Clinicians can often face dilemmas in the care of adolescents owing to the lack of understanding over the legal rights and ethical responsibilities involved in their care. A clinician looking after an adolescent should have a good understanding of the principles of adolescent consenting. Often it is necessary to involve the multidisciplinary team and, in extreme circumstances, the court when there is a dispute regarding the competence of the adolescent to consent. Every unit should ensure that they have guidelines for paediatric adolescent gynaecology (PAG) consenting. Areas requiring specific consideration in PAG consent are discussed in this article.
{"title":"Consenting, competence and confidentiality in paediatric adolescent gynaecology","authors":"R. Pillai, M. Narayanan, M. Choudhary","doi":"10.1111/tog.12866","DOIUrl":"https://doi.org/10.1111/tog.12866","url":null,"abstract":"Clinicians can often face dilemmas in the care of adolescents owing to the lack of understanding over the legal rights and ethical responsibilities involved in their care. A clinician looking after an adolescent should have a good understanding of the principles of adolescent consenting. Often it is necessary to involve the multidisciplinary team and, in extreme circumstances, the court when there is a dispute regarding the competence of the adolescent to consent. Every unit should ensure that they have guidelines for paediatric adolescent gynaecology (PAG) consenting. Areas requiring specific consideration in PAG consent are discussed in this article.","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44032556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abortion is never far from the news: the past 12 months has seen the United States Supreme Court overturn Roe v Wade and the introduction of buffer zones outside of abortion clinics in England and Wales. Regardless of each clinician’s views or workplace, we will all encounter patients who need or who have had abortions. Globally, each year an estimated 25 million unsafe abortions take place, which is why the Royal College of Obstetricians and Gynaecologists (RCOG)‘s Centre for Women’s Health has prioritised safe abortion through the Leading Safe Choices and Making Abortion Safe programmes. Although the legal framework will differ between countries, clinical guidelines can be found in the RCOG Best Practice Papers, in four different languages. Furthermore, The Obstetrician & Gynaecologist (TOG) has published numerous articles relevant to clinicians caring for people who have abortions. In this Spotlight, several have been identified to highlight some of the most relevant issues.
{"title":"Spotlight on… abortion care","authors":"Kate Sutcliffe, N. Mullin","doi":"10.1111/tog.12864","DOIUrl":"https://doi.org/10.1111/tog.12864","url":null,"abstract":"Abortion is never far from the news: the past 12 months has seen the United States Supreme Court overturn Roe v Wade and the introduction of buffer zones outside of abortion clinics in England and Wales. Regardless of each clinician’s views or workplace, we will all encounter patients who need or who have had abortions. Globally, each year an estimated 25 million unsafe abortions take place, which is why the Royal College of Obstetricians and Gynaecologists (RCOG)‘s Centre for Women’s Health has prioritised safe abortion through the Leading Safe Choices and Making Abortion Safe programmes. Although the legal framework will differ between countries, clinical guidelines can be found in the RCOG Best Practice Papers, in four different languages. Furthermore, The Obstetrician & Gynaecologist (TOG) has published numerous articles relevant to clinicians caring for people who have abortions. In this Spotlight, several have been identified to highlight some of the most relevant issues.","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48268221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Okolo, Malini Prasad, Farah Siddiqui, Jo Mountfield, Rehan Khan, S. Ward, E. Peregrine, K. Joash, Simon Bowen, Bridget Agboola, C. Edwards, Sarah Elkhatim, Sonia Dore, R. Thakar
