Experience with amniocentesis at the Johannesburg Amniocentesis Clinic in 1976

One hundred and seventy-six amniocenteses were performed in the Johannesburg Amniocentesis Clinic in 1976. These were for genetic studies, assessment of fetal lung maturity and assessment of the severity of rhesus disease. The indications for amniocentesis and the results are discussed. The overall complication rate was low. This was due to certain precautions and approaches taken, which are detailed.

Clinical utility of a rapid diagnostic test series for elderly psychiatric outpatients

Psychiatric evaluation of the elderly is especially difficult for several reasons, e.g., the presence of organic impairment, the effects of multiple drug therapy, and the tendency to confuse the normal concomitants of aging with neurotic symptoms. The authors have developed and evaluated a brief series of self-report assessment tests (GRDB) designed to assist the psychiatrist in the process of diagnosis. Coefficients of the internal consistency of the seven scales are presented. A comparison was make between 28 psychiatric patients attending a geriatric clinic and 48 well-functioning elderly persons matched for age and sex, and living in the same community. Results showed that the geriatric outpatients functioned at a lower level of adaptation than did the control group, on all seven scales - depression, daily living skills, social interaction, cognitive skills, number of illnesses, number of life problems, and the use of drugs and alcohol. These findings provide a measure of discriminant validity. The advantages of this brief assessment instrument are discussed.

The Johns Hopkins ambulatory-care coding scheme

A classification and coding system for ambulatory-care problems has been developed at the Johns Hopkins Medical Institutions and three affiliated institutions. The provider's statement of the patient's problem, as recorded on an encounter from, is kept in a computer file. Codes from the classification scheme, based on those used in four existing schemes, are automatically assigned to diagnoses, symptoms, well-care services, and treatment procedures categorized by physiological system and subsystem. About 85 percent of recorded problems are machine-codable; the remainder are alphabetized for efficient manual coding. The coding system is integrated with an overall information system that allows linkage of coded problem data to diverse data on patient and provider characteristics. Examples are given of the uses and limitations of the linked data for care evaluation, management, and clinical research.

Therapeutic abortion in an out-patient clinic. A prospective investigation of complications and patient acceptability

The incidence of complications associated with therapeutic termination of pregnancy was analysed in 1349 patients, whose average age was 26.3 years. Of the patients, 51.8% were 25 years or under; 56.3% were seen in or before the 8th week of pregnancy, and 17.4% had previously had one or more legal abortions. All the operations were performed under local anaesthesia and by the same doctor, who was an experienced gynaecologist. Complications associated with the operation occurred in 14 patients (1%), viz. infections in the uterus and tubes, 9 cases; incomplete abortion necessitating repeat curettage, 4 cases; and profuse bleeding requiring blood transfusion, 1 case. No uterine perforations or cervical ruptures were encountered. Questioned about subjective discomforts of the opeation, 7.4% of the women answered that the discomfort had been considerable, whereas 62.6% described it as only slight; 4.8% would have perferred general anaesthesia. We conclude that therapeutic abortion can be performed safely and with an acceptably low incidence of complications in out-patients, provided the operations are performed by an experienced gynaecologist.

Are there social class differences in patients' treatment conceptions?

Traditionally, lower-class individuals who have sought psychiatric help have been hampered in their efforts by classrelated inequities in the delivery of psychiatric services. A common explanation for this phenomenon has been that the treatment conceptions of lower-class individuals are "inappropriate." This report presents theoretical and research evidence challenging this notion. A review of the literature from 1954 through 1974 yielded no good evidence that lower-class patients need, expect, or want treatments incongruent with those of upper-middle-class therapists. An experimental study of the requests for help made by 278 walk-in clinic patients confirmed this observation. Patient requests, as measured by an 84-item, self-rated questionnaire, were largely independent of social class. It was concluded that social class differences in treatment disposition and outcome cannot be attributed to social class differences in patients' treatment conceptions. The possibility that methodological and sociological factors can account for the discrepancies between the findings of this study and past studies is discussed. Strategies for minimizing treatment biases against lower-class patients and for maximizing treatment effectiveness with higher-class patients are also suggested.

Experience with a sustained-release formulation of oxprenolol in the management of angina pectoris in hospital out-patient departments

One hundred and two patients with angina pectoris under treatment with beta-receptor antagonists prescribed on a multi-dose basis were openly switched to treatment with once-daily sustained-release oxprenolol (160 mg per tablet). Eighty-eight patients were successfully managed on once-daily oxprenolol and 70% achieved significant benefit with a single morning dose of 160 mg. The mean number of anginal attacks and the mean glyceryl trinitrate consumption were both significantly reduced. It is concluded that once-daily treatment with oxprenolol in sustained-release form offers the advantage of reduced tablet ingestion without symptomatic detriment in the management of angina pectoris.

Effectiveness of an outpatient urine screening program

We evaluated the effectiveness of a routine outpatient urinalysis screening program on a sample population of 2600 patients. The 189 abnormal urine results found in 182 patients were followed up by study of any new clinical and laboratory investigations or therapeutic modifications initiated on the basis of any abnormal test result. The urinalysis screening program appeared to have significant bearing on diagnosis or treatment in only 13 patients. Abnormalities found in 150 of the 182 patients were either not noted or no further positive action was taken. Thus we concluded that under the conditions of this study the urine screening program added to hospital costs without significant benefit to the patient.

Social skills training of out-patient groups. A controlled study of rehearsal and homework

Fifty-one out-patients with social skills deficits (two-thirds men) completed ten weekly sessions of 75-minute group treatment; 44 were followed up for a mean of 16 months. Random assignment was to one of three conditions: (I) Cohesive group discussion; (2) Modelling and role-rehearsal; or (3) Modelling and role-rehearsal + daily social homework. All three treatment conditions produced significant but incomplete improvement at the end of treatment and follow-up. The two role-rehearsal conditions were significantly superior to group discussion on several measures. Patients who completed daily social homework assignments did significantly better than patients who completed control homework. Alcohol and drug abuse patients usually dropped out. Schizophrenic patients in remission had lost their improvement at follow-up. Patients with other diagnoses retained their gains to 16-month follow-up.