Publications by Rupert Fawdry, arranged chronologically.
You might also like to read Richard Lilford's article from September 2014,The WISDAM of Rupert Fawdry.
Rupert Fawdry's comment on National Health Executive news item: New palliative care data sets to provide nationwide picture of end-of-life care http://www.nationalhealthexecutive.com/Health-Care-News/new-palliative-care-data-sets-to-provide-nationwide-picture-of-end-of-life-care 29 September 2015
Rupert Fawdry's comment on NHS England news that Tim Kelsey is to leave NHS England https://www.england.nhs.uk/2015/09/tim-kelsey-to-leave/#comment-480909 18 September 2015
Fawdry R. Paper is the Way Forward. Talk at the Open Source Skunkworks, EHI Live, National Exhibition Centre, Birmingham, 4 November 2014. View on YouTube
Fawdry R. Extensive paperwork stops retired doctors from working. Daily Telegraph, 7 November 2013. View on Telegraph website
How IT systems can address Francis Report findings article by Paul Shannon on Hospital Doctor DrBlogs 25 March 2013. Rupert Fawdry's comments posted 27 March 2013.
Fawdry R. Paper fights back: over 50 neglected advantages of paper. British Journal of Healthcare Computing, 29 January 2013. http://www.bj-hc.co.uk/views/views-news-detail.html?news=2371&lang=en&feed=124
Carlisle D. Well past the due date. EHI special report: maternity. Includes quotes from an interview with Rupert Fawdry. eHealth Insider, 21 January 2013. http://www.ehi.co.uk/Features/item.cfm?&docId=398
Bewley S, Perry HJ, Cumming GP, Fawdry R. Re. Should patients be able to control their own records? One Size Won’t Fit All. BMJ Rapid Response 2012 Aug 30 http://www.bmj.com/content/345/bmj.e4905/rr/600382
MyView. The Sun 30 August 2012 - comments on "Grin ‘n bear it" news item about NHS cuts in caesareans and epidurals
Fawdry R, Perry H, Bewley S, Cumming G. Re. Open science and reproducible research. Open, web-based discussions are key. BMJ Rapid Response 2012 Jul 9 http://www.bmj.com/content/344/bmj.e4383/rr/593384
Signatories on the letter to The Times and clergy proctors of London Diocese Ctrl-F to search on the page for Rupert Fawdry to read his comment 10 February, 2012.
NHS Future Forum calls on healthcare professionals to lead way on patient-centred care Ctrl-F to search on the page for Rupert Fawdry to read his comment 11 January, 2012.
Fawdry R, Bewley S, Cumming G, Perry H. Data re-entry overload: time for a paradigm shift in maternity IT? J R Soc Med. 2011 Oct;104(10):405-12. link to full text
ABSTRACT: This paper provides an overview of maternity information technology (IT) in Britain, questioning the usability, effectiveness and cost efficiency of the current models of implementation of electronic maternity records. UK experience of hand-held paper obstetric notes and computerized records reveals fundamental problems in the relationship between the two complementary methods of recording maternity data. The assumption that paper records would inevitably be replaced by electronic substitutes has proven false; the rigidity of analysable electronic records has led to immense incompatibility problems. The flexibility of paper records has distinct advantages that have so far not been sufficiently acknowledged. It is suggested that continuing work is needed to encourage the standardization of electronic maternity records, via a new co-creative, co-development approach and continuing international electronic community debate.
Bewley S, Perry H, Fawdry R, Cumming G. NHS IT requires the wisdom of the crowd not the marketplace BMJ. 2011 Oct 12;343:d6484. doi: 10.1136/bmj.d6484. link to full text
Royal College of Midwives. Response to the Future Forum consultation on information, education and training, and the public’s health. October 2011 Rupert Fawdry is mentioned on page 5:
We also believe that there are opportunities to significant reduce the time spent in information gathering for healthcare. For example, Rupert Fawdry has proposed software that would allow a woman to answer a wide range of questions in advance of her first booking appointment with a midwife. Booking appointments, while absolutely crucial for the face-to-face interaction they allow between women and midwives, are often taken up by going through questions that could easily be completed in advance. The system would also enable women to access information about her options for care during pregnancy and allow more time in the booking appointment to discuss those options. For more information the proposal, see the Department of Health’s ‘new health app’ forum.
Fawdry R, Perry H, Bewley S, Cumming G. Magic and mayhem. Obstet Gynecol. 2011 Feb;117(2 Pt 1):405-6. No abstract available.
