Australian & New Zealand Journal of Obstetrics & Gynaecology, 1998
EDITORIAL COMMENT: We accepted this paper for publication because it discusses the important subj... more EDITORIAL COMMENT: We accepted this paper for publication because it discusses the important subject of prolonged pregnancy and whether induction of labour is associated with a significant change in the operative delivery rate and the perinatal mortality and morbidity rates. In many centres induction of labour is performed at 41 weeks' gestation in those patients who consent or wish this to be performed and indeed it is often the patient's motivation that determines the induction. Because of this practice the incidence of prolonged pregnancy which is defined as 42 weeks' gestation or beyond, has fallen from approximately 10–12% 30 years ago to about 2% in the 1990's. One of the senior reviewers of this paper provided the following statements which he considered should be kept in mind by readers of this paper. Although this is a carefully conducted study, the results and conclusions need to be interpreted with extreme caution. The words in the title ‘an observational study’ alert the reading audience to pitfalls which could result from systematic differences between the induction and ‘control’ groups which would necessarily be reflected in differences in outcomes which could then (erroneously) be attributed to the intervention. For example, women who declined the offer of induction of labour (who would therefore be ‘controls’) might also decline a recommendation for instrumental delivery which could then be misinterpreted to mean that induction of labour result in a ‘higher’ operative delivery rate compared to controls. A second caveat applies to the practice of multiple analyses of characteristics of 2 populations; 1 of 20 of such comparisons will result in p = 0.05 by chance alone. This point needs to be considered when interpreting findings reported here such as more married than unmarried women having induction of labour performed, or the conflicting finding of a decrease in the Caesarean section rate following induction for multiparas but an increase in nulliparas. These findings, and others, may be due to chance, and cannot in this observational study be viewed with the same confidence as findings derived from a randomized controlled trial.Summary: The aim of the study was to compare the 2 management protocols for postterm pregnancy; elective induction of labour at 42 weeks' gestation and continuing the pregnancy with fetal monitoring while awaiting spontaneous labour. A retrospective observational study compared a cohort of 360 pregnancies where labour was induced with 486 controls. All pregnancies were postterm (>294 days) by an early ultrasound scan. Induction of labour was achieved with either prostaglandin vaginal pessaries or gel or forewater rupture and Syntocinon infusion. The control group consisted of women with postterm pregnancies who were not induced routinely and who usually had twice weekly fetal assessment with cardiotocography and/or ultrasound. Women who had their labour induced differed from those who awaited spontaneous labour. Nulliparas (OR 1.54; 95% CI 1.24–1.83) and married women (OR 1.76; 95% CI 1.45–2.06) were more likely to have their labour induced. There was no association between the type of caregiver and induction of labour. Induction of labour was associated with a reduction in the incidence of normal vaginal delivery (OR 0.63, 95% CI 0.43–0.92) and an increased incidence of operative vaginal delivery (OR 1.46; 95% CI 1.34–2.01). There was no difference in the overall rate of Caesarean section. There was no difference in fetal or neonatal outcomes. Parity had a major influence on delivery outcomes from a policy of induction of labour. Nulliparas in the induced group had worse outcomes with only 43% achieving a normal vaginal delivery (OR 0.78, 95% CI 0.65–0.95). In contrast for multiparas, the induced group had better outcomes with less Caesarean sections (OR 0.88, 95% CI 0.81–0.96). This retrospective observational study of current clinical practice shows that induction of labour for postterm pregnancy appears to be favoured by nulliparous married women. It suggests that induction of labour may improve delivery outcomes for multigrin as but has an adverse effect for nulliparas.
