Dear members,
Thanks very much for the reply from Chris Hendry.
Really helpful discussion of some of the concerns that will arise from such systems. If anyone else has comments for the group or directly to myself, I would be grateful.
I, of course, have to be objective!! (lets not go there!) As I am researching how labour ward staff react to such a system, how it affects decision-making, staff teamwork, and whether it aids staff and avoids risk situations, or whether it may even add to their anxiety. The reaction of the birthing woman and her partner will also be interesting and of course should be a central factor in its use.
In my literature searches on the CTG itself, I have found much literature on the questionable nature of the CTG itself; on what it can actually reliably measure and how it has become widely used in spite of the fact that it was never clinically piloted or proved. Also on the difficulty of interpretation, and how experts differ between themselves and even give different interpretations when given the same CTG at another time.
Nevertheless, the CTG is used on the majority of high risk cases, and in some hospital on all women who have an epidural. Though I see that the latest recommendations are not to use it on 'normal' labourers, it is used in a high number of cases. The designers of the decision support system consider that if the interpretation (given all the provisos) could be made more reliable, this would be beneficial.
However, back to decision support systems and intelligent systems in general, has anyone any experience of such systems, and comments to make?
Thanks again, Gloria
-----Original Message-----
From: hendry [mailto:[log in to unmask]]
Sent: Thu 08/05/2003 21:51
To: [log in to unmask]
Cc:
Subject: Re: Computerised Decision support systems/intelligent systems
Hi to you all from the wintry south.
I really appreciate the interesting conversations and information on this
list. I am a regular lurker, but could not hold myself back on this one!
I am really concerned about the potential application of an intelligent
electronic CTG system. Firstly, how reliable are CTGs in actually telling
the story. If the woman is at an odd angle, the baby sleeping, the mother
anxious etc, all, in my experience, impact on the CTG tracing. How are you
going to get it right for the computer. Place women in a moulded bed (I hope
I am not giving anyone ideas), in a specifically simulated environment? No
matter how hard you will not replicate the 'normal' environment for that
women, so how can you determine the 'cause' of an 'irregular' CTG tracing?
What about the human dimension. Pregnancy and birthing are generally anxiety
provoking for most women. I could not imagine anything worse than being
lined up, placed in an artificial position (most pregnant women do not lie
still all day) and being told by someone else how your baby is. Are we
taking away from women their ability to judge their bodies and from midwives
the skills of knowing the subtle changes that occur in pregnancy and birth
and the 'symptoms' displayed by mother and baby as a result? What about the
effect of environment?
I really think we need to step back and think about the long term effects
for both us and women of the belief that we can safely electronically
observe pregnancy and childbirth. This has the potential to further create a
dependence on technology in pregnancy and childbirth which leads to a loss
of skills. What about the routine use of scans to determine DOB even when
the woman can pin point the date of conception!!
I am not anti technology, but I think we need to include a philosophical
critique of the potential for such technology to guide development.
Chris Hendry
(03-3489-347) or
(021-655-355)
----- Original Message -----
From: Gloria Lankshear <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, May 09, 2003 4:07 AM
Subject: Computerised Decision support systems/intelligent systems
> Dear list members,
>
> I am studying a computerised decision support system which is going to be
implemented into a NHS delivery suite shortly. It is a system that will
assist in interpreting the CTG reading of the fetal heart rate.
>
> In my literature searches I have come across many papers on the design of
expert systems and intelligent systems but no papers except the following
asking the users what they think of such systems and whether they are indeed
helpful.
>
> Hartland, J. (1993), 'The use of intelligent machines for
electrocardiograph interpretation', in Button, G. (ed.), Technology in
Working Order.
>
> Have any members had any experience of such systems themselves? Or do they
know of such systems in actual use, rather than in the design stage. I have
read about MYCIN.
>
>
>
> Thanks
>
>
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