Isioma Dianne Okolo MBChB DTMH MPH MRCOG,* Malini Prasad FRCOG MMed Edu MSc MD, Farah Siddiqui MD FRCOG, Jo Mountfield FRCOG, Rehan Khan MRCOG DipIPM, Susan Ward FRCOG, Elisabeth Peregrine FRCOG, Karen Joash MRCOG, Simon Bowen MBA BA, Bridget Agboola, Carly Edwards, Sarah Elkhatim MRCOG, Sonia Dore Psych MSc BSc, Ranee Thakar MD FRCOG Research Fellow, Program in Global Surgery & Social Change, Harvard Medical School, Boston, MA 02115, USA Specialty Registrar ST7, Department of Obstetrics and Gynaecology, Royal Infirmary of Edinburgh, Edinburgh, Lothian EH16 4SA, UK Consultant, Department of Obstetrics and Gynaecology, West Suffolk Hospital NHS Foundation Trust, Bury St Edmunds IP33 2QZ, UK Consultant in Fetal and Maternal Medicine and Obstetrician Training Programme Director, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK Vice President Workforce and Professionalism, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, Royal London Hospital, London E1 1FR, UK Differential Attainment Advisor, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, Sherwood Forest Hospitals NHS Trust, Sutton-InAshfield, Nottinghamshire NG17 4JL, UK Vice President Education, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK Consultant, Department of Obstetrics and Gynaecology, Kingston Hospital NHS Foundation Trust, Surrey KT2 7QB, UK Educational Supervisor Champion, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, Queen Charlotte’s & Chelsea Hospital, London W12 0HS, UK Director of Membership, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK Medical Student, College of Medicine & Veterinary Medicine, University of Edinburgh, Lothian EH16 4SA, UK Executive Director, Education and Quality, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK Specialty Doctor, Obstetrics & Gynaecology, Pilgrim Hospital, United Lincolnshire Hospitals Trust, LN2 5QY, UK Head of Programme, Race Equality Taskforce, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK Consultant Urogynaecologist, Urogynaecology Department, Croydon University Hospital, London CR7 7YE, UK Chair, Race Equality Taskforce, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK President, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK *Correspondence: Isioma Dianne Okolo. Email: isioma.okolo@nhslothian.scot.nhs.uk
Isioma Dianne Okolo MBChB DTMH MPH MRCOG，* Malini Prasad FRCOG MMed Edu MSc MD, Farah Siddiqui MD FRCOG, Jo Mountfield FRCOG, Rehan Khan MRCOG DipIPM, Susan Ward FRCOG, Elisabeth Peregrine FRCOG, Karen Joash MRCOG, Simon Bowen MBA BA, Bridget Agboola, Carly Edwards, Sarah elkatim MRCOG, Sonia Dore心理学理学硕士BSc, Ranee Thakar MD FRCOG研究员，全球外科与社会变革项目，哈佛医学院，马萨诸塞州波士顿02115，美国专业注册ST7，爱丁堡皇家医院妇产科，爱丁堡，洛锡安EH16 4SA，英国顾问，西萨福克医院NHS基金会信托，伯里圣埃德蒙兹IP33 2QZ，英国胎儿和孕产妇医学顾问和产科医生培训计划主任，莱斯特大学医院NHS信托，莱斯特le15 ww，英国副总裁劳动力和专业，皇家妇产科学院，伦敦SE1 1SZ，英国皇家伦敦医院妇产科咨询医师，伦敦E1 1FR，英国皇家妇产科学院差异成就顾问，伦敦SE1 1SZ，英国妇产科咨询医师，诺丁汉郡萨顿-伊什菲尔德舍伍德森林医院NHS信托，英国妇产科咨询医师，英国皇家妇产科学院教育副校长，伦敦SE1 1SZ，萨里KT2 7QB金士顿医院NHS基金会信托基金英国妇产科顾问，英国教育督导冠军，皇家妇产科学院，伦敦SE1 1SZ，英国妇产科顾问，伦敦w120hs夏洛特女王和切尔西医院，伦敦SE1 1SZ，英国皇家妇产科学院会员主任，英国医科学生，爱丁堡大学医学与兽医学院，洛锡安EH16 4SA，英国教育与质量执行董事，皇家妇产科学院，伦敦SE1 1SZ，英国专科医生，妇产科，联合林肯郡医院信托基金会，ln25qy，英国项目负责人，种族平等工作组，皇家妇产科学院，伦敦SE1 1SZ，英国泌尿妇科顾问，泌尿妇科，克罗伊登大学医院，伦敦CR7 7YE，英国皇家妇产科学院种族平等工作组主席，伦敦SE1 1SZ，英国皇家妇产科学院院长，伦敦SE1 1SZ *通讯:Isioma Dianne Okolo。电子邮件:isioma.okolo@nhslothian.scot.nhs.uk
{"title":"A race to the finish line","authors":"I. Okolo, Malini Prasad, Farah Siddiqui, Jo Mountfield, Rehan Khan, S. Ward, E. Peregrine, K. Joash, Simon Bowen, Bridget Agboola, C. Edwards, Sarah Elkhatim, Sonia Dore, R. Thakar","doi":"10.1111/tog.12863","DOIUrl":"https://doi.org/10.1111/tog.12863","url":null,"abstract":"Isioma Dianne Okolo MBChB DTMH MPH MRCOG,* Malini Prasad FRCOG MMed Edu MSc MD, Farah Siddiqui MD FRCOG, Jo Mountfield FRCOG, Rehan Khan MRCOG DipIPM, Susan Ward FRCOG, Elisabeth Peregrine FRCOG, Karen Joash MRCOG, Simon Bowen MBA BA, Bridget Agboola, Carly Edwards, Sarah Elkhatim MRCOG, Sonia Dore Psych MSc BSc, Ranee Thakar MD FRCOG Research Fellow, Program in Global Surgery & Social Change, Harvard Medical School, Boston, MA 02115, USA Specialty Registrar ST7, Department of Obstetrics and Gynaecology, Royal Infirmary of Edinburgh, Edinburgh, Lothian EH16 4SA, UK Consultant, Department of Obstetrics and Gynaecology, West Suffolk Hospital NHS Foundation Trust, Bury St Edmunds IP33 2QZ, UK Consultant in Fetal and Maternal Medicine and Obstetrician Training Programme Director, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK Vice President Workforce and