Oral poster abstracts excluded the patients with the vaginal and cervical laceration and the case... more Oral poster abstracts excluded the patients with the vaginal and cervical laceration and the cases of Cesarean section (27 cases), postpartum hysterectomy (5 cases). At each scan we evaluated the location of bleeding points. If we could not find out the bleeding points, at the first, we grasped deeply the uterine cervix with ring forceps in the direction of 12, 3, 6 and 9 o' clock. After that we inserted three tablets of misoprostol (cytotec) to the anus and infused uterotonic drugs (oxytocin). When the bleeding focus was at upper segment of the uterus, we could control the bleeding with uterotonic drugs. If the bleeding was from lower segment of the uterus, we could stop the bleeding with grasping the uterine cervix with ring forceps in the direction of 12, 3, 6 and 9 o' clock and placement of the sutures at the same site. Results: The causes of the bleeding from upper segment of the uterus (15/23, 65%) were placental remnant (9 cases), atonic bleeding (5 cases), uterine inversion (1 case). we could find out the bleeding point in 80% (12/15) on ultrasonographic evaluation and stop bleeding with evacuation, curettage, manual reduction and uterotonic drugs. But we could see the bleeding point in only 25% women (2/8) with bleeding from lower segment of the uterus (8/23, 35%) on ultrasonographic examination. We could control the bleeding in these patients by grasping the cervix with ring forceps in the direction of 12, 3, 6 and 9 o' clock. Conclusions: We think that ultrasonographic examination is useful method to managing the women with postpartum bleeding, particularly the patients with bleeding from upper segment of the uterus. have collaborated in developing an educational program in the use of ultrasound technology in pregnancy care for advanced midwives in the province of KwaZulu-Natal, South Africa. The education is taking place on campus in Durban, and a follow-up Internet solution is developed. The educational program is evaluated in a Ph.D. project. The preliminary results are presented here. Objectives: The first objective is to evaluate cross-cultural, communicative and didactic challenges related to the education of the advanced midwives, both when it comes to the education on campus and the education on the Internet. The second objective is to evaluate how the advanced midwives experience the match between the educational program on the one hand and their daily work on the other. Methods: Both quantitative and qualitative methods are applied in the collection of the empirical material. The material is analyzed through theories on language and communication, mainly Critical Discourse Analysis inspired by Norman Fairclough.
Around 11,700 people in New Zealand are members of the Royal New Zealand Foundation of the Blind ... more Around 11,700 people in New Zealand are members of the Royal New Zealand Foundation of the Blind (RNZFB) and suffer from some form of visual impairment. The foundation supplies a wide range of assisted living devices along with advice and support. Recently the RNZFB has begun working with AUT to investigate potential applications of Radio Frequency identification Devices (RFID) for particular problems. This paper describes some of the application areas currently being investigated and the proof of concept prototypes that are currently being developed.
Ontologies represent a method of formally expressing a shared understanding of information, and h... more Ontologies represent a method of formally expressing a shared understanding of information, and have been seen by many authors as a prerequisite for the "Semantic web". A mapping between query terms and members of an ontology is usually a key part of any ontology enhanced searching tool. However the relative importance of a particular mapping to an overloaded term may be different for different users, and this information is vital for accurate satisfaction of a query.
and mortality from asthma in the Western world is increasing despite effective prophylactic drugs... more and mortality from asthma in the Western world is increasing despite effective prophylactic drugs. Beta agonists are increasingly considered causal; while under-prescribing of inhaled steroids or other antiinflammatories are accepted as causes for the problems, but the role of non-compliance with inhaled asthma therapy is rarely mentioned. Using a novel electromechanical counter MD1 actuations have been recorded in three small (9-l 1 patients), short (2-3 weeks) studies. When aware compliance with prescribed inhaled steroids was under scrutiny, six patients were fully compliant, two took just 70% ofthe prescibed regimen, but two did not follow the prescribed regimen at all. When unware of scrutiny, six out of 11 were compliant but five patients were estimated as taking less than 30-S 1% of the prescribed dose of inhaled steroid. When asked to monitor rescue bronchodilator usage patients consistently under-recorded.
