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Biomedical subjects

E M Wall

Publications and source records attributed to E M Wall.

17 recordsLinked to original sources
PubMed1989

The relationship between assessed obstetric risk and maternal-perinatal outcome.

The relationship between antepartum risk assessment and subsequent maternal and perinatal outcome was examined in a retrospective study of 430 randomly selected deliveries at the Oregon Health Sciences University during the 1986 calendar year. Antepartum risk scores at the initial prenatal visit and at 37 weeks' gestation were positively correlated with each other. Antepartum risk scores were correlated with maternal length of stay and maternal hospital charges, but not with gestational age, birth weight, or Apgar scores. Increased intrapartum risk scores were strongly correlated with increasing length of stay for mother and baby, lower birth weight, and lower estimated gestational age at birth. The ability of the risk-scoring system to predict selected adverse outcomes was then assessed using a high-risk cutoff score of 5 or greater. Sensitivity and positive predictive value were found to be quite low while specificity and negative predictive value were reasonably high. The results suggest that the risk-scoring system used at this institution is effective in identifying low obstetrical risk and that prenatal care reduces the probability of poor neonatal outcome among infants of women at high obstetrical risk identified through antepartum multivariate assessment. Two antepartum risk assessments, each measuring different factors, may be redundant. Not yet known are which specific factors by their identification result in more effective prenatal care.

Delivery, Obstetric↗
PubMed1988

Assessing obstetric risk. A review of obstetric risk-scoring systems.

The primary purpose of formal risk assessment in obstetrics is the prevention and consequent reduction of perinatal morbidity and mortality through early identification and intervention. Obstetric risk scoring quantifies identified risk factors according to their relative contribution to adverse perinatal outcomes and aggregates individual factor scores. A review of existing scoring methods reveals consistently low positive predictive values and more accurate prediction when the assessment occurs closer to the time of actual delivery. While numerous scoring systems exist in the literature, few are convenient in practice, and none appear to assess effectively the dynamic character of pregnancy.

Female↗
PubMed1985

Diagnosis cluster frequency in a community-based family practice residency program. Comparison with large ambulatory data sets.

Ambulatory encounters in a community-based family practice residency program were analyzed using diagnosis clusters. During an 18-month period (July 1982 through December 1983), demographic information and clinical diagnoses for 44,453 successive patient visits were collected and stored in a computerized data base. The 30 most frequent diagnosis clusters accounted for 70% of all recorded clinical diagnoses. Comparison with NAMCS, USC-MAMP (Western Region) and Virginia studies revealed a younger, more indigent population with a higher frequency of visits for hypertension, prenatal and postnatal care, diabetes, chronic respiratory illness and congestive heart failure. Consistent with the other large ambulatory data sets, the general medical examination, hypertension and acute upper respiratory conditions were the most frequent diagnosis clusters. Differences with other reported data sets reflected the site-specific demographic characteristics of patients and providers, regional and environmental influences on the incidence of specific disease states and the relative abundance of other subspecialist physicians. Such local or regional data bases not only provide valuable information as to clinical content but also may help in identifying previously unrecognized health problems.

Adolescent↗
PubMed1985

Development of a decision aid for women choosing a method of birth control.

The choice of a contraceptive method is complex and difficult. This study identifies issues for concern for women in selecting a birth control method, examines the accuracy of a self-administered questionnaire based upon these outcomes in predicting actual use, and in a preliminary fashion evaluates the usefulness of such an instrument as a decision aid. A questionnaire was designed to assess women's perceptions of the likelihood of each issue of concern for four birth control methods--oral contraceptives, intrauterine device (IUD), diaphragm, and foam or condoms--as well as the relative value of each issue. It was then tested among a convenience sample of 106 women. A weighted score was constructed by combining likelihood and value estimates for each contraceptive method. The method with the highest score was compared with actual contraceptive use and the intention to use such methods in the future. Positive predictive values were highest for pill use (83 percent) and lowest for IUD use (40 percent). While 65 percent of the sample were satisfied with their current method, 60 percent also found the questionnaire helpful. This attitude was most prevalent among younger, unmarried women. A decision aid for contraceptive decision making appears to be reasonably predictive of actual contraceptive use and helpful in thinking about the choice of a birth control method.

Adolescent↗