Professionalism, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, Royal London Hospital, London E1 1FR, UK Differential Attainment Advisor, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, Sherwood Forest Hospitals NHS Trust, Sutton-InAshfield, Nottinghamshire NG17 4JL, UK Vice President Education, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK Consultant, Department of Obstetrics and Gynaecology, Kingston Hospital NHS Foundation Trust, Surrey KT2 7QB, UK Educational Supervisor Champion, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, Queen Charlotte’s & Chelsea Hospital, London W12 0HS, UK Director of Membership, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK Medical Student, College of Medicine & Veterinary Medicine, University of Edinburgh, Lothian EH16 4SA, UK Executive Director, Education and Quality, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK Specialty Doctor, Obstetrics & Gynaecology, Pilgrim Hospital, United Lincolnshire Hospitals Trust, LN2 5QY, UK Head of Programme, Race Equality Taskforce, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK Consultant Urogynaecologist, Urogynaecology Department, Croydon University Hospital, London CR7 7YE, UK Chair, Race Equality Taskforce, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK President, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK *Correspondence: Isioma Dianne Okolo. Email: isioma.okolo@nhslothian.scot.nhs.uk","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42225629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Khairudin, Z. Alfirevic, F. Mone, K. Navaratnam
Hydrops fetalis is the accumulation of two or more fetal fluid collections, including pericardial effusion, pleural effusion(s), ascites and skin oedema. In the absence of red cell alloimmunisation, hydrops fetalis is non‐immune and affects approximately 1 in 2000 pregnancies. Non‐immune hydrops fetalis (NIHF) is associated with severe perinatal morbidity/mortality and significant maternal risks, including maternal mirror syndrome. Priorities for clinicians are determining the cause antenatally to optimise management and discuss treatment options, if available. Systematic reviews have indicated that a cause can be identified prenatally in ~60% cases. Recent evidence indicates fetal exome sequencing can provide a diagnosis in 30% of previously unexplained cases.
{"title":"Non‐immune hydrops fetalis: a practical guide for obstetricians","authors":"D. Khairudin, Z. Alfirevic, F. Mone, K. Navaratnam","doi":"10.1111/tog.12862","DOIUrl":"https://doi.org/10.1111/tog.12862","url":null,"abstract":"Hydrops fetalis is the accumulation of two or more fetal fluid collections, including pericardial effusion, pleural effusion(s), ascites and skin oedema. In the absence of red cell alloimmunisation, hydrops fetalis is non‐immune and affects approximately 1 in 2000 pregnancies. Non‐immune hydrops fetalis (NIHF) is associated with severe perinatal morbidity/mortality and significant maternal risks, including maternal mirror syndrome. Priorities for clinicians are determining the cause antenatally to optimise management and discuss treatment options, if available. Systematic reviews have indicated that a cause can be identified prenatally in ~60% cases. Recent evidence indicates fetal exome sequencing can provide a diagnosis in 30% of previously unexplained cases.","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44698075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Freeman, Gareth Squire, A. Herrey, K. Hogrefe, R. Allen
Maternal mortality from cardiovascular disease has not improved in almost 20 years; this contrasts to significant sustained improvement in cardiovascular outcomes in the nonpregnant population, particularly regarding acute coronary syndrome (ACS). Many of the women who died in recent MBRRACE‐UK reports presented with cardiac symptoms and signs, but this was not always recognised upon clinical review. The incidence of ACS is increasing alongside advancing maternal age, with an accompanying increased prevalence of typical and pregnancy‐specific cardiac risk factors. Early involvement of senior clinicians and a multidisciplinary approach is crucial for improving maternal outcomes. Counselling women on long term prognosis and implications for future pregnancy is vital.
