Ian W. Ricketts

Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial

Objectives To determine the effects of two computer based decision aids on decisional conflict and mode of delivery among pregnant women with a previous caesarean section. Design Randomised trial, conducted from May 2004 to August 2006. Setting Four maternity units in south west England, and Scotland. Participants 742 pregnant women with one previous lower segment caesarean section and delivery expected at ≥37 weeks. Non-English speakers were excluded. Interventions Usual care: standard care given by obstetric and midwifery staff. Information programme: women navigated through descriptions and probabilities of clinical outcomes for mother and baby associated with planned vaginal birth, elective caesarean section, and emergency caesarean section. Decision analysis: mode of delivery was recommended based on utility assessments performed by the woman combined with probabilities of clinical outcomes within a concealed decision tree. Both interventions were delivered via a laptop computer after brief instructions from a researcher. Main outcome measures Total score on decisional conflict scale, and mode of delivery. Results Women in the information programme (adjusted difference −6.2, 95% confidence interval −8.7 to −3.7) and the decision analysis (−4.0, −6.5 to −1.5) groups had reduced decisional conflict compared with women in the usual care group. The rate of vaginal birth was higher for women in the decision analysis group compared with the usual care group (37% v 30%, adjusted odds ratio 1.42, 0.94 to 2.14), but the rates were similar in the information programme and usual care groups. Conclusions Decision aids can help women who have had a previous caesarean section to decide on mode of delivery in a subsequent pregnancy. The decision analysis approach might substantially affect national rates of caesarean section. Trial Registration Current Controlled Trials ISRCTN84367722.

Lessons from a randomized controlled trial designed to evaluate computer decision support software to improve the management of asthma.

PRIMARY OBJECTIVE To investigate whether computer decision support software used in the management of patients with asthma improves clinical outcomes. RESEARCH DESIGN Randomized controlled trial with practices each reporting on 30 patients with asthma over a 6 month period. METHODS AND PROCEDURES 447 patients were randomly selected from practice asthma registers managed by 17 general practices from throughout the UK. Intervention practices used the software during consultations with these patients throughout the study while control practices did not. MAIN OUTCOMES AND RESULTS Practice consultations, acute exacerbations of asthma, hospital contacts, symptoms on assessment and medication use. A smaller proportion of patients within the intervention group initiated practice consultations for their asthma: 34 (22%) vs 111 (34%), odds ratio (OR) = 0.59, 95% confidence interval (CI) (0.37-0.95); and suffered acute asthma exacerbations: 12 (8%) vs 57 (17%), OR = 0.43, 95% CI = 0.21-0.85 six months after the introduction of the computer decision support software. There were no discernable differences in reported symptoms, maintenance prescribing or use of hospital services between the two groups. CONCLUSION The use of computer decision support software that implements guidelines during patient consultations may improve clinical outcomes for patients with asthma.Primary objective : To investigate whether computer decision support software used in the management of patients with asthma improves clinical outcomes. Research design : Randomized controlled trial with practices each reporting on 30 patients with asthma over a 6 month period. Methods and procedures : 447 patients were randomly selected from practice asthma registers managed by 17 general practices from throughout the UK. Intervention practices used the software during consultations with these patients throughout the study while control practices did not. Main outcomes and results : Practice consultations, acute exacerbations of asthma, hospital contacts, symptoms on assessment and medication use. A smaller proportion of patients within the intervention group initiated practice consultations for their asthma: 34 (22%) vs 111 (34%), odds ratio (OR)= 0.59, 95% confidence interval (CI) (0.37-0.95); and suffered acute asthma exacerbations: 12 (8%) vs 57 (17%) , OR = 0.43, 95% CI = 0.21- 0.85 six months after the introduction of the computer decision support software. There were no discernable differences in reported symptoms, maintenance prescribing or use of hospital services between the two groups. Conclusion : The use of computer decision support software that implements guidelines during patient consultations may improve clinical outcomes for patients with asthma.

Motivating mobility: designing for lived motivation in stroke rehabilitation

How to motivate and support behaviour change through design is becoming of increasing interest to the CHI community. In this paper, we present our experiences of building systems that motivate people to engage in upper limb rehabilitation exercise after stroke. We report on participatory design work with four stroke survivors to develop a holistic understanding of their motivation and rehabilitation needs, and to construct and deploy engaging interactive systems that satisfy these. We reflect on the limits of motivational theories in trying to design for the lived experience of motivation and highlight lessons learnt around: helping people articulate what motivates them; balancing work, duty, fun; supporting motivation over time; and understanding the wider social context. From these we identify design guidelines that can inform a toolkit approach to support both scalability and personalisability.

Effect of asthma and its treatment on growth: four year follow up of cohort of children from general practices in Tayside, Scotland

