Effects of feedback of information on clinical practice: a review.

OBJECTIVE--To establish what is known about the role of feedback of statistical information in changing clinical practice. DESIGN--Review of 36 studies of interventions entailing the use of statistical information for audit or practice review, which used a formal research design. SUBJECTS--Papers identified from computer searches of medical and health service management publications, of which 36 describing studies of interventions designed to influence clinical care and including information feedback from clinical or administrative data systems were reviewed. MAIN OUTCOME MEASURES--Evidence for effect of information feedback on change in clinical practice. RESULTS--Information feedback was most likely to influence clinical practice if it was part of strategy to target decision makers who had already agreed to review their practice. A more direct effect was discernable if the information was presented close to the time of decision making. The questions of the optimum layout and quantity of information were not addressed; the 36 papers were insufficient for defining good formats for information to be used for audit or quality assurance. CONCLUSIONS--Given the cost of information processing and the current emphasis on closing the audit loop in the health services, it is important that the use of information in the audit process should be critically evaluated.     

A review of general practice reports: the need for standardisation.

Fifty general practice annual reports were reviewed with a checklist to determine how much information was commonly included and whether they described the patients, the practice, and practice activity. The reports varied widely: important information was sometimes missing, practice activity was measured in different ways, and terms were often not defined. About half the reports reviewed did not draw conclusions or suggest plans for the future. Annual reports should include comparable basic information about patients, the practice, and the practice activity to optimise their usefulness in evaluation, planning, and decision making. Many relevant data are available from family practitioner committees and district health authorities.     

An Experiment on Prediction Markets in Science

Prediction markets are powerful forecasting tools. They have the potential to aggregate private information, to generate and disseminate a consensus among the market participants, and to provide incentives for information acquisition. These market functionalities can be very valuable for scientific research. Here, we report an experiment that examines the compatibility of prediction markets with the current practice of scientific publication. We investigated three settings. In the first setting, different pieces of information were disclosed to the public during the experiment. In the second setting, participants received private information. In the third setting, each piece of information was private at first, but was subsequently disclosed to the public. An automated, subsidizing market maker provided additional incentives for trading and mitigated liquidity problems. We find that the third setting combines the advantages of the first and second settings. Market performance was as good as in the setting with public information, and better than in the setting with private information. In contrast to the first setting, participants could benefit from information advantages. Thus the publication of information does not detract from the functionality of prediction markets. We conclude that for integrating prediction markets into the practice of scientific research it is of advantage to use subsidizing market makers, and to keep markets aligned with current publication practice.     

Obtaining useful information from expert based sources.

Clinicians rely heavily on expert based systems-consultation with colleagues, journal reviews and textbooks, and continuing education activities-to obtain new information. The usefulness of sources such as these depends on the relevance and validity of the information and the work it takes to obtain it. Useful information can be distinguished from the useless by asking three questions: Does the information focus on an outcome that my patients care about? Is the issue common to my practice, and is the intervention feasible? If the information is true, will it require me to change my practice? If the answer to all three questions is yes, then the information is a common POEM (patient oriented evidence that matters), capable of improving the lives of your patients and must be evaluated for validity. Conclusions based on results of well designed clinical trials are more likely to be valid than those drawn from observations based on experience in clinical practice. Both members of the team, clinicians and experts, must take responsibility for their respective roles.     

Characterization of Information-Based Learning Benefits with Submovement Dynamics and Muscular Rhythmicity