{"title":"Acute coronary syndromes in pregnancy: a literature review","authors":"A. Freeman, Gareth Squire, A. Herrey, K. Hogrefe, R. Allen","doi":"10.1111/tog.12861","DOIUrl":"https://doi.org/10.1111/tog.12861","url":null,"abstract":"Maternal mortality from cardiovascular disease has not improved in almost 20 years; this contrasts to significant sustained improvement in cardiovascular outcomes in the nonpregnant population, particularly regarding acute coronary syndrome (ACS). Many of the women who died in recent MBRRACE‐UK reports presented with cardiac symptoms and signs, but this was not always recognised upon clinical review. The incidence of ACS is increasing alongside advancing maternal age, with an accompanying increased prevalence of typical and pregnancy‐specific cardiac risk factors. Early involvement of senior clinicians and a multidisciplinary approach is crucial for improving maternal outcomes. Counselling women on long term prognosis and implications for future pregnancy is vital.","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46790557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
W. Yoong, V. Sampson, Lusekelo Mwenechanya, J. Baekelandt
Endoscopic Surgery): is this the future of gynaecological surgery? Wai Yoong MD FRCOG,* Victoria Sampson MRCOG, Lusekelo Mwenechanya MBBS, Jan Baekelandt MD PhD Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK Specialist Trainee, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK Gynaecological Oncologist, Department of Gynaecology, Imelda Hospital, Bonheiden, Belgium *Correspondence: Wai Yoong. Email: waiyoong@nhs.net
{"title":"vNOTES (vaginal Natural Orifice Transluminal Endoscopic Surgery): is this the future of gynaecological surgery?","authors":"W. Yoong, V. Sampson, Lusekelo Mwenechanya, J. Baekelandt","doi":"10.1111/tog.12860","DOIUrl":"https://doi.org/10.1111/tog.12860","url":null,"abstract":"Endoscopic Surgery): is this the future of gynaecological surgery? Wai Yoong MD FRCOG,* Victoria Sampson MRCOG, Lusekelo Mwenechanya MBBS, Jan Baekelandt MD PhD Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK Specialist Trainee, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK Gynaecological Oncologist, Department of Gynaecology, Imelda Hospital, Bonheiden, Belgium *Correspondence: Wai Yoong. Email: waiyoong@nhs.net","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48190530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jacqueline Sia, S. Strong, T. Doulgeraki, Emily Benson, E. Ball
Dear Editor, We read with interest the article on telemedicine in obstetrics and gynaecology. Following this, we were inspired to undertake a patient satisfaction survey with virtual appointments within our gynaecology clinics. In line with the NHS vision for ‘digitally enabled’ health care, virtual clinics were introduced rapidly during the COVID-19 pandemic. In July 2020, ‘remote first’ became a long-term government policy with plans for a future high proportion of virtual appointments. Although Trusts were given the video platform ‘attend anywhere’, most remote consultations have been and remain by telephone. We note that in UK gynaecology units, the uptake of video consultations is lower compared with other specialties. Video appointments present the additional benefit of allowing patients to see their clinicians and aids rapport building through nonverbal communication, simulating ‘face-to-face’ interaction. We audited against the ‘Getting It Right First Time (GIRFT)’ standard that 25% of all gynaecological consultations should be virtual and found that in our unit, the percentage of virtual consultations was 18.3%. A total of 80 service users were asked about satisfaction with their phone appointment held between October and December 2021, in a variety of gynaecology clinics in an ethnically diverse, busy, inner London teaching hospital, using a questionnaire based on published validated surveys. Of the women questioned, 76% were from a Black, Asian and Minority Ethnic (BAME) background. Using a Likert scale from 1–5, most (87.5%) ‘strongly agreed’ or ‘agreed’ that they felt comfortable communicating about their condition over the telephone, 79% felt that their doctor understood their concern and 71.2% felt that their healthcare needs were addressed. Whilst these values of satisfaction appeared high, only 50% scored a ‘4’ or a ‘5’ when asked if they were happy with their management and about satisfaction with their consultation. Less than half (41%) would want to use the service again. Bhalla et al.’s call to provide an evidence-base in telemedicine is essential amidst widespread implementation of telephone consultations within NHS gynaecology services. We question if telephone appointments should be given to all women by default and if more consideration should be given to video consultations. Our unit’s population comes from one of the most deprived London boroughs, and such patients from lower socioeconomic backgrounds and ethnic minority groups are at higher risk of health inequalities, particularly from remote consultations. Further inquiry into the factors to explain the mismatch between our patients’ expectations and care received could potentially reduce the health inequality gap with remote consultations, in keeping with a previously published notion “if virtual gynaecology clinics are here to stay, we need to include everyone”.