Bewley S, Fawdry R, Cummings [sic] G, Perry H. Electronic health records. The naked truth. BMJ. 2010 Oct 13;341:c5637. doi: 10.1136/bmj.c5637. link to full text
Fawdry RDS. Accoucheur : a misnomer? The Obstetrician and Gynaecologist 2008; 10: 275. downloadable via ResearchGate.
Fawdry R. Electronic records in maternity care: where are we exactly? MIDIRS Midwifery Digest 2007 Jun; 17(2):291-8.
ABSTRACT: Improving UK maternity computer records. Following discussion of the limitations of the electronic storage systems currently in use, it is demonstrated that creating a system which includes all possible data items is unrealistic, and a method of prioritising items is suggested. A dataset of 500 priority items is recommended as the basis of any updated maternity system.
DR. SPIN Hospital Doctor 2007 Feb 1; page 55.ABSTRACT: The article highlights various issues related to medical care in Great Britain.
It describes a map of the British National Health Service (NHS) information technology from the point of view of a mapmaker with 25-year experience of electronic patient records for maternity care. [...]TRANSCRIPTION FOLLOWS: Dr Spin this week received a map of NHS IT from the point of view of a 'mapmaker' with 25 years' experience of electronic patient records for maternity care. The map lays out the topography of the chasm of partially but virtually uncharted territory between the 'World of NHS IT' and the 'World of Acute Hospital Medicine'. Doctors with an interest in cartography (and computers) will discover the forest of confusion, the fields of ignorance, the foothills of over-hyped software, the mountains of wasted taxpayers' money swathed in the clouds of fantasy, the ditch of glazed eyes and, of course, the slough of despond. With thanks to Dr Rupert Fawdry of Milton Keynes General.
Barach P, Bentham L, Bion J, Bradburn S, Bullock I, Daniels H, Fawdry R, Lilford R, Mohammed M, Woodroffe R. Teaching life support and resuscitation competencies in health care : Current practice and strategies for future research. Birmingham: University of Birmingham Department of Public Health & Epidemiology, 2005. Full text PDF (189 pages)
Aslam MF, Gilmour K, Fawdry RD. Who wants a caesarean section? A study of women's personal experience of vaginal and caesarean delivery. J Obstet Gynaecol. 2003 Jul;23(4):364-6.
ABSTRACT: The Changing Childbirth report, 1999, explicitly endorsed the right of women to be involved in childbirth decisions and to have a choice in childbirth and it has been suggested that maternal requests for a caesarean birth has been a significant factor in the recently observed increases in caesarean section rates. There have been reports of both obstetrician's views and midwives' views regarding the mode of delivery. However, there is a lack of literature reporting the views of women who have experienced personally both a caesarean section and a vaginal delivery. Fifty women in Milton Keynes who had had at least one vaginal delivery and at least one caesarean section were asked for their opinion.
House of Commons. Select Committee on Health. Fourth Report. (HC-464)
- 4. The staffing structure of maternity care teams. Rupert Fawdry's comments are in paragraph 157:
157. Community midwives play a pivotal role within the maternity care team. Rupert Fawdry, a consultant obstetrician and gynaecologist, argued that community midwives should always work in teams covering a particular part of a local area and that each team should liaise closely with a particular multi-disciplinary hospital team. In this way, Mr Fawdry told us, the majority of pregnant women would have the benefit of a "much more closely integrated group of health professionals." Health visitors also have an important role to play in this group of health professionals as they support women through the postnatal period, providing a vital link between maternity units and community and social services.
Fawdry R. Great brain robbery. New Scientist 2003 June 14. Full text on journal website - registration or subscription required
Comment on "A Female Friend At The Bedside Boosts The Chances Of A Natural Birth" Locate Rupert Fawdry with Ctrl-F
Channel 4 series: Why Doctors Make Mistakes. View on YouTube
- German versions at http://www.netdoktor.de/News/Totgeburt-durch-Haemoglobin-1036761.html (Germany) and http://www.austriainfocenter.com/archivnw.asp#395(Austria) Use Ctrl-F to search on page for Fawdry
Fawdry R, Bainton D, Robins J, Anthony G. A classification by presenting problem in gynaecology. Health Trends 1996;28(1):31-35. No abstract available.
