To ascertain the number and type of obstetric computer systems (OCS) in Great Britain, and to ascertain user satisfaction with these systems.
A postal questionnaire was circulated to every consultant ...obstetrician in Great Britain at the beginning of 1992.
Information was sought on the hardware, software and uses of obstetric computer systems. Satisfaction with, benefits and problems of the system were also assessed.
There was an 87.5% response rate. Of the 264 units questioned, 100 units reported that they had a computer system. Sixty-five units used terminals connected to a mainframe or minicomputer and 17 used stand-alone personal computers (PCs). Local area networks (LANs) were used in 19 units and wide area network (WANs) in 22 units. Software varied from commercial turnkey systems to in-house systems. The quoted annual running cost ranged from 50 pounds to 48,000 pounds. Most units were satisfied with their system. Problems included slow operating times, unreliability, user unfriendliness, deficiencies in training and inadequate customer support services.
Obstetric computer systems are now coming into widespread use. Despite problems, the use of such systems is likely to increase. This survey establishes a database for those units who are considering acquiring or changing their computer system for the purpose of audit or research.
Although Hirschsprung's disease is diagnosed most commonly during infancy and childhood, some cases are seen in adults, when clinical features are usually similar to those described in younger ...patients. We report a case whose unusual clinical presentation led to an initial diagnosis and subsequent treatment of colonic Crohn's disease. The correct diagnosis was made only after motility measurements suggested the possibility of adult Hirschsprung's disease and prompted the histological examination of the myoenteric plexus, which led to the establishment of the correct diagnosis.
Audit of compliance with antenatal protocols YOONG, A. F. E; LIM, J; HUDSON, C. N ...
BMJ. British medical journal (International ed.),
1992, Letnik:
305, Številka:
6863
Journal Article
Childhood urticaria pigmentosa is generally considered to have a good prognosis with the majority of cases undergoing spontaneous resolution. However, there have been a number of reports of ...haematological malignancies occurring in association with urticaria pigmentosa. We describe a child with extensive urticaria pigmentosa and a congenital cardiac anomaly who developed acute lymphoblastic leukaemia and suggest a possible common aetiology.
OBJECTIVE--To assess the implementation of action protocols dictated by antenatal risk factors noted at the initial (booking) antenatal visit. DESIGN--Retrospective study of 2000 women delivered ...between 1 March 1990 and 29 March 1991. SETTING--Maternity department of a district general hospital supporting a multiethnic population in inner London. MAIN OUTCOME MEASURES--Comparison of clinical actions performed against those dictated by the department's protocols. Analysis according to clinical importance, gestation at booking, maternal age, parity, birth order, ethnic origin, and certainty of gestational age. RESULTS--Interobserver agreement between the two auditors was good (kappa statistic for risk factors detected, 0.78; for actions generated, 0.80). Of the 15,658 actions dictated by department protocols, 3673 (23.5%) were actually performed by the clinicians. The 63 combinations of risk factors and actions believed by consultants to be of particular clinical importance had an action rate of 28.3% compared with 18.6% for those considered less important (p < 0.001). Mothers who first visited the hospital antenatal clinic at or before 24 weeks' gestation had 25.2% of relevant protocols fulfilled (p < 0.001). Compliance was significantly improved in women aged 36 or over (32.4%), black women (24.9%), and cases of uncertain gestation (24.5%). Parity and birth order were not associated with an altered action rate. Ethnic origin deemed as "other" (than white, black, Asian, or oriental) or "unknown" was associated with poor compliance (19.3%). CONCLUSIONS--Compliance to a set of agreed protocols was poor even though a computer system was available and a protocol manual had been distributed. Protocols were more likely to be implemented in women who booked early and in some groups of women deemed at high risk including older mothers, black women, and those denoted as having uncertain gestational age.
...bacterial vaginosis could be a marker of risk rather than a cause of adverse outcome of pregnancy. Because of this the results of controlled interventional studies, such as the one currently being ...undertaken by Hay and colleagues, should be awaited and the risks and benefits of intervention established before a potentially large number of asymptomatic women are treated, especially during pregnancy, when the use of drugs should be minimised. Four of the 197 women with normal (grade I) flora delivered before term compared with one of the nine with grade II flora and five of the 32 with grade III flora. ...as for other women with abnormal flora, primigravidas with grades II and III flora were significantly more likely to have a preterm delivery (odds ratio 6.7 (95% confidence interval 1.35 to 35.05); P<0.01 (Fisher's exact test)).
This paper reports the results of a case-note audit undertaken to detect the antenatal risk factors found at the initial booking visit, including the subsequent clinical action taken. From a total of ...2,139 case-notes of women booked via an obstetric computer system, and delivered between March 1990 and March 1991, 136 (6.4%) were missing. The results showed that these 136 mothers experienced significantly worse delivery outcomes, ie higher incidence of perinatal death; preterm labour; a baby with a low Apgar score and low birth weight. There was also a higher incidence of perinatal death and babies with a low Apgar score for women booked manually compared with those booked via the computer system. These results show that many audit procedures may be the subject of substantial bias due to the problem of missing information. The extended use of a computer-based medical record system should help to resolve this problem, although hybrid information systems can themselves be biased.
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