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M L Barclay

Publications and source records attributed to M L Barclay.

52 records · Page 3Linked to original sources
PubMed1989

The integration of computer conferencing into the medical school curriculum.

A computer conference was developed for use with students, faculty, and staff at a large state-funded medical school. The conference was intended to increase communication among these groups which study, work, and train at a variety of locations across the state. To date, 583 participants (91% are students, 6% are faculty, and 2% are staff) have discussed a variety of academic, ethical, social, and administrative issues. Conference use is required during the obstetrics-gynecology third year clerkship, and has also been used to evaluate courses and critique course examinations. The procedures for creating a computer conference, implementing its use in the curriculum, and evaluating its effectiveness are discussed.

Communication↗
PubMed1987

A new technique to overcome failed second-trimester amniocentesis due to membrane tenting.

Membrane tenting during amniocentesis is a significant cause of dry taps, leading to immediate procedure failure or multiple needle insertions. Because of the increased risk of fetal loss and other minor complications reported with multiple taps, a means of accomplishing fluid retrieval on a single pass is desirable. We describe a new single-pass technique that involves further needle penetration into the posterior myometrium, under ultrasound guidance, physically displacing the obstructing membranes down the shaft away from the tip.

Amniocentesis↗
PubMed1981

Gestational age assessment. II. Prediction from combined clinical observations.

Accurate assessment of the estimated date of confinement is a cornerstone of obstetric care. In an earlier report, we examined the time of occurrence of various historical and clinical estimators of gestational age in relation to the date of delivery. We now examine the possibility of combining multiple clinical estimators to improve the prediction of delivery date. Formulas for predicting delivery date from multiple clinical estimators were developed in a group of 418 patients who were delivered of infants weighing greater than or equal to 3,000 gm, after spontaneous onset of labor. These formulas were tested in a separate group of 107 patients who fulfilled similar criteria. In patients with a known last menstrual period, additional clinical information did not improve the prediction of delivery date; however, if the last menstrual period was uncertain or unknown, averaging the predicted delivery dates by several clinical examinations provided a prediction of delivery date as precise as if the last menstrual period were known.

Female↗
PubMed1981

Gestational age assessment. I. analysis of individual clinical observations.

Accurate assessment of the estimated date of confinement is a cornerstone of obstetric care. Traditionally this date has been predicted from historical and clinical examinations; however, there have been few studies of the accuracy of such predictions. Multiple estimators of gestational age were examined in 418 patients who were delivered of infants weighting larger than or equal to 3,000 gm, following spontaneous onset of labor. Mean intervals from an event to delivery were calculated for last menstrual period (284.2 days), quickening (156.3 days), first audible fetal heart tones (136.2 days), uterine fundus at the umbilicus (140.8 days), and measurements of the fundal height. The variability in each of these estimators was examined and compared. The last menstrual period, if known with certainty, is the most accurate estimator, followed by the uterus at the umbilicus, first heard fetal heart tones, fundal height, and quickening.

Adolescent↗
PubMed1980

Plasma estriol in the evaluation of third-trimester gestational age.

This study attempts to confirm previous reports of a clinically useful serum unconjugated estriol surge at 36 weeks' gestation. Although an apparently physiologic estriol surge occurred at 36 +/- 2.1 weeks in 25 of 32 patients, clinical reality makes weekly plasma sampling difficult. In individual cases, use of the "surge point" predicted gestational age within a 4-week range with only 66% accuracy, and potentially serious errors in dating occurred. Other biochemical (lecithin:sphingomyelin, phosphatidylglycerol) and sonographic methods are superior in resolving problems with dating gestational age in the third trimester.

Estriol↗
PubMed1979

Diurnal variations in unconjugated and total plasma estriol levels in late normal pregnancy.

Diurnal variations in plasma unconjugated and total estriol were assessed in 11 third-trimester subjects with uncomplicated pregnancies. Commercially available 125I-labeled radioimmunoassay kits were used. Total plasma estriols reach a nadir during the hours of sleep (400 and 700 hours) which exceeds the episodic fluctuations seen from day to day or during a given 90-minute period. Plasma unconjugated estriol fluctuations over 24 hours did not significantly exceed our previously reported episodic fluctuation of 15.6 +/- 8.2%. The data are interpreted as showing no circadian rhythm, but reflecting, in the case of total plasma estriols, an effect of improved renal clearance during hours of rest. Plasma unconjugated estriol emerges as the test of choice in the monitoring of high-risk pregnancies.

Adult↗
PubMed1978

Plasma estriol vs. estrogen assays in 24-h urines as an index to fetal status.

Conventionally, urinary estrogens are measured to monitor fetal well-being in the third trimester of pregnancy. There are many theoretical and practical advantages to the use of recently introduced plasma estriol assays; consequently, we undertook to compare the results of a spectrophotometric assay for total urinary estrogen with values for plasma total and free (unconjugated) estriol obtained by radioimmunoassay with commercially available kits. The data correlate well, r = 0.70 for plasma total estriol with urinary estrogen (expressed as milligrams of estrogens per gram of creatinine [E/C]), r = 0.79 for plasma free estriol with E/C, and r = 0.71 between the two plasma values. Minute-to-minute fluctuations during 90 min and day-to-day fluctuations followed during five days suggest that fluctuations of up to +/- 45% are within the normal range (means +/- SD of the day-to-day fluctuations were 16.9 +/- 7.7% and 15.6+/- 8.2%). Turn-around time is a minimum of 29 h for the urinary estrogen assay, 4.5 h for the plasma total estriol, and 3 h for the plasma free estriol.

Estriol↗
PubMed1977

Wave-form analysis of intrauterine pressure curves with methods and models developed in cardiac research.

With the Hill model of muscle dynamics and a modified cardiac model, a series of computer programs have been generated which permit the description of certain aspects of uterine contractility and uterine function in human parturition. Patterns of labor relating to delivery outcome, dysfunctional uterine activity, and use of drugs are discussed with reference to the parameters measured in the study. Central tendencies among 70 spontaneous and induced labors (6,302 contractions) are presented and discussed. (Am. J. Obstet. Gynecol.

Cardiology↗
PubMed1976

Aspects of the normal psychology of pregnancy: the midtrimester.

In this study of nonpregnant women were compared with pregnant women. A set of feelings and attitudes along with questions relevant to the anatomy and physiology of parturition were the measures of comparison. The pregnant women and the nonpregnant women had almost identical feelings and attitudes. There were, however, three exceptions to this general condordance. They were: (1) the nonpregnant women's regard of pregnancy as a depressive and withdrawing experience, (2) a greater fear for the fetus among the nonpregnant women, and (3) higher scores on a pregnancy information inventory among the pregnant women.

Adjustment Disorders↗
PubMedDate not supplied

ESTAGEST: an obstetrical application program in BASIC for the computation of estimated date of confinement.

The establishment of the estimated date of confinement (EDC) is an essential element in the care of pregnant women. Unfortunately, accurate information on the last menstrual period, the usual determinant of EDC, is not always available, or clinical estimations of gestational age may be discrepant. Prior studies have demonstrated that an average of several clinical examinations can provide a useful prediction of EDC. We have developed a simple BASIC computer program which allows the clinician to input up to 20 clinical examinations and determines the average EDC based on the clinical dates. The program displays the EDC for each individual examination, which provides an indication of the dispersion, or discrepancy, among the examinations. Average intervals to delivery date from the occurrence of clinical estimators of gestation are based on observed data at our institution and can be easily modified to fit local norms.

Algorithms↗