Crowdsourcing is a technique that uses the internet to allow large numbers of people to contribut... more Crowdsourcing is a technique that uses the internet to allow large numbers of people to contribute small amounts of time and effort to a research project. Selection of SNOMED CT subsets and confirmation of algorithmic coding seems particularly appropriate use of this approach The aim of this project is to confirm that the use of a fuzzy ontology based medical coding systems is practical and effective. This paper describes the development of a prototype system that uses fuzzy logic to characterise the membership of a concept within a subset. Further development will require public access to such an engine to allow learning of relations and confirmation of their utility. Effectiveness measures including ease of use and quality of coding will confirm or refute the validity of this approach.
Gynaecology that deals with high risk pregnancies. Unlike other tertiary services such as liver t... more Gynaecology that deals with high risk pregnancies. Unlike other tertiary services such as liver transplantation, MFM deals with many different diagnoses, and often provides diagnostic advice rather than particular interventions. Because of the distributed nature of the expertise and the need to deal with many parts of the health system a Coordinated Network of expert centres has been proposed. Along with face-to-face meetings an electronic network has been proposed to facilitate this process.
In fulfilling their primary aim of patient safety, anaesthetists have traditionally focused on mo... more In fulfilling their primary aim of patient safety, anaesthetists have traditionally focused on monitoring patients' vital signs during anaesthesia. In recent years, analysis of adverse events in medicine and other safety-critical domains has seen increased interest in 'system' and 'human' factors. Task analysis is one approach that has been used to gain a deeper understanding of anaesthetists' activities and interaction with other theatre staff. In the past such studies have been intermittent, complicated by the expense and potential intrusiveness of observers. This has motivated our current research project, Towards Automated Detection of Anaesthetic Activity (TADAA). In this paper we identify three key abilities for anaesthetists -record keeping, technical knowledge and skills, and communication -and consider how ongoing, automated, real-time task analysis might enable anaesthetists to practice continuous improvement.
This paper documents work-in-progress to use Radio Frequency Identification (RFID) technology as ... more This paper documents work-in-progress to use Radio Frequency Identification (RFID) technology as part of the clinical assessment of a system to improve patient safety during anaesthesia. RFID equipment has been selected and set up to record anaesthetists' movements. The next stage will analyse the collected data to accurately identify anaesthetic activity.
Australian & New Zealand Journal of Obstetrics & Gynaecology, 1998
EDITORIAL COMMENT: We accepted this paper for publication because it discusses the important subj... more EDITORIAL COMMENT: We accepted this paper for publication because it discusses the important subject of prolonged pregnancy and whether induction of labour is associated with a significant change in the operative delivery rate and the perinatal mortality and morbidity rates. In many centres induction of labour is performed at 41 weeks' gestation in those patients who consent or wish this to be performed and indeed it is often the patient's motivation that determines the induction. Because of this practice the incidence of prolonged pregnancy which is defined as 42 weeks' gestation or beyond, has fallen from approximately 10–12% 30 years ago to about 2% in the 1990's. One of the senior reviewers of this paper provided the following statements which he considered should be kept in mind by readers of this paper. Although this is a carefully conducted study, the results and conclusions need to be interpreted with extreme caution. The words in the title ‘an observational study’ alert the reading audience to pitfalls which could result from systematic differences between the induction and ‘control’ groups which would necessarily be reflected in differences in outcomes which could then (erroneously) be attributed to the intervention. For example, women who declined the offer of induction of labour (who would therefore be ‘controls’) might also decline a recommendation for instrumental delivery which could then be misinterpreted to mean that induction of labour result in a ‘higher’ operative delivery rate compared to controls. A second caveat applies to the practice of multiple analyses of characteristics of 2 populations; 1 of 20 of such comparisons will result in p = 0.05 by chance alone. This point needs to be considered when interpreting findings reported here such as more married than unmarried women having induction of labour performed, or the conflicting finding of