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Biomedical subjects

J M Grant

Publications and source records attributed to J M Grant.

At least 19 recordsLinked to original sources
PubMed1992

Sweeping of the membranes is an effective method of induction of labour in prolonged pregnancy: a report of a randomized trial.

OBJECTIVE: To determine whether sweeping of the membranes is an effective method of induction of labour in women with prolonged pregnancy. DESIGN: Randomized controlled trial. SETTING: A district maternity hospital. SUBJECTS: 65 women attending an antenatal clinic; 33 randomized to sweeping of the membranes and 32 to a control group. MAIN OUTCOME MEASURE: Proportion of women achieving spontaneous labour. RESULTS: Spontaneous labour occurred more often in the sweeping of the membranes group than in the control group (25/33 (76%) vs 12/32 (38%); odds ratio (OR) 4.65; 95% confidence interval (CI) 1.75 to 12.31; P = 0.002). In addition a greater proportion of women in the sweeping group had a cervical dilatation of 4 cm or more at the first vaginal examination in the labour ward (16/33 (49%) vs 5/32 (16%); OR 4.39; 95% CI 1.56 to 12.32; P = 0.005). There were fewer maternal infections in the sweeping group (0/33 vs 4/32 (12%); OR 0.12; 95% CI 0.02 to 0.88; P = 0.04). There were no differences in the type of analgesia used in labour, the mode of delivery or neonatal outcome. CONCLUSIONS: Sweeping of the membranes is an effective method of induction of labour in women with prolonged pregnancy.

Adult↗
PubMed1992

Management of prelabour rupture of the membranes in term primigravidae: report of a randomized prospective trial.

OBJECTIVE: To compare a conservative and an active policy (immediate oxytocin infusion) of management of prelabour rupture of the membranes in term primigravidae. DESIGN: Randomized trial involving 444 women. SETTING: District maternity hospital. MAIN OUTCOME MEASURES: Caesarean section rate in each group; also the rate of forceps deliveries, spontaneous deliveries, length of labour, number of vaginal examinations, type of analgesia, pyrexia in labour or the puerperium and antibiotic use in the mother and the infant in each group. The caesarean section rate for the whole trial where the latent period was greater than 12 h was compared to that where the latent period was less than or equal to 12 h. RESULTS: There were fewer caesarean sections in the conservative group (odds ratio (OR) 0.60, 95% confidence interval (CI) 0.35 to 1.02; P = 0.06). There was a similar number of forceps deliveries (OR 0.79; 95% CI 0.52 to 1.19; P = 0.26) but more spontaneous deliveries (OR 1.57; 95% CI 1.08 to 2.29; P = 0.02) in the conservative group. More women managed conservatively required inhalational analgesia only for pain relief in labour (OR 2.88; 95% CI 1.46 to 5.68; P = 0.003), a similar number required pethidine (OR 1.29; 95% CI 0.85 to 1.94; P = 0.23), and fewer required epidural analgesia (OR 0.57; 95% CI 0.39 to 0.84; P = 0.005). The number of vaginal examinations was less in the conservative group (difference between mean 0.53; 95% CI 0.25 to 0.80; P less than 0.001). Fewer women managed conservatively experienced four or more vaginal examinations in labour (OR 0.58; 95% CI 0.39 to 0.86; P = 0.007). There were no differences in the lengths of labour, the proportions of women who developed pyrexia in labour or the puerperium or who required antibiotics or in the proportions of infants who required antibiotics. CONCLUSIONS: These results argue in favour of a conservative policy in managing primigravidae at term with prelabour rupture of the membranes.

Adult↗
PubMed1991

The fetal heart rate trace is normal, isn't it? Observer agreement of categorical assessments.

The limitations of the kappa statistic method to measure inter-observer variation of categorical assessments are shown by means of a hypothetical example. Another method for assessing the inter-observer variation of categorical variables, the proportion of agreement, is used for the same example, and reasons why it is preferable to the kappa statistic are given. Since this method allows measurement of the inherent difficulty of carrying out a particular assessment, it has wide applicability in the introduction of new technology. If a proportion of agreement study shows poor inter-observer agreement for a new method, the technology must either be improved or abandoned.

Bias↗
PubMed1990

Effectiveness of ultrasound determination of fetal abdominal circumference and fetal ponderal index in the diagnosis of asymmetrical growth retardation.