Bradbrook J, Carmi M, Danby J, Fawdry R, Fletcher J, Gill D, Jackson-Baker A, Jewell D, McKenzie M, Noble A, Porter R, Seaman B, Smith L, Young G. GMSC's advice on intrapartum care is unhelpful. BMJ. 1996 Apr 6;312(7035):910-1. Free Full Text via PubMed Central
Fawdry R. A.L. Fawdry (obituary) BMJ. 1995 Oct 21;311(7016):1085. Free Full Text via PubMed Central
Fawdry R. Assessing the consequences of changing childbirth. Smart cards are expensive and easily damaged. BMJ. 1995 Apr 22;310(6986):1066-7. Free Full Text via PubMed Central
Fawdry R. Antenatal casenotes 2: general comments. Br J Midwifery 1994 Aug; 2(8):371-4.
ABSTRACT: Comments on the trend towards encouraging pregnant women to contribute to their medical records.
Lee B. An international perspective on maternity care here and abroad. Report of meeting of Forum on Maternity & the Newborn, 27 October 1993 J Roy Soc Med 1994 Jul;87:427-429. Free Full Text via PubMed Central. Rupert Fawdry's contribution is reported on p.428-9.
Fawdry R. Antenatal casenotes: comments on design. Br J Midwifery 1994 Jul; 2(7):320-7.
ABSTRACT: Recommends the use of a single 'coop' patient record card to be used by GPs, midwives, hospitals and the pregnant woman.
see also updated version 2008
Fawdry R. Midwives and the care of 'normal' childbirth. Br J Midwifery 1994 Jul; 2(7):302-3.
ABSTRACT: Editorial. Call for the roles of midwives and obstetricians to be clarified.
Fawdry R. Prescribing the leaflets. Br J Hosp Med. 1994 May 18-31;51(10):551-3.
ABSTRACT: For legal reasons, but even more for the practice of good medicine, patients require much more information about their diseases, and about any proposed investigations or surgery than was customary in the past. In view of well-documented problems with the assimilation of purely verbal information, there is an increasing need for words to be backed by appropriate written material.
Redman CWG, de Swiet M, Collins R, Grant A, et al. CLASP: A randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women. The Lancet 1994 Mar 12;343(8898):619-629.
ABSTRACT: Pre-eclampsia is a common and serious complication of pregnancy that affects both mother and child. Review of previous small trials of antiplatelet therapy, particularly low-dose aspirin, suggested reductions of about three-quarters in the incidence of pre-eclampsia and some avoidance of intrauterine growth retardation (IUGR), but larger trials have not confirmed these results. In our multicentre study 9364 women were randomly assigned 60 mg aspirin daily or matching placebo. 74% were entered for prophylaxis of pre-eclampsia, 12% for prophylaxis of IUGR, 12% for treatment of pre-eclampsia, and 3% for treatment of IUGR. Overall, the use of aspirin was associated with a reduction of only 12% in the incidence of proteinuric pre-eclampsia, which was not significant. Nor was there any significant effect on the incidence of IUGR or of stillbirth and neonatal death. Aspirin did, however, significantly reduce the likelihood of preterm delivery (19.7% aspirin vs 22.2% control; absolute reduction of 2.5 [SD 0.9] per 100 women treated; 2p = 0.003). There was a significant trend (p = 0.004) towards progressively greater reductions in proteinuric pre-eclampsia the more preterm the delivery. Aspirin was not associated with a significant increase in placental haemorrhages or in bleeding during preparation for epidural anaesthesia, but there was a slight increase in use of blood transfusion after delivery. Low-dose aspirin was generally safe for the fetus and newborn infant, with no evidence of an increased likelihood of bleeding. Our findings do not support routine prophylactic or therapeutic administration of antiplatelet therapy in pregnancy to all women at increased risk of pre-eclampsia or IUGR. Low-dose aspirin may be justified in women judged to be especially liable to early-onset pre-eclampsia severe enough to need very preterm delivery. In such women it seems appropriate to start low-dose aspirin prophylactically early in the second trimester.
Fawdry R. Long term follow up of women after hysterectomy with a history of pre-invasive cancer of the cervix. Br J Obstet Gynaecol. 1993 Jul;100(7):703. No abstract available
Fawdry R. Quality maternity care from GPs and midwives. Br J Hosp Med. 1992 Apr 1-14;47(7):548. No abstract available
Fawdry R. Symptoms analysis for the diagnosis of genuine stress incontinence. Br J Obstet Gynaecol. 1992 Mar;99(3):271. No abstract available
Lumb M, Fawdry R. Linking and integrating computers for maternity care. Baillieres Clin Obstet Gynaecol. 1990 Dec;4(4):743-70.