{"title":"Re: Working remotely: a perspective on telemedicine in delivery of obstetrics and gynaecology health care","authors":"Jacqueline Sia, S. Strong, T. Doulgeraki, Emily Benson, E. Ball","doi":"10.1111/tog.12859","DOIUrl":"https://doi.org/10.1111/tog.12859","url":null,"abstract":"Dear Editor, We read with interest the article on telemedicine in obstetrics and gynaecology. Following this, we were inspired to undertake a patient satisfaction survey with virtual appointments within our gynaecology clinics. In line with the NHS vision for ‘digitally enabled’ health care, virtual clinics were introduced rapidly during the COVID-19 pandemic. In July 2020, ‘remote first’ became a long-term government policy with plans for a future high proportion of virtual appointments. Although Trusts were given the video platform ‘attend anywhere’, most remote consultations have been and remain by telephone. We note that in UK gynaecology units, the uptake of video consultations is lower compared with other specialties. Video appointments present the additional benefit of allowing patients to see their clinicians and aids rapport building through nonverbal communication, simulating ‘face-to-face’ interaction. We audited against the ‘Getting It Right First Time (GIRFT)’ standard that 25% of all gynaecological consultations should be virtual and found that in our unit, the percentage of virtual consultations was 18.3%. A total of 80 service users were asked about satisfaction with their phone appointment held between October and December 2021, in a variety of gynaecology clinics in an ethnically diverse, busy, inner London teaching hospital, using a questionnaire based on published validated surveys. Of the women questioned, 76% were from a Black, Asian and Minority Ethnic (BAME) background. Using a Likert scale from 1–5, most (87.5%) ‘strongly agreed’ or ‘agreed’ that they felt comfortable communicating about their condition over the telephone, 79% felt that their doctor understood their concern and 71.2% felt that their healthcare needs were addressed. Whilst these values of satisfaction appeared high, only 50% scored a ‘4’ or a ‘5’ when asked if they were happy with their management and about satisfaction with their consultation. Less than half (41%) would want to use the service again. Bhalla et al.’s call to provide an evidence-base in telemedicine is essential amidst widespread implementation of telephone consultations within NHS gynaecology services. We question if telephone appointments should be given to all women by default and if more consideration should be given to video consultations. Our unit’s population comes from one of the most deprived London boroughs, and such patients from lower socioeconomic backgrounds and ethnic minority groups are at higher risk of health inequalities, particularly from remote consultations. Further inquiry into the factors to explain the mismatch between our patients’ expectations and care received could potentially reduce the health inequality gap with remote consultations, in keeping with a previously published notion “if virtual gynaecology clinics are here to stay, we need to include everyone”.","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43048824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Back in 2015 I was asked to write the first ‘Spotlight on. . . maternal medicine’ – here I am reprising it in 2022. It has given me great delight to look back at The Obstetrician and Gynaecologist (TOG)’s publishing history over the last 7 years to see the ongoing commitment by way of relevant, highquality, authoritative articles on subjects ranging from suicide to sepsis. There are many such articles, so I have chosen to focus on the ones relevant to the most recent MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) Maternal Mortality Surveillance and Confidential Enquiry Report. TOG has been privileged to feature regular articles from Prof Marian Knight informing us on the highlights from MBRRACE-UK and the UK obstetric surveillance system (UKOSS). Many of you will have seen the recent MBRRACEUK report, which again highlights suicide, cardiac disease, thrombosis and neurological disease (commonly epilepsy) as the commonest causes of maternal death in the UK. These subjects, and more, have been covered in TOG.