For skill advancement, motor variability must be optimized based on target information during practice sessions. This study investigated structural changes in kinematic variability by characterizing submovement dynamics and muscular oscillations after practice with visuomotor tracking under different target conditions. Thirty-six participants were randomly assigned to one of three groups (simple, complex, and random). Each group practiced tracking visual targets with trajectories of varying complexity. The velocity trajectory of tracking was decomposed into 1) a primary contraction spectrally identical to the target rate and 2) an intermittent submovement profile. The learning benefits and submovement dynamics were conditional upon experimental manipulation of the target information. Only the simple and complex groups improved their skills with practice. The size of the submovements was most greatly reduced by practice with the least target information (simple > complex > random). Submovement complexity changed in parallel with learning benefits, with the most remarkable increase in practice under a moderate amount of target information (complex > simple > random). In the simple and complex protocols, skill improvements were associated with a significant decline in alpha (8–12 Hz) muscular oscillation but a potentiation of gamma (35–50 Hz) muscular oscillation. However, the random group showed no significant change in tracking skill or submovement dynamics, except that alpha muscular oscillation was reduced. In conclusion, submovement and gamma muscular oscillation are biological markers of learning benefits. Effective learning with an appropriate amount of target information reduces the size of submovements. In accordance with the challenge point hypothesis, changes in submovement complexity in response to target information had an inverted-U function, pertaining to an abundant trajectory-tuning strategy with target exactness.     

Computerization of family practice.

The primary focus of computer systems for family practice is on patient billing. Primary care physicians should be aware of the many other benefits that can and should be considered when planning a system for their practice. This article describes the type and extent of information that can be stored in a family practice data base and explores some of the applications in areas of practice and patient management, prevention and research.     

Mapping practice population and morbidity with a computer.

A method of dividing a map of the practice area into a grid based on postcode locations is described. The distribution of the practice population may thus be shown graphically and trends observed. The geographical incidence and prevalence of morbidity may also be charted and variations of statistical significance determined. This is a practical tool that will have greater potential as information technology in general practice develops.     

When Less Is More: Reduced Usefulness Training for the Learning of Anticipation Skill in Tennis

Participants in this study practiced with feedback to anticipate the left-right direction of forehand tennis shots played by stick-figure players. A technique based on principal component analysis was used to remove dynamical differences that are associated with shots to different directions. Different body regions of the stick-figure players were neutralized with this procedure in the pretests and posttests, and in the practice phases. Experiment 1 showed that training is effective if during practice information is consistently present in the whole body of the player, but not if the information is neutralized in the whole body in half of the practice trials. Experiment 2 showed that training is effective if the variance associated with the direction of the shots is consistently present in one body region but neutralized in others, and that transfer occurs from practice with information in one body region to performance in conditions with information preserved only in other regions. Experiment 3 showed that occlusion has a much larger detrimental effect on learning than the applied neutralization technique, and that transfer between body regions occurs also with occlusion. Discussed are theoretical implications for understanding how biological motion is perceived and possible applications in a type of training referred to as reduced usefulness training.     

Gazetteer of General Practices in the Aylesbury Area

One reason for defects in communication between hospitals and general practitioners may be that hospital staff lack information about local practices. We compiled a handbook giving information about 55 (86%) of the practices which use the district general hospital group in Aylesbury. This included biographical details about each doctor in each practice, when he was available on the telephone, what ancillary staff worked in the practice, and so on. The handbook was given to 500 staff in all grades and departments in the group. It seems to have been effective in improving communications, relationships, and morale within the area.     

图书馆开展大学生信息素养教育的优势与途径

论述了对大学生进行信息素养教育的意义,阐明了图书馆在开展大学生信息素养教育过程中起到的优势作用,提出了利用图书馆进行大学生信息素养教育的6种途径。     

关于在神经外科实习教学中采用Web-CPBL教学模式的探讨

在医学生临床实习带教过程中,神经外科实习教学由于其教学内容具有专业性强、信息量大、知识更新快的特点,与其它专业相比更具难度,教学效果往往难达到预期水平。Web-CPBL教学模式,是将传统的PBL教学理念与网络信息技术有机融合,延伸和发展出的一种新型教学模式。在神经外科实习教学中,巧妙得当的借力于网络资源平台,有助于打破临床师资缺乏、实操场地不足的局限,能更充分的发挥PBL教学的优势。此模式在培养和锻炼医学生临床思维能力的同时,也帮助他们尽早养成主动学习、善于协作、乐于共享的良好学习习惯,提高其医学人文素养。     