ABSTRACT: Functionally separate computer systems have been developed for many different areas relevant to maternity care, e.g. maternity data collection, pathology and imaging reports, staff rostering, personnel, accounting, audit, primary care etc. Using land lines, modems and network gateways, many such quite distinct computer programs or databases can be made accessible from a single terminal. If computer systems are to attain their full potential for the improvement of the maternity care, there will be a need not only for terminal emulation but also for more complex integration. Major obstacles must be overcome before such integration is widely achieved. Technical and conceptual progress towards overcoming these problems is discussed, with particular reference to the OSI (open systems interconnection) initiative, to the Read clinical classification and to the MUMMIES CBS (Common Basic Specification) Maternity Care Project. The issue of confidentiality is also briefly explored.
Fawdry R. Antenatal care: a consultant's comments. Practitioner. 1990 Apr 8;234(1486):352-6. No abstract available
De Bono M, Fawdry RD, Lilford RJ. Size of trials for evaluation of antenatal tests of fetal wellbeing in high risk pregnancy. J Perinat Med. 1990;18(2):77-87.
ABSTRACT: A retrospective study of maternity records from 1977-1985 (38,000 deliveries) was conducted to determine the number of stillbirths that might have been prevented by a new method of antenatal assessment. During this period there were 240 stillbirths, 154 of which involved a normally formed fetus who died prior to the onset of labour. After a review of the literature, a set of risk factors were selected relevant to stillbirth. Such factors were found in 60% of the study group, compared with 38% of control patients. Seventy-five of the normally formed 'antepartum stillbirths' occurred in the high-risk group after 31 weeks gestation, so that a perfect method of prediction and treatment, applied from 31 weeks onwards, would potentially have prevented half of the 154 deaths in this study. Since intensive monitoring and the subsequent intervention cannot attain such perfection, an assessment was made, using realistic sensitivity and specificity values and other reasonable assumptions, to show that approximately one third of antepartum stillbirths might have been prevented by a new method for monitoring of all high-risk pregnancies. A sensitivity analysis was used to test this conclusion over a range of possible test performance values. The implications of these findings for clinical trials and cost-utility analysis are discussed.
Fawdry R. The development and evaluation of a computerised antenatal questionnaire. Int J Gynaecol Obstet. 1989 Mar;28(3):229-35.
ABSTRACT: A computerised questionnaire, for convenience entitled "PAM" (Programmed Aid for use in Midwifery), was created for use at the time of first antenatal assessment. The system required simple direct input by the expectant mother; and in response to a short descriptive letter, 73.4% of 349 women were prepared to try the new method. The response of 100 consecutive women who tried the system was further analysed. Seventy women liked PAM, four disliked the technique and the remainder had no strong feelings. Asked by the midwife which they would prefer, 46 women expressed a preference for the computer questionnaire and only nine would rather have had a traditional interview with a midwife asking the same questions. PAM or similar systems provide a new opportunity, both for research and as a means of reliably decentralizing the initial assessment of a pregnancy.
Fawdry, Rupert Why Korner maternity needs a year's grace. British Journal of Healthcare Computing 1987 Nov;4(6):(page numbers missing from HMIC database reference).
ABSTRACT: The author argues that innovative patterns of antenatal care may be hindered by the introduction of computerisation to comply with Korner timescales. He considers how hospital maternity systems could be extended into the community and how microcomputers in General Practitioners' surgeries might be used for community-based maternity care. He suggests that these, with a special antenatal booking program, an overnight electronic mail box link and a fully compatible hospital computer system might be the most practical way to provide acceptable antenatal care.
Fawdry R. Greeks bearing gifts. BMJ 1987 Nov 7;295(6607):1209. Free Full Text via PubMed Central
Please note that the paper referred to in this letter was not actually published. See Antenatal care: a consultant's comments (1990) and Why Korner maternity needs a year's grace (1987) for articles dealing with the same ideas and views.
The computer in obstetrics and gynaecology : based on the conference of the same name held at Churchill College, Cambridge, April 7-8, 1986 edited by Kevin J.Dalton and Rupert Fawdry. Oxford: IRL, 1987. ISBN: 1852210109
Fawdry RDS. Antenatal history taking: the acceptability of a computer questionnaire requiring simple direct input by the expectant mother. Journal of Obstetrics and Gynaecology 1985;5(4):206.
