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 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.

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.

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.

[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.

Observations on severity and activity indices in a therapeutic trial of active Crohn's disease.

: We describe the use of activity indices during a prospective trial of 91 patients with active Crohn's disease. Data were recorded by experienced physician investigators in four centres, and several activity indices were compared. The indices studied included modifications of the Crohn's Disease Activity Index (CDAI), the Dutch Activity Index, and the European Severity/Activity Index.

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.

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.

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.

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.

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.

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.