven percent of units did not have access to either Effective Care or the Oxford Database, with significant differences between district general hospitals and teaching hospitals in lack of availability (33/74 (45%) versus 3/24 (12%) respectively, P = 0.02). Effective Care was available in 51% of district general hospitals and 79% of teaching hospitals, compared with the availability of the Oxford Database which was only available in 16% and 62%, respectively. Reasons given for not obtaining either included non-awareness, expense, and perceived lack of need. The consultants with neither Effective Care nor the Oxford Database claimed to keep up to date by various methods, usually as information from colleagues. CONCLUSIONS: These results reflect both inefficient dissemination of medical knowledge in obstetrics and the reluctance of obstetricians to consider adapting their practice as a result of evidence from meta-analyses of randomised controlled trials. Although Effective Care is more widely available than the Oxford Database, its datedness renders it inferior to the database as a means of facilitating effective care in obstetrics.

Clinical Competence↗
PubMed1995

Formalisation of safety reasoning in protocols and hazard regulations.

Written protocols are often employed to guide patient care. For treatment within a clinical trial, compliance with the trial protocol may be critical in ensuring efficacy and safety. Previous empirical work has established generic safety principles for reasoning about adverse events in clinical trials and their formalisation has been applied in a decision support system for managing treatment plans in oncology. The same generic knowledge can be reused to generate specific safety clauses when designing new treatment plans. Typically, clinicians devise trial protocols relatively infrequently and so software aids, especially those assisting with regulatory/safety conformance, will encourage more effective use of their time. A similar approach to the formalisation of safety knowledge in the control of hazardous industrial processes is discussed.

Artificial Intelligence↗
PubMed1994

Development of Design-a-Trial, a knowledge-based critiquing system for authors of clinical trial protocols.

Many published clinical trials are poorly designed, suggesting that the protocol was incomplete, disorganised or contained errors. This fact, doctors' limited statistical skills and the shortage of medical statisticians, prompted us to develop a knowledge-based aid, Design-a-Trial, for authors of clinical trial protocols. This interviews a physician, prompts them with suitable design options, comments on the statistical rigour and feasibility of their proposed design and generates a 6-page draft protocol document. This paper outlines the process used to develop Design-a-Trial, presents preliminary evaluation results, and discusses lessons we learned which may apply to the developed of other medical decision-aids.

Clinical Trials as Topic↗
PubMed1994

Safety and decision support in oncology.

The management of patients with cancer involves the administration of complex treatment protocols with frequent monitoring of the effects of treatment on the malignant disease as well as on the general health of the patient. The number and wide variety of protocols used in treatment trials, and the amount of clinical data generated suggest the need for computer-based support. The toxicity of many of the treatments used and the severity of the disease itself underline the safety-critical nature of all decisions made by oncologists, the physicians and surgeons who treat cancer patients. This paper presents recent work on the analysis of safety issues arising from the design and implementation of a prototype decision-support system for oncologists. It illustrates the benefits of combining both informal and formal approaches to the analysis and representation of safety, firmly based on a thorough and detailed study of the domain in cooperation with oncologists, pharmacists and medical informaticians.

Antineoplastic Agents↗
PubMed1993

Design and evaluation of multimedia stimuli to evoke clinical concepts.

Continuous speech recognition systems have the potential to facilitate clinical data entry, but evaluating them rigorously is difficult. We describe a tool to aid evaluators of such systems. The tool is a HyperCard stack with stimuli consisting of pictures, sounds and the minimum of words to evoke 20 QMR physical findings. Despite using up to four different stimuli to communicate each finding and piloting the material on six subjects, eight test subjects made a total of 66 errors (42%) in interpreting the 20 sets of stimuli, of which 22 errors (14%) were serious. These results are relevant to those designing interfaces for decision-support, tutorial and student testing systems.

Computer Graphics↗