Interobserver variation in the assessment of fetal heart rate recordings.

Electronic fetal heart rate monitoring (EFM) has not fulfilled its expectations. To improve its validity various attempts were made to standardize terminology and assessment of fetal heart rate (FHR) recordings. In a multinational study, 21 experienced obstetricians were asked to segment and classify FHR patterns, recorded in 13 obstetric cases. In addition, the referees were asked to give their interpretation of the FHR pattern, to assess the fetal condition and to propose obstetric management. The kappa statistic showed fair agreement among the obstetricians for the classification of accelerations, baseline segments and decelerations. Poor agreement was found when the referees had to classify baseline variability or the type of deceleration. Also, the clinical assessment of fetal condition and proposals for obstetric management showed poor agreement among the referees. We conclude there is still a lack of unequivocal terminology and definitions in the assessment of FHR recordings.

Interpretation of low kappa values.

The use of the kappa statistic is commonly accepted as a measure for interobserver variability. However, in some situations, the interpretation of kappa should be handled with care. In this study 21 obstetricians were asked to segment and classify 13 cardiotocographic recordings for the major fetal heart rate (FHR) patterns acceleration, baseline FHR level, deceleration and undefined segments. In two cases the kappa statistic showed a poor group agreement. These low kappa values, however, were mainly due to the high proportion of baseline segments indicated by the referees. This finding will be exemplified by a discussion of one of the cases.

The effects of neurotensin, naloxone and haloperidol on elements of excessive grooming behavior induced by bombesin.

The influence of naloxone, haloperidol and neurotensin was investigated on bombesin-induced excessive grooming in rats. All three drugs reduced the amount of bombesin-induced grooming. Haloperidol induced a general reduction in excessive grooming as induced by bombesin, without changing the composition of grooming behavior, whereas naloxone and neurotensin suppressed bombesin-induced grooming and caused a shift in the distribution of grooming elements. The main suppressive effect of these latter drugs appeared to be on the element scratching. From these data it is suggested that bombesin-induced scratching is mainly displayed by activation of opiate receptor systems, whereas the other elements of bombesin-induced excessive grooming are mainly regulated by dopaminergic systems.

A computer program for the analysis of serial electrocardiograms from patients who suffered a myocardial infarction.

A program is described, which compares serial ECG recordings of patients, who suffered a myocardial infarction. The comparison of the ECGs is based on the measurements, delivered by the Modular ECG/VCG Interpretation System. The two most recent ECGs are compared and a trend analysis based on all ECG recordings of the patient is performed. The criteria in the comparison program are based, among others, on data obtained from a combined cardiological and respiratory survey in The Netherlands in 1973 and 1976.

Comparison between excessive grooming induced by bombesin or by ACTH: the differential elements of grooming and development of tolerance.

Bombesin and ACTH-(1-24) induce a dose dependent increase in grooming behavior. Lower doses of bombesin induce a more general type of compulsive grooming in which most elements are involved, whereas higher amounts of bombesin induce a shift towards the element scratching at the cost of bodily grooming and sexual grooming. In contrast ACTH-(1-24) induces a dose dependent increase of all elements of grooming. It is concluded that the grooming displayed by animals treated with ACTH-(1-24) or with bombesin is of a completely different nature. In addition it is observed that under the conditions used tolerance occurs for the grooming inducing effect of ACTH-(1-24), but not for that of bombesin. Moreover, it appears that no cross tolerance exists between bombesin and ACTH-(1-24).