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Wed, 15 Nov 2006 07:52:54 -0500 |
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Dear Heather and others:
Heather - I have already explained numerous times why ALL measures of intake are
subject to problems of dependability. When you say "that's just poor practice" regarding
examples of people who used a clinical indicator such as observing swallowed I would
heartily disagree. Sometimes you see a baby at one moment in time, especially in the
early days and they ARE doing fine at that moment. You may see tham a week later and
that may change entirely. Ditto if you used a scale. Many have heartily argued the
opposite - that the scale is not good because you only get one feeding, but you cannot
have it both ways. If one feeding is insufficient to judge a situation, it is insufficient to
judge a situation no matter what indicator you use. The POINT is that you really need to
do follow up and watch mother and baby over time to get a full picture.
Also, as you mentioned the second study used syringes not bottles. As has already been
posted, these are not accurate or precise either. A 10% range in the measurement of the
syringes as was previously posted can be quite large depending upon the volume. I just
calculated the range of the scale at 0.03%. That is a 100 fold difference in the precision.
Calibration is the way one judges the precision and accurancy of a tool and you have
evidence sent in to Lacnet to show that the precision and accuracy of the scale trumps the
precision and accuracy of syringes.
I would be happy to take you through the science and epidemiology of this. The studies
were poorly designed and do not follow good epidemiologic procedure for comparing
indicators. Unfortunately some doctors do not get enough training in epidemiological
techniques. One may be quite skilled in neonatology and not have a clue how to design
a good study. These studies would never have made through some of the journals that I
used to submit papers to, nor would they have even been deemed worthy of our time
when we were graduate students and THE main thing we were judged upon was how we
analyzed a study in front of our peers. The two studies would not be even considered
worthy of dissecting. If you have a copy (I'm not spending the money to download these
articles) I would be happy to privately analyze these for your.
The ISSUE that is the most important is when and how we use our tools. There are
plenty of examples of exceedingly poor use of tools. When one sets up a system where
the tool becomes primary and clinical acument and individual guidance are discarded, be
it a nipple shield, an SNS, a scale or even our hands - that tool is more of a detriment.
When it is used judiciously and in context it can be a benefit.
So, instead of harping on the accuracy and precision which is irrelevant to the discussion,
the issue is the utility of our observations of intake. We need to know their functionality
to tell us something useful. What would we change with the piece of information we get
from watching swallows or using a scale?
Again, I would argue that THE MOST important use of the scale is to prevent unecessary
bottle feeding by doctors that do not understand that bottle feeding and pumping tells us
nothing about how a baby feeds at the breast.
Best, Susan
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