Abstract Objective: To investigate whether asthma or its treatment impairs childrens growth, after allowing for socioeconomic group. Design: 4 year follow up of a cohort of children aged 1-15. Setting: 12 general practices in the Tayside region of Scotland. Subjects: 3347 children with asthma or features suggestive of asthma registered with the general practices. Main outcome measures: Height and weight standard deviation scores. Results: Children who lived in areas of social deprivation (assessed by postcode) had lower height and weight than their contemporaries (mean standard deviation score −0.26 (SD 1.02) and −0.18 (1.15) respectively, P<0.001 for both). Children who were receiving ≥400 μg daily of inhaled steroids and who were attending both hospital and general practice for asthma care had lower height and weight than average, independent of the effect of deprivation (mean standard deviation score −0.62 (1.01), P=0.002, for height and −0.58 (0.94), P=0.005, for weight). Children receiving high doses of inhaled corticosteroids also showed lower growth rates (mean change in standard deviation score −0.19 (0.51), P=0.003). However, no other children with asthma showed growth impairment. Conclusion: Most children with asthma were of normal height and weight and had normal growth rates. However, children receiving high doses of inhaled steroids and requiring both general practice and hospital services had a significant reduction in their stature. This effect was independent from but smaller than the effect of socioeconomic group on stature. Key messages Social deprivation has an adverse effect on the height and weight of children irrespective of any disease process Neither asthma nor its treatments had any noticeable effect on the height and weight of most of the children in this primary care study Children who received high doses of inhaled corticosteroids and used hospital services for asthma were shorter and lighter than their contemporaries after social deprivation was allowed for Children receiving high doses of inhaled corticosteroids had lower than normal growth rates

Human Pose Estimation Using Learnt Probabilistic Region Similarities and Partial Configurations

A model of human appearance is presented for efficient pose estimation from real-world images. In common with related approaches, a high-level model defines a space of configurations which can be associated with image measurements and thus scored. A search is performed to identify good configuration(s). Such an approach is challenging because the configuration space is high dimensional, the search is global, and the appearance of humans in images is complex due to background clutter, shape uncertainty and texture.

Facing the challenges of e-learning initiatives in African universities

This paper explores the possibility of bringing e-learning to African universities through collaborative networks of public–private partnerships. It is envisaged that this approach will solve the dual problem of infrastructural barriers and weak ICT policies. As technology is used more in education, the teachers’ roles are increasingly integrated with those of support staff, administrators and technical staff. The needs of e-learning environments suggest the viability of multistakeholder networks to share expertise and resolve issues related to training needs. The paper concludes that collaboration networks that include e-learning sponsors, policy makers, telecommunication network service providers and educators are required to solve the problems of online education in Africa.

Can text messages reach the parts other process measures cannot reach: an evaluation of a behavior change intervention delivered by mobile phone?

Background Process evaluation is essential in developing, piloting and evaluating complex interventions. This often involves observation of intervention delivery and interviews with study participants. Mobile telephone interventions involve no face to face contact, making conventional process evaluation difficult. This study assesses the utility of novel techniques for process evaluation involving no face to face contact. Methods Text messages were delivered to 34 disadvantaged men as part of a feasibility study of a brief alcohol intervention. Process evaluation focused on delivery of the text messages and responses received from study participants. The computerized delivery system captured data on receipt of the messages. The text messages, delivered over 28 days, included nine which asked questions. Responses to these questions served as one technique for process evaluation by ascertaining the nature of engagement with the study and with steps on the causal chain to behavior change. Results A total of 646 SMS text messages were sent to participants. Of these, 613 messages (95%) were recorded as delivered to participants’ telephones. 88% of participants responded to messages that asked questions. There was little attenuation in responses to the questions across the intervention period. Content analysis of the responses revealed that participants engaged with text messages, thought deeply about their content and provided carefully considered personal responses to the questions. Conclusions Socially disadvantaged men, a hard to reach population, engaged in a meaningful way over a sustained period with an interactive intervention delivered by text message. The novel process measures used in the study are unobtrusive, low cost and collect real-time data on all participants. They assessed the fidelity of delivery of the intervention and monitored retention in the study. They measured levels of engagement and identified participants’ reactions to components of the intervention. These methods provide a valuable addition to conventional process evaluation techniques.

Hand tracking for behaviour understanding

Abstract A real-time computer vision system is described for tracking hands thus enabling behavioural events to be interpreted. Forearms are tracked to provide structural context, enabling mutual occlusion, which occurs when hands cross one another, to be handled robustly. No prior skin colour models are used. Instead adaptive appearance models are learned on-line. A contour distance transform is used to control model adaptation and to fit 2D geometric models robustly. Hands can be tracked whether clothed or unclothed. Results are given for a ‘smart desk’ and an in-vehicle application. The ability to interpret behavioural events of interest when tracking a vehicle drivers hands is described.

Decision‐making about mode of delivery after previous caesarean section: development and piloting of two computer‐based decision aids

Objective  To develop and pilot two computer‐based decision aids to assist women with decision‐making about mode of delivery after a previous caesarean section (CS), which could then be evaluated in a randomized‐controlled trial.

Knowledge May Not Be the Best Target for Strategies to Influence Evidence-Based Practice: Using Psychological Models to Understand RCT Effects

BackgroundInterventions to enhance the implementation of evidence-based practice have a varied success rate. This may be due to a lack of understanding of the mechanism by which interventions achieve results.PurposeUse psychological models to further an understanding of trial effects by piggy-backing on a randomised controlled trial testing 2 interventions (Audit & Feedback and Computer-aided Learning) in relation to evidence-based third molar management.MethodAll participants of the parent trial (64 General Dental Practitioners across Scotland), regardless of intervention group, were invited to complete a questionnaire assessing knowledge and predictive measures from Theory of Planned Behaviour and Social Cognitive Theory. The main outcome was evidence-based extracting behaviour derived from patient records.ResultsNeither intervention significantly influenced behaviour in the parent trial. This study revealed that the interventions did enhance knowledge, but knowledge did not predict extraction behaviour. However, the interventions did not influence variables that did predict extraction behaviour (attitude, perceived behavioural control, self-efficacy). Results suggest both interventions failed because neither influenced possible mediating beliefs for the target behavior.ConclusionUsing psychology models elucidated intervention effects and allowed the identification of factors associated with evidence based practice, providing the basis for improving future intervention design.