a decrease in the Caesarean section rate following induction for multiparas but an increase in nulliparas. These findings, and others, may be due to chance, and cannot in this observational study be viewed with the same confidence as findings derived from a randomized controlled trial.Summary: The aim of the study was to compare the 2 management protocols for postterm pregnancy; elective induction of labour at 42 weeks' gestation and continuing the pregnancy with fetal monitoring while awaiting spontaneous labour. A retrospective observational study compared a cohort of 360 pregnancies where labour was induced with 486 controls. All pregnancies were postterm (>294 days) by an early ultrasound scan. Induction of labour was achieved with either prostaglandin vaginal pessaries or gel or forewater rupture and Syntocinon infusion. The control group consisted of women with postterm pregnancies who were not induced routinely and who usually had twice weekly fetal assessment with cardiotocography and/or ultrasound. Women who had their labour induced differed from those who awaited spontaneous labour. Nulliparas (OR 1.54; 95% CI 1.24–1.83) and married women (OR 1.76; 95% CI 1.45–2.06) were more likely to have their labour induced. There was no association between the type of caregiver and induction of labour. Induction of labour was associated with a reduction in the incidence of normal vaginal delivery (OR 0.63, 95% CI 0.43–0.92) and an increased incidence of operative vaginal delivery (OR 1.46; 95% CI 1.34–2.01). There was no difference in the overall rate of Caesarean section. There was no difference in fetal or neonatal outcomes. Parity had a major influence on delivery outcomes from a policy of induction of labour. Nulliparas in the induced group had worse outcomes with only 43% achieving a normal vaginal delivery (OR 0.78, 95% CI 0.65–0.95). In contrast for multiparas, the induced group had better outcomes with less Caesarean sections (OR 0.88, 95% CI 0.81–0.96). This retrospective observational study of current clinical practice shows that induction of labour for postterm pregnancy appears to be favoured by nulliparous married women. It suggests that induction of labour may improve delivery outcomes for multigrin as but has an adverse effect for nulliparas.
Oral poster abstracts excluded the patients with the vaginal and cervical laceration and the case... more Oral poster abstracts excluded the patients with the vaginal and cervical laceration and the cases of Cesarean section (27 cases), postpartum hysterectomy (5 cases). At each scan we evaluated the location of bleeding points. If we could not find out the bleeding points, at the first, we grasped deeply the uterine cervix with ring forceps in the direction of 12, 3, 6 and 9 o' clock. After that we inserted three tablets of misoprostol (cytotec) to the anus and infused uterotonic drugs (oxytocin). When the bleeding focus was at upper segment of the uterus, we could control the bleeding with uterotonic drugs. If the bleeding was from lower segment of the uterus, we could stop the bleeding with grasping the uterine cervix with ring forceps in the direction of 12, 3, 6 and 9 o' clock and placement of the sutures at the same site. Results: The causes of the bleeding from upper segment of the uterus (15/23, 65%) were placental remnant (9 cases), atonic bleeding (5 cases), uterine inversion (1 case). we could find out the bleeding point in 80% (12/15) on ultrasonographic evaluation and stop bleeding with evacuation, curettage, manual reduction and uterotonic drugs. But we could see the bleeding point in only 25% women (2/8) with bleeding from lower segment of the uterus (8/23, 35%) on ultrasonographic examination. We could control the bleeding in these patients by grasping the cervix with ring forceps in the direction of 12, 3, 6 and 9 o' clock. Conclusions: We think that ultrasonographic examination is useful method to managing the women with postpartum bleeding, particularly the patients with bleeding from upper segment of the uterus. have collaborated in developing an educational program in the use of ultrasound technology in pregnancy care for advanced midwives in the province of KwaZulu-Natal, South Africa. The education is taking place on campus in Durban, and a follow-up Internet solution is developed. The educational program is evaluated in a Ph.D. project. The preliminary results are presented here. Objectives: The first objective is to evaluate cross-cultural, communicative and didactic challenges related to the education of the advanced midwives, both when it comes to the education on campus and the education on the Internet. The second objective is to evaluate how the advanced midwives experience the match between the educational program on the one hand and their daily work on the other. Methods: Both quantitative and qualitative methods are applied in the collection of the empirical material. The material is analyzed through theories on language and communication, mainly Critical Discourse Analysis inspired by Norman Fairclough.
