Activities of alkaline phosphatase in first trimester chorion biopsy tissue

We have determined the activity of alkaline phosphatase in chorionic villous tissue obtained in the first trimester of pregnancy, in order to obtain the normal range of values as a prerequisite for application to the prenatal diagnosis of the rare bone disease hypophosphatasia. The activities found were a combination of intestinal and liver/bone/kidney types; traces of placental type were present in only one sample.

Use of a microcomputer network for history taking in a prenatal clinic

A stand-alone microcomputer was installed at St. Bartholomew's Hospital to obtain the booking (first prenatal) history. This system has many well-documented advantages over the manual method, particularly with respect to the completeness and quality of the history produced. However, a single microcomputer system is unable to deal with the load of a busy clinic, and initially, several independent terminals were required. We now describe the installation of a local area network to link several microcomputers with a single database in the Antenatal Clinic at Queen Charlotte's Maternity Hospital.

Computerized histories facilitate patient care in a termination of pregnancy clinic: the use of a small computer to obtain and reproduce patient information

An inexpensive microcomputer has been programmed to obtain histories from patients attending a pregnancy termination clinic. The system is nurse-interactive; yes/no and multiple-choice questions are answered on the visual display unit by a light pen. Proper nouns and discursive text are typed at the computer keyboard. A neatly formatted summary of the history is then provided by an interfaced printer. The history follows a branching pattern; of the 370 questions included in the program, only 68 are answered in the course of an average history. The program contains numerous error traps and the user may request explanations of questions which are not immediately understood. The system was designed to ensure that no factors of anaesthetic or medical importance would be overlooked in the busy out-patient clinic. The computer provides a much more complete history with an average of 42 more items of information than the pre-existing manual system. This system is demanding of nursing time and possible conversion to a patient-interactive system is discussed. A confidential questionnaire revealed a high degree of consumer acceptance.

Strengths and weaknesses of direct patient interviewing by a microcomputer system in specialist gynaecological practice

An inexpensive microcomputer system has been used to obtain histories in the gynaecological clinic. Initially, this system was applied to infertility/endocrine patients, but the programs were subsequently expanded to deal with a wide range of presenting symptoms. Questions are displayed on a visual display unit and the patient enters her answers on a simplified keypad. A formatted summary is provided by an interfaced printer. Cross-over comparison with manual histories showed that the computer produces an accurate and exhaustive record containing many additional items. This improvement was most marked for the infertility/endocrine system, where the computer provided 2.9-times as much information as a clinician. In the case of the general gynaecological history the computer obtained 1.6-times as much information. Both systems showed a high degree of consumer acceptance. This was more marked in the case of the specialist application: 77.5% of infertility/endocrine patients felt that the questionnaire had adequately covered their problem, compared to 44.5% of general gynaecological patients. Over-reporting of apparently trivial symptoms was more marked in the general system. Thus, we conclude that direct patient-interviewing systems can be recommended for relatively complex specialist applications, such as infertility/endocrinology. They may be less suitable for general applications such as gynaecology as a whole.

Long-term phenothiazine treatment does not cause pituitary tumours

In order to explore the possibility that prolactinomas may be caused by prolonged under-inhibition of prolactin-secreting cells we examined the pituitary fossa in 69 patients on long-term phenothiazine treatment. The average duration of treatment was 12.5 years and 55 (80 per cent) of the patients had persistently raised serum prolactin levels. The incidence of radiologically detectable pituitary fossa abnormalities was not significantly different to that in control populations. In 62 per cent of patients the skull x-rays from an earlier admission were available. Comparison of these with earlier films did not show a higher incidence of pituitary fossa abnormalities after prolonged exposure to phenothiazines.

Interpretation of single progesterone measurement in diagnosis of anovulation and defective luteal phase: observations on analysis of the normal range

Single serum progesterone determinations were made in 79 apparently normal women with a regular menstrual cycle. A normal range (40 subjects) was derived from the concentrations in the follicular phase and used to define an "anovular" range for luteal phase values (nine out of 39 subjects). The remaining luteal phase values were used to construct an "ovular" range for the luteal phase and, within this range, to define a group of values (less than the 20th centile) which could be described as a "defective luteal phase." The cut off limits between ovular and anovular and between normal and defective luteal phases were respectively two and four times the follicular phase median. It is proposed that the numerical findings of this study may be used as a rule of thumb for defining normality and abnormality from a single serum progesterone determination.

