IMIST-AMBO shows promise for improving the ambulance-ED handover communication interface. Involving paramedics and ED clinicians in its development enhanced the resulting protocol, strengthened ED clinicians' and ambulance paramedics' sense of ownership over the protocol and bolstered their peers' willingness to adopt it.

OBJECTIVES: Several studies have evaluated whether evidence-based medicine (EBM) training courses can improve skills such as literature searching and critical appraisal but to date, few data exist on whether teaching EBM skills and providing evidence-based resources result in change in behavior or clinical outcomes. This study was conducted to evaluate whether a multifaceted EBM intervention consisting of teaching EBM skills and provision of electronic evidence resources changed clinical practice.DESIGN: Before/after study. SETTING:The medical inpatient units at a district general hospital.PARTICIPANTS: Thirty-five attending physicians and 12 medicine residents. INTERVENTION:A multicomponent EBM intervention was provided including an EBM training course of seven 1-hour sessions, an EBM syllabus and textbook, and provision of evidence-based resources on the hospital network. MEASUREMENTS AND MAIN RESULTS:The primary outcome of the study was the quality of evidence in support of therapies initiated for the primary diagnoses in 483 consecutive patients admitted during the month before and the month after the intervention. Patients admitted after implementation of the EBM intervention were significantly more likely to receive therapies proven to be beneficial in randomized controlled trials (62% vs 49%; P = .016). Of these trial-proven therapies, those offered after the EBM intervention were significantly more likely to be based on high-quality randomized controlled trials (95% vs 87%; P = .023). CONCLUSIONS:A multifaceted intervention designed to teach and support EBM significantly improved evidence-based practice patterns in a district general hospital. METHODSWe performed a before and after study of the quality of evidence in support of therapies initiated for the primary diagnosis of patients admitted to a medical inpatient unit of a district general hospital. It was conducted at Queen's Hospital in Burton-upon-Trent, Staffordshire, United Kingdom (a 465-bed district general hospital without a university affiliation but with a fully integrated information support system as one of the two nationally funded pilot sites for the development of the electronic patient record). There were 35 attending physicians and 3 teams (consisting of 2 junior and 2 senior residents) in the department of medicine, none of whom had received prior training in clinical epidemiology or EBM. InterventionThe EBM intervention was multifaceted. First, we reviewed all discharge summaries for a 2-week period (July 1998) to identify the most common admitting diagnoses. Therapies were identified for each common medical diagnosis and literature searches were conducted to retrieve evidence supportive of these therapies. For each topic, 1-page summaries of the evidence (critically appraised topics; CATs 3 ) were prepared and entered into a database. Second, we provided all participants with the syllabus Practising Evidence-based Medicine and relevant excerpts from the book Evidence-based Medicine: How to Practise and Teach EBM. 4,5 Third, we con...

The process and outcome of clinical tasks in an acute psychiatric unit were compared using four different communication modes: face to face, telephone, hands-free telephone, and a low-cost videoconferencing system. Six doctors and six patients took part in the study. Four assessment measures were used. The videoconferencing system was positively received by both patients and doctors. Both doctors and patients preferred communication modes with visual cues. However, there were few significant differences between communication modes when using single measures; only multiple levels of analysis can adequately assess the differences between such modes of communication.

This study reports the results of the use of a low-cost videoconferencing system (LCVC) for communication in an acute psychiatric service. Qualitative research methodology was used to examine the use of the LCVC in interactions between psychiatrists, patients and nursing staff, including information on refusals. One hundred and five clinical interactions were studied over four months. The LCVC proved technically reliable and compatible with the performance of a wide range of clinical tasks. However, the results suggest the need for better understanding of the nature and origins of the attitudes that users bring to the use of such communications technology. A framework is presented for the classification of user responses in terms of preexisting attitudes of the users, technological limitations of the system and the mental state of the users. The study demonstrated the potential for interactive television to support many of the communication tasks necessary in a dispersed psychiatric service and for telepsychiatry to become a major method of service provision.

Telemedicine, the delivery of health care with the patient and health professional at different locations, has been around for over 30 years. Its driving force has been developments in communications technology, and as new communications systems are developed health applications are proposed such as supporting the delivery of primary health care to geographically remote areas or regions underserved through the maldistribution of professional expertise. Despite rapid technological advances, evaluations of such systems have been largely superficial, and more thorough evaluations have failed to show significant advantages for more advanced and expensive technology over older technology such as the telephone. Methods for evaluating the impact of particular technologies on the health care system need to be developed and clearer benefits shown in terms of improved standards of care.

People over the age of 65 were recruited from an inner-city old-age psychiatry service. Subjects had a structured interview (the CAMCOG test) by videoconferencing, and also face to face, by an investigator blind to the results of the test in the other mode. Reassessments were carried out within one week of the initial assessment. Eleven subjects were initially enrolled in the study and eight completed both modes. The number of patients in this study is very small but the results suggest that the CAMCOG test can be used reliably over a videoconferencing system without major modification.

Background This study examines the prevalence of physical morbidity in elderly psychiatric inpatients and the possible relationships between major psychiatric disorders (organic mental disorders, schizophrenic and mood disorders) and physical illnesses. The clinical implications of such relationships are discussed. Method Data were obtained from two old age psychiatry wards over a six month period. Seventy‐nine subjects were studied and information was obtained from their medical files. Demographic characteristics, psychiatric diagnosis, number of physical illnesses and number of body systems affected were collected. Analysis of variance (ANOVA) was used to compare the psychiatric groups on continuous outcome data and χ2 test to compare psychiatric groups on categorical data. Results Seventy‐five per cent of subjects had at least one physical illness. The number of medical illnesses was independent from the psychiatric disorder. Subjects with mood disorders, and especially depression, were more likely to suffer from hypertension, diabetes and cardiovascular illnesses than subjects with schizophrenic or organic disorders. Subjects with organic disorders had the lowest prevalence of endocrine disease and diabetes. Conclusions It was concluded the link between mood disorders (depression), cardiovascular diseases and hypertension could be of a ‘cause/effect' type or are the results of a survivor effect. The high prevalence of physical morbidity has implications for training and continuing professional development of those in Old Age Psychiatry Services. It should also be taken into consideration when the location of services is being decided. Copyright © 2000 John Wiley & Sons, Ltd.

The telephone is used by all mental health professionals and many of their clients. Despite this, the telephone has been formally evaluated only occasionally. This paper reviews the literature on cognitive testing by telephone and by videoconferencing, and summarizes the different strategies employed to do this task. There remain weaknesses in the use of the telephone for cognitive testing but it could certainly be used more extensively in both clinical work and research, although the choice of test must be made with a clear view of what the assessment is designed to achieve and the limitations of the assessment instrument itself. Assessment by videoconferencing remains at an early stage of development, with much work to be done before it can be routinely employed as a clinical tool. However, videoconferencing shows promise for the future because it allows a much wider range of assessment than the telephone.