ABSTRACT: In order that each expectant mother should be given the appropriate antenatal, intrapartum and postnatal care, it is important not only that a good history should be recorded at the first attendance, but also that significant items of information or decisions made should not subsequently be overlooked. The pre-printed record used in most antenatal clinics tends to be either too brief to be useful, or so complex as to be unamanageable (Fawdry and Mutch, 1985). Computers have the ability to improve both the selection and presentation of information. They can also, by providing suggestions for management, make it less likely that important tests should be overlooked (Lilford et al., 1983). They cannot do this without the prior input of a large quantity of individual information. A study was therefore made to assess what proportion of expectant mothers might be willing to enter a significant proportion of the data themselves using a simple yes, no or query keyboard. All women attending a series of booking clinics in a large teaching hospital were questioned. Of 349 women, 266 (73 per cent) were willing to try a computerised questionnaire (Figure 1a). More than a quarter of all the women were noted to have already worked regularly with a typewriter or computer keyboard. The computer system was for convenience entitled PAM (Programmed Aid for use in Midwifery). A printed report was produced by PAM for each expectant mother, and a midwife then used this report as the basis for completing the booking interview. On questioning of 100 consecutive women who had used the computer system, in answer to the midwife's enquiry only 9 replied that they would rather have had the traditional type of booking interview (Figure 1b). Forty-six preferred the computerized questionnaire and the remaining 45 held no strong opinion either way.
Fawdry RDS, Mutch LMM. Antenatal history taking: what are we asking? Journal of Obstetrics and Gynaecology 1985;5(4):201-205.
ABSTRACT: It might reasonably be assumed that recording an antenatal booking history is a relatively standard procedure. An analysis of case notes from the booking clinics of 41 teaching hospitals in the United Kingdom showed wide variation in the items considered worthy of inclusion in the printed record. Five hundred and seventy-one different items were recorded, although the average number per hospital was 80. This highlights the tendency to collect data without sufficient evidence of their value. It is suggested that there are 52 items (common to 50 per cent of case notes) which should be recorded. From these can be derived most of the risk factors in the clinical checklist developed at Sighthill, Edinburgh, and commended by the Royal College of Obstetricians and Gynaecologists Working Party on Antenatal and Intrapartum Care (1982), as well as data items recommended by the Standard Maternity Information System (Thomson and Barron, 1980) and the Steering Group on Health Services Information (1982) for routine monitoring of the maternity health services.
Fawdry RDS. "BNF"s for the Third World BMJ 1984 Nov 17;289(6455):1384. Free Full Text via PubMed Central
Fawdry RD. Carcinoma-in-situ of the cervix: is post-hysterectomy cytology worthwhile? Br J Obstet Gynaecol. 1984 Jan;91(1):67-72.
ABSTRACT: The cytological records for the years 1950-1980 from South East Scotland revealed 1062 patients who had had histologically confirmed carcinoma-in-situ (or severe dysplasia) of the cervix at the time of hysterectomy. Ten cases of early 'recurrence' were detected in the first year of follow-up. During 4304 women-years of subsequent regular follow-up by vaginal vault smears, only one further confirmed recurrence was detected, this being a poorly differentiated squamous carcinoma in a 26-year-old patient, 4 years after hysterectomy. Two further patients not in regular follow-up presented clinically with invasive carcinoma. The implications for follow-up policies are discussed.
Lilford RJ, Bingham P, Fawdry R, Setchell M, Chard T. The development of on-line history-taking systems in antenatal care. Methods of Information in Medicine 1983 Oct;22(4):189-97.
ABSTRACT: The main purpose of the first antenatal visit (booking visit) is to obtain a full history. This information is used to assess risk and plan further management. We have developed an on-line microcomputer system to obtain and reproduce this antenal 'booking' history. The study was designed to provide a formal evaluation of these programs by comparing the traditional and computerised methods. A cross-over study showed that the computer provided a much more complete history with an average of 16 additional items. Further analysis showed that much of this information was of such importance as to warrant specific action on the part of the clinician. Little extra time was required to obtain this improvement in detail and a high degree of consumer acceptance was recorded.
Fawdry RD. Infant resuscitation at low cost. Trop Doct. 1983 Apr;13(2):65-9. No abstract available.
TI: Microcomputers in antenatal care AU: Fawdry RDS, Benson TJR. SO: BMJ 1981 Oct 31;283(6300):1188. Free Full Text via PubMed Central