{"title":"Spotlight on… maternal medicine","authors":"Kate Harding","doi":"10.1111/tog.12851","DOIUrl":"https://doi.org/10.1111/tog.12851","url":null,"abstract":"Back in 2015 I was asked to write the first ‘Spotlight on. . . maternal medicine’ – here I am reprising it in 2022. It has given me great delight to look back at The Obstetrician and Gynaecologist (TOG)’s publishing history over the last 7 years to see the ongoing commitment by way of relevant, highquality, authoritative articles on subjects ranging from suicide to sepsis. There are many such articles, so I have chosen to focus on the ones relevant to the most recent MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) Maternal Mortality Surveillance and Confidential Enquiry Report. TOG has been privileged to feature regular articles from Prof Marian Knight informing us on the highlights from MBRRACE-UK and the UK obstetric surveillance system (UKOSS). Many of you will have seen the recent MBRRACEUK report, which again highlights suicide, cardiac disease, thrombosis and neurological disease (commonly epilepsy) as the commonest causes of maternal death in the UK. These subjects, and more, have been covered in TOG.","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45259352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
identification of HIV in a hidden population Emily Keating MSc DTMH DFSRH, Sophie Forsyth MRCOG DipGUM DipHIV DFSRH, Jessica Daniel MRCP DipGUM DipHIV DFSRH, Emma Torbe MRCOG PGDip* Specialty Trainee in Community Sexual & Reproductive Health, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon SN3 6BB, UK Consultant in Sexual Health and HIV, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon SN3 6BB, UK Consultant in Obstetrics and Gynaecology, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon SN3 6BB, UK *Correspondence: Emma Torbe. Email: e.torbe@nhs.net
隐藏人群中HIV的识别Emily Keating DTMH DFSRH硕士、Sophie Forsyth MRCOG DipGUM DipHIV DFSRH、Jessica Daniel MRCP DipGUM DipHIV DFSRH、Emma Torbe MRCOG PGDip*社区性与生殖健康专业实习生，Great Western Hospitals NHS Foundation Trust，Marlborough Road，Swindon SN3 6BB，英国性健康与HIV顾问，Great Western Hospitals NHS Foundation Trust，Marlborough Road，Swindon SN3 6BB，英国妇产科顾问，Great Westerns Hospitals英国国家医疗服务体系基金会信托，Marlborough Road，Swinton SN3 6BB，英国*通讯：Emma Torbe。电子邮件：e.torbe@nhs.net
{"title":"Facilitating HIV testing in colposcopy clinics to improve identification of HIV in a hidden population","authors":"E. Keating, S. Forsyth, J. Daniel, E. Torbé","doi":"10.1111/tog.12852","DOIUrl":"https://doi.org/10.1111/tog.12852","url":null,"abstract":"identification of HIV in a hidden population Emily Keating MSc DTMH DFSRH, Sophie Forsyth MRCOG DipGUM DipHIV DFSRH, Jessica Daniel MRCP DipGUM DipHIV DFSRH, Emma Torbe MRCOG PGDip* Specialty Trainee in Community Sexual & Reproductive Health, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon SN3 6BB, UK Consultant in Sexual Health and HIV, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon SN3 6BB, UK Consultant in Obstetrics and Gynaecology, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon SN3 6BB, UK *Correspondence: Emma Torbe. Email: e.torbe@nhs.net","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42362563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Nambiar, J. Thachil, W. Yoong, Deepa Balachandran Nair
Thromboembolism is a major cause of preventable morbidity and mortality. Hospital acquired thrombosis (HAT) accounts for 50–60% of all thromboembolic events. As well as effects on patient safety, there are considerable cost implications to both prophylaxis and treatment. While guidance exists on thromboprophylaxis for patients in obstetrics and those undergoing general surgery, there is a paucity of guidance relating to gynaecological practice. Increasing prevalence of risk factors and multimorbidity is paralleled by higher risk of thromboembolic events. Gynaecological surgery presents some unique risk factors for thrombosis.
{"title":"Thromboprophylaxis in gynaecology: a review of current evidence","authors":"D. Nambiar, J. Thachil, W. Yoong, Deepa Balachandran Nair","doi":"10.1111/tog.12849","DOIUrl":"https://doi.org/10.1111/tog.12849","url":null,"abstract":"Thromboembolism is a major cause of preventable morbidity and mortality. Hospital acquired thrombosis (HAT) accounts for 50–60% of all thromboembolic events. As well as effects on patient safety, there are considerable cost implications to both prophylaxis and treatment. While guidance exists on thromboprophylaxis for patients in obstetrics and those undergoing general surgery, there is a paucity of guidance relating to gynaecological practice. Increasing prevalence of risk factors and multimorbidity is paralleled by higher risk of thromboembolic events. Gynaecological surgery presents some unique risk factors for thrombosis.","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48295887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：