Joseph F. Britto

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OBJECTIVE To determine what complications children have during interhospital transfer for intensive care, and how often these complications occur. DESIGN Observational study of all children transferred over a six month period, including interviews with patient escort, patient review, and severity of illness scoring. MAIN OUTCOME MEASURES Timing and(More)
The development, and the results of clinical evaluation of ISABEL, an Internetdelivered integrated clinical decision-support system developed over the past 3 years, is described. Utilising a novel technique, pattern-recognition software from AutonomyTM is used to search standard medical text. The system consists of an innovative differential diagnosis tool(More)
OBJECTIVE To evaluate the morbidity and severity of illness during interhospital transfer of critically ill children by a specialised paediatric retrieval team. DESIGN Prospective, descriptive study. SETTING Hospitals without paediatric intensive care facilities in and around the London area, and a paediatric intensive care unit at a tertiary centre. (More)
OBJECTIVES It is apparent that delays and inadequate or inappropriate management occur frequently and may contribute to the continued high mortality seen in meningococcal disease. An attempt has been made to define the major sources of delay or inappropriate treatment. METHODS A prospective, descriptive study of children with meningococcal disease(More)
Design: Sets of differential diagnoses and clinical management plans generated by 71 clinicians for six simulated cases, before and after decision support from a Web-based pediatric differential diagnostic tool (ISABEL), were used. Measurements: A composite quality score was calculated separately for each diagnostic and management plan by considering the(More)
The proportion and trend in absolute number of pertussis notifications in young infants has increased each year in England and Wales since the accelerated immunization schedule was introduced. We report five infants all less than 3 months of age admitted with life threatening pertussis infection to two paediatric intensive care units. Despite aggressive(More)
Meningococcal disease remains a major cause of mortality in children in the UK. Aggressive early volume resuscitation, meticulous attention to the normalisation of all physiological and laboratory parameters, and prompt referral to specialist paediatric intensive care may lead to a sharp reduction in mortality. Application of the management algorithm(More)
BACKGROUND Diagnostic error is a significant problem in specialities characterised by diagnostic uncertainty such as primary care, emergency medicine and paediatrics. Despite wide-spread availability, computerised aids have not been shown to significantly improve diagnostic decision-making in a real world environment, mainly due to the need for prolonged(More)