Investigating mental health risk assessment in primary care and the potential role of a structured decision support tool,GRiST

Aim To explore current risk assessment processes in general practice and Improving Access to Psychological Therapies (IAPT) services, and to consider whether the Galatean Risk and Safety Tool (GRiST) can help support improved patient care.Background Much has been written about risk assessment practice in secondary mental health care, but little is known about how it is undertaken at the beginning of patients'' care pathways, within general practice and IAPT services.Methods Interviews with eight general practice and eight IAPT clinicians from two primary care trusts in the West Midlands, UK, and eight service users from the same region. Interviews explored current practice and participants'' views and experiences of mental health risk assessment. Two focus groups were also carried out, one with general practice and one with IAPT clinicians, to review interview findings and to elicit views about GRiST from a demonstration of its functionality. Data were analysed using thematic analysis.Findings Variable approaches to mental health risk assessment were observed. Clinicians were anxious that important risk information was being missed, and risk communication was undermined. Patients felt uninvolved in the process, and both clinicians and patients expressed anxiety about risk assessment skills. Clinicians were positive about the potential for GRiST to provide solutions to these problems.Conclusions A more structured and systematic approach to risk assessment in general practice and IAPT services is needed, to ensure important risk information is captured and communicated across the care pathway. GRiST has the functionality to support this aspect of practice.     

Assessment of bone architecture with ultrasonometry: experimental and clinical experience

Over the last decade, ultrasound technology has been introduced as a method of analysing bone tissue in clinical practice, and several studies have compared various ultrasound devices with dual-energy X-ray absorptiometry (DXA). Unlike DXA, the ultrasound technique is not limited to the measurement of bone density - it also has the potential to provide information on the mechanical and architectural characteristics of bone. The first generation of ultrasound devices used the speed of sound and attenuation of the ultrasound signal to obtain information on bone mineral content. Second generation ultrasound devices, which analyse the ultrasound signal received, permit the study of bone structure and elasticity, in addition to its mineral content, in both experimental studies and clinical practice. This is accomplished by signal processing analysis, the study of backscattering and the application of Biot's theory. This approach to the study of bone tissue represents the future for the development of ultrasound technology for use in clinical practice.     

Novel role for specialist nurses in managing diabetes in the community.

To develop care of diabetes further a specialist nurse established contact with general practices in Sheffield Health District and identified difficulties in providing a service for diabetics. One hundred and thirty practices were visited, and full data were collected from 104. Each practice agreed to establish a register of diabetics, and information and support were subsequently provided to help in developing services. In collecting information from each practice the nurse covered specific points on staff, facilities, and organisation. Over two years the service offered in 60 practices considerably improved, allowing a minimum standard of diabetic care to be achieved. This allowed coordinated and effective referral of certain patients from hospital diabetic clinics and improved services to those not attending any clinics.     

Are general practitioners prepared to share information about their patients and their work?

A questionnaire survey of the 44 general practices in Central Nottinghamshire Health District elicited 43 responses. Ten scenarios on sharing information were graded on a five point scale by each practice according to its willingness to share the information. Responses varied from 41 practices that would at least “probably” give the number of their young chronic sick patients to the local district health authority to 17 practices that were positive towards sharing with a local charity the names of elderly patients living alone. This second example raises profound issues of confidentiality. The extent to which practices were prepared theoretically to share practice generated information with outside bodies was generally high and showed a willingness to do so if the reasons were sound and the requesting body was acceptable.     

DNA probes and automation.

Current methods for DNA probe analysis in principle provide access to the total genetic information of any organism and permit applications in health care, for example. In practice, however, greatly improved efficiency of methods for decoding genetic information is required for both research and routine applications. This review describes recent progress towards automated DNA probe assays.     

Information scanning – keeping in touch with best practice in breastfeeding

This paper describes some of the methods practitioners can use to scan sources for up-to-date information about best practice in breastfeeding.