The use of a small computer to provide action suggestions in the booking clinic

The principal function of antenatal care is the identification of clinical features which require further action. Nevertheless, human vigilance is imperfect and medical staff fail to recognise 20% of risk factors. We describe here the use of microcomputers to supply action suggestions (clinical reminders) on the basis of the antenatal booking interview. Interactive programs obtain the history and provide a neatly formated hard-copy containing the action suggestions. A total of 82 suggestions are included in the programs and the average history generates 1.5 of these. These reminders are a form of quality control and they will become even more important as technological advances expand the range of possible investigations. This method is presented as an alternative to risk scoring. The suggestions are intended as reminders of items that may have passed unnoticed; they are not intended to limit or constrain individual judgement. Furthermore, they can easily be altered to suit the resources and preferences of individual hospitals. As a result of the low cost of newer microcomputers, this form of electronic reminder has now become a viable proposition on a large scale.

The use of a patient-interactive microcomputer system to obtain histories in an infertility and gynecologic endocrinology clinic

An inexpensive microcomputer has been programmed to obtain histories from patients attending an infertility and gynecologic endocrinology clinic. The system is directly interactive; patients enter their answers on a specially designed keyboard containing only "yes," "no," and "don't know" buttons and the numbers 1 to 5. A neatly formatted summary of the history is then provided by an interfaced printer. The history follows a branching pattern: Of the 330 questions incorporated in the program only 76 are asked in the course of the average history. The program contains numerous features which make it easy to use. For example, patients are provided with more detailed explanations of questions they find difficult to answer. These are produced either on command or automatically if the response time is prolonged. Crossover comparison with manual histories showed that the computer produces an accurate and exhaustive record containing many additional significant items. This system was designed to facilitate and not replace the physician interview. A confidential questionnaire revealed a high degree of consumer acceptance.

Maternal blood levels of human placental lactogen in the prediction of fetal growth retardation: choosing a cut-off point between normal and abnormal

Single estimations of serum human placental lactogen (hPL) were made in 527 unselected women between 36 and 40 weeks gestation. The association between decreased serum levels of hPL and intrauterine growth retardation was confirmed. The effect of changing the cut-off point between normality and abnormality on the sensitivity, specificity and predictive value was determined. When the 10th centile of hPL values was used, 29% of all growth-retarded fetuses were identified and 91% of all 'normal' fetuses were excluded. The 15th and 25th centiles yielded improved sensitivities of 37 and 50% respectively, but specificity was reduced. It is suggested that the 10th centile provides a good compromise between sensitivity on the one hand and specificity and predictive value on the other.

Problems and pitfalls of risk assessment in antenatal care

Current obstetric risk-scoring systems do not make a precise prediction of the chances of an abnormal outcome and so cannot be used in formal decision analysis. We examine here the feasibility of using Bayes' theorem to provide an accurate assessment of fetal risk and conclude that two severe limitations effectively exclude this approach as a useful contribution to antenatal care: (1) inaccuracy of the data base: geographical variations and the 'treatment paradox' conspire to reduce the reliability on which any assessment may be made; (2) 'dependency' of the risk factors: most obstetric variables are interdependent and are not therefore amenable to analysis by means of Bayes' theorem. Although fetal risk will be assessed subjectively for the foreseeable future, obstetricians should be aware of the essentially mathematical nature of decision-making.

Microcomputers in antenatal care: a feasibility study on the booking interview

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The use of ultrasound in the diagnosis of pelvic masses

Two hundred and two patients were referred to the ultrasound department for evaluation of a pelvic mass during 1977, and of these only 120 underwent an operation enabling a definitive diagnosis to be made. The diagnostic accuracy of ultrasound was compared with the final operative diagnosis. The great majority (98%) of pelvic masses could be detected, and ultrasound was accurate in predicting the antatomical site of a pelvic lesion in 88% of cases. Uterine lesions were precisely diagnosed in 87% of cases, but only 30% of adnexal conditions could be specifically recognized. Numerous situations in which ultrasound provided additional information of great clinical value were noted.