A total of 310 unselected women attending an antenatal clinic was screened for growth retardation by ultrasound between 34 and 36 weeks gestation, by measuring the fetal abdominal circumference (AC) and femoral length (FL), from which the 'fetal ponderal index' (AC/FL) was calculated. Asymmetrical growth retardation in the newborn was assessed by Rohrer's ponderal index and the mid-arm/occipito-frontal circumference (MAC/OFC) ratio within 72 h of birth, a neonatal ponderal index or MAC/OFC ratio below the 10th centile being considered abnormal. The sensitivities of an AC below the 25th centile in identifying a birthweight, neonatal ponderal index or MAC/OFC ratio below the 10th centile were 86, 62 and 67% respectively, the specificities being 80, 78 and 76%. The sensitivities of a fetal ponderal index below the 25th centile in identifying a neonatal ponderal index or MAC/OFC ratio below the 10th centile were 52 and 47% respectively, the specificities being 77 and 77%. A possible reason for the poor performance of the fetal ponderal index is discussed.

Abdomen↗
PubMed1989

A comparison of three methods of assessing inter-observer variation applied to ultrasonic fetal measurement in the third trimester.

The inter-observer variation of fetal biparietal diameter, head circumference, abdominal circumference, and femoral length measured in the third trimester by ultrasound was studied by three different methods--coefficient of variation, correlation coefficient, and the 95% limits of agreement. The coefficients of variation were 1.6 to 3.7%, the correlation coefficients were 0.89 to 0.98 with P values of less than 0.001, yet the limits of agreement when applied to centile charts were found to be too wide to separate reliably small fetuses from those that were not small. We conclude that the limits of agreement is the preferred method of assessing inter-observer variation, and we suggest that future research into growth retardation move away from ultrasonic measurements of the fetus.

Abdomen↗
PubMed1989

A comparison of three methods of assessing inter-observer variation applied to measurement of the symphysis-fundal height.

This study assesses the inter-observer variation of symphysis-fundal height measurements by three methods--the coefficient of variation, the correlation coefficient and the limits of agreement. The coefficient of variation was 4% and the correlation coefficient 0.959, yet the limits of agreement were very wide. Applying these limits to centile charts of symphysis-fundal height shows that the fundal height cannot be measured by different observers with sufficient agreement to separate small fundal heights from those which are not small, and this severely limits the usefulness of measurement of the symphysis-fundal height as a screening test for intrauterine growth retardation. We conclude that inter-observer variation should be assessed by the method of limits of agreement, and not by calculating the coefficient of variation or the correlation coefficient.

Female↗
PubMed1986

Spinal injury and computerized tomography: a review of fracture pathology and a new approach to canal decompression.

The plain X-rays and CT scans of 23 cases of thoracolumbar and 18 cases of lower cervical (below C2) spinal compression fractures were compared. A new picture of the fracture pathology has emerged as several features consistently appeared and are described: a midline or slightly oblique split of the vertebral body; posterolateral fractures of the body in the region of the developmental neurocentral joint; fragments of the body displaced backwards into the canal at the level of the pedicles; oblique laminal fractures; and separation of the zygapophyseal rim in thoracolumbar fractures. With this more complete picture of the bony injury, in particular canal encroachment, a new method of anterolateral canal decompression has been tried and is described.

Adolescent↗
PubMed1986

Clinical course and outcome of severe head injury in Australia.

The records of 159 severely head-injured patients (all in coma for longer than 6 hours) from Sydney, Australia, were studied. The clinical course, charted over a 2-week period, indicated that 60% of deaths occur by Day 3 and that 12% of patients remain in coma (Glagow Coma Scale (GCS) score less than 7) for more than 2 weeks. Overall, at long-term follow-up review more than 2 years after injury, 51% of patients were dead, 7% were severely disabled or vegetative, and 42% had a good to moderate recovery. Outcome of the patients in prolonged coma was assessed separately, with only one-third making a good or moderate recovery; two-thirds of the severely disabled patients came from this group. The high proportion of poor outcomes associated with prolonged coma suggests that this group of patients should be specifically targeted in research. One appropriate intervention with this group would be the restructuring and intensification of early rehabilitation. However, the GCS score lacks the precision needed for this type of study, and a better measure of recovery should be developed.

Adult↗
PubMed1985

Arterial Brown-Séquard's syndrome after a penetrating injury of the spinal cord at the cervicomedullary junction.

A case of a 12-year-old boy, in whom a partial Brown-Séquard's syndrome developed after a gunshot injury to the back of the neck, is reported. The bullet, which was removed at operation, penetrated the left side of the spinal cord at the cervicomedullary junction. The patient recovered useful function in his left leg within a month after the injury, and was able to walk with the aid of a crutch on discharge from hospital. The case is unusual, because of the survival and subsequent good recovery of the patient after a high, penetrating injury of the spinal cord.

Child↗
PubMed1978

Cutaneous manifestation of internal malignancies (I). Acanthosis nigricans.

Skin changes may be the first clue to a neoplastic process at a stage when it still is treatable (Such as the development of Acanthosis Nigrican (AN) in an otherwise healthy adult). Ninety percent of the neoplasm responsible for the development of AN originate in the abdomen. The tumor, even in a subclinical state, seems to possess unidentified properties that activate the dermatosis.

Acanthosis Nigricans↗