Over the past few years, a substantial shift has occurred in how we deliver care to our patients. Although many factors can be beyond our control, we need to learn to adapt and move with the times to ensure we deliver the best care possible. Adhering to good clinical governance allows us to maintain high standards in the care we deliver to our patients. Governance seeks to reduce the wide disparity in care between various locations throughout the UK. Clinical governance can be described in many different ways, most commonly through its seven pillars: information and IT; patient and public involvement; education and training; staff management; risk management; clinical audit; and clinical effectiveness. Using these pillars as standards, we review the various articles published in recent issues of The Obstetrician & Gynaecologist (TOG) that help guide us to improve in our clinical practice.
{"title":"Spotlight on… clinical governance and patient safety","authors":"Victoria Braden, Thomas Tang, W. Yoong","doi":"10.1111/tog.12837","DOIUrl":"https://doi.org/10.1111/tog.12837","url":null,"abstract":"Over the past few years, a substantial shift has occurred in how we deliver care to our patients. Although many factors can be beyond our control, we need to learn to adapt and move with the times to ensure we deliver the best care possible. Adhering to good clinical governance allows us to maintain high standards in the care we deliver to our patients. Governance seeks to reduce the wide disparity in care between various locations throughout the UK. Clinical governance can be described in many different ways, most commonly through its seven pillars: information and IT; patient and public involvement; education and training; staff management; risk management; clinical audit; and clinical effectiveness. Using these pillars as standards, we review the various articles published in recent issues of The Obstetrician & Gynaecologist (TOG) that help guide us to improve in our clinical practice.","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47392364","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}
increasing operating time, minimises blood loss and intraor postoperative complications, and reduces conversion rate to laparotomy. Th e introduction of a robot as an additional tool in laparoscopic procedures has also overcome many of the limitations of conventional laparoscopy by providing superior dexterity, intuitive movement, 3D vision, improved ergonomics, autonomy of camera control and a shorter learning curve. A robot could be considered safe and a more eff ective surgical tool than conventional keyhole surgery for women who have to undergo complex gynaecology surgery or have associated medical issues. Th e introduction of robots has resulted in a decrease in the number of traditional open surgeries and the risk of conversion to open surgery; both of which should be considered when examining the cost–benefi t of using a robot. In womb cancer surgery there is good evidence that introducing robotics into the service improves outcomes for women and may reduce costs. Th is Scientifi c Impact Paper considers the technical advances that have expanded the use of RAL. It further assesses the use of RAL in diff erent fi elds of gynaecological surgery and the associated benefi ts and limitations. Written by: Laura Dean-Osgood, Assistant Editor, RCOG, UK. Download all RCOG guidance from: www.rcog.org.uk/guidelines SIP SUMMARY Scientifi c Impact Paper No. 71: Robotic Surgery in Gynaecology
增加手术时间，减少出血量和术后并发症，降低转开腹率。引入机器人作为腹腔镜手术的附加工具，也克服了传统腹腔镜手术的许多局限性，提供了卓越的灵活性、直观的运动、3D视觉、改进的人体工程学、相机控制的自主性和更短的学习曲线。对于必须接受复杂妇科手术或有相关医疗问题的女性来说，机器人可以被认为是安全的，而且比传统的锁眼手术更有效的手术工具。机器人的引入减少了传统开放式手术的数量和转换为开放式手术的风险;在评估使用机器人的成本效益时，这两点都应该考虑进去。在子宫癌手术中，有充分的证据表明，将机器人技术引入这项服务可以改善女性的治疗效果，并可能降低成本。这篇科学影响论文考虑了扩大RAL使用的技术进步。它进一步评估了RAL在妇科外科不同领域的使用及其相关的益处和局限性。Written by: Laura Dean-Osgood，英国RCOG助理编辑。从www.rcog.org.uk/guidelines下载所有RCOG指南。科学影响论文71号:妇科机器人手术
{"title":"Scientific Impact Paper No. 71: Robotic Surgery in Gynaecology","authors":"","doi":"10.1111/tog.12842","DOIUrl":"https://doi.org/10.1111/tog.12842","url":null,"abstract":"increasing operating time, minimises blood loss and intraor postoperative complications, and reduces conversion rate to laparotomy. Th e introduction of a robot as an additional tool in laparoscopic procedures has also overcome many of the limitations of conventional laparoscopy by providing superior dexterity, intuitive movement, 3D vision, improved ergonomics, autonomy of camera control and a shorter learning curve. A robot could be considered safe and a more eff ective surgical tool than conventional keyhole surgery for