Around 11,700 people in New Zealand are members of the Royal New Zealand Foundation of the Blind ... more Around 11,700 people in New Zealand are members of the Royal New Zealand Foundation of the Blind (RNZFB) and suffer from some form of visual impairment. The foundation supplies a wide range of assisted living devices along with advice and support. Recently the RNZFB has begun working with AUT to investigate potential applications of Radio Frequency identification Devices (RFID) for particular problems. This paper describes some of the application areas currently being investigated and the proof of concept prototypes that are currently being developed.
Ontologies represent a method of formally expressing a shared understanding of information, and h... more Ontologies represent a method of formally expressing a shared understanding of information, and have been seen by many authors as a prerequisite for the "Semantic web". A mapping between query terms and members of an ontology is usually a key part of any ontology enhanced searching tool. However the relative importance of a particular mapping to an overloaded term may be different for different users, and this information is vital for accurate satisfaction of a query.
and mortality from asthma in the Western world is increasing despite effective prophylactic drugs... more and mortality from asthma in the Western world is increasing despite effective prophylactic drugs. Beta agonists are increasingly considered causal; while under-prescribing of inhaled steroids or other antiinflammatories are accepted as causes for the problems, but the role of non-compliance with inhaled asthma therapy is rarely mentioned. Using a novel electromechanical counter MD1 actuations have been recorded in three small (9-l 1 patients), short (2-3 weeks) studies. When aware compliance with prescribed inhaled steroids was under scrutiny, six patients were fully compliant, two took just 70% ofthe prescibed regimen, but two did not follow the prescribed regimen at all. When unware of scrutiny, six out of 11 were compliant but five patients were estimated as taking less than 30-S 1% of the prescribed dose of inhaled steroid. When asked to monitor rescue bronchodilator usage patients consistently under-recorded.
Crowdsourcing is a technique that uses the internet to allow large numbers of people to contribut... more Crowdsourcing is a technique that uses the internet to allow large numbers of people to contribute small amounts of time and effort to a research project. Selection of SNOMED CT subsets and confirmation of algorithmic coding seems particularly appropriate use of this approach The aim of this project is to confirm that the use of a fuzzy ontology based medical coding systems is practical and effective. This paper describes the development of a prototype system that uses fuzzy logic to characterise the membership of a concept within a subset. Further development will require public access to such an engine to allow learning of relations and confirmation of their utility. Effectiveness measures including ease of use and quality of coding will confirm or refute the validity of this approach.
Gynaecology that deals with high risk pregnancies. Unlike other tertiary services such as liver t... more Gynaecology that deals with high risk pregnancies. Unlike other tertiary services such as liver transplantation, MFM deals with many different diagnoses, and often provides diagnostic advice rather than particular interventions. Because of the distributed nature of the expertise and the need to deal with many parts of the health system a Coordinated Network of expert centres has been proposed. Along with face-to-face meetings an electronic network has been proposed to facilitate this process.
In fulfilling their primary aim of patient safety, anaesthetists have traditionally focused on mo... more In fulfilling their primary aim of patient safety, anaesthetists have traditionally focused on monitoring patients' vital signs during anaesthesia. In recent years, analysis of adverse events in medicine and other safety-critical domains has seen increased interest in 'system' and 'human' factors. Task analysis is one approach that has been used to gain a deeper understanding of anaesthetists' activities and interaction with other theatre staff. In the past such studies have been intermittent, complicated by the expense and potential intrusiveness of observers. This has motivated our current research project, Towards Automated Detection of Anaesthetic Activity (TADAA). In this paper we identify three key abilities for anaesthetists -record keeping, technical knowledge and skills, and communication -and consider how ongoing, automated, real-time task analysis might enable anaesthetists to practice continuous improvement.
This paper documents work-in-progress to use Radio Frequency Identification (RFID) technology as ... more This paper documents work-in-progress to use Radio Frequency Identification (RFID) technology as part of the clinical assessment of a system to improve patient safety during anaesthesia. RFID equipment has been selected and set up to record anaesthetists' movements. The next stage will analyse the collected data to accurately identify anaesthetic activity.
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