women who have to undergo complex gynaecology surgery or have associated medical issues. Th e introduction of robots has resulted in a decrease in the number of traditional open surgeries and the risk of conversion to open surgery; both of which should be considered when examining the cost–benefi t of using a robot. In womb cancer surgery there is good evidence that introducing robotics into the service improves outcomes for women and may reduce costs. Th is Scientifi c Impact Paper considers the technical advances that have expanded the use of RAL. It further assesses the use of RAL in diff erent fi elds of gynaecological surgery and the associated benefi ts and limitations. Written by: Laura Dean-Osgood, Assistant Editor, RCOG, UK. Download all RCOG guidance from: www.rcog.org.uk/guidelines SIP SUMMARY Scientifi c Impact Paper No. 71: Robotic Surgery in Gynaecology","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41796411","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}
(cid:1) Initial studies of omicron infection in adult populations (who not were not pregnant) indicated a lower risk of severe pulmonary disease with this variant than with the previous delta variant of concern. It was unclear whether this was also the case for pregnant women, and whether prior vaccination had an impact on disease severity. The objective of this study was to use the UK obstetric surveillance system (UKOSS) to describe the characteristics of pregnant women admitted to hospital with SARS-CoV-2 infection including their vaccination status, severity of infection, pharmacological management, and pregnancy and perinatal outcomes, in the period when the omicron variant of concern was first dominant in the UK.
{"title":"UKOSS update","authors":"M. Knight","doi":"10.1111/tog.12838","DOIUrl":"https://doi.org/10.1111/tog.12838","url":null,"abstract":"(cid:1) Initial studies of omicron infection in adult populations (who not were not pregnant) indicated a lower risk of severe pulmonary disease with this variant than with the previous delta variant of concern. It was unclear whether this was also the case for pregnant women, and whether prior vaccination had an impact on disease severity. The objective of this study was to use the UK obstetric surveillance system (UKOSS) to describe the characteristics of pregnant women admitted to hospital with SARS-CoV-2 infection including their vaccination status, severity of infection, pharmacological management, and pregnancy and perinatal outcomes, in the period when the omicron variant of concern was first dominant in the UK.","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45087315","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}
Tamara Howe, Katy Lankester, T. Kelly, Ryan D. Watkins, S. Kaushik
Dear Editor, We would like to thank Lowe-Zinola and co-authors for their interest in our article and for the opportunity to respond to the queries raised. We respond to them directly below. Interestingly, you have highlighted the area of treatment for women in pregnancy that we too identified as challenging, i.e. FIGO stage IIA and IB3 (FIGO 2018). It goes without saying that counselling cancer patients in various stages of pregnancy regarding their management decisions is never easy. The paucity of evidence for treatment of all cancers in pregnancy contributes to a distinct lack of guidance and hence leaves treatment options open to discussion, but, most importantly, also allows for individualised care. The randomised controlled trial (RCT) performed by Gupta et al. concluded thatCisplatin-based concomitant chemoradiation resulted in superior disease-free survival (DFS) compared with neoadjuvant chemotherapy followed by radical surgery in locally advanced cervical cancer. This study was designed on the presumption that neoadjuvant chemotherapy would substantially reduce the risk of distant recurrence and facilitate local control when compared with local chemo-radiation. The difference in DFS did not reach statistical significance. Furthermore, the study results did not suggest a difference in Overall Survival between the two groups (OS). As one armof the study includes full pelvic radiotherapy (associated with spontaneous abortion, congenital malformations and paediatric malignancy in pregnancy), extrapolating these results to a pregnant population with locally advanced disease would not be suitable. By the authors’ admission, this study was not powered to definitively assess differences in treatment strategies in operable cervical cancer i.e stage 1B2, 1B3 and stage 2A, which perhaps would have been more relevant to our own practice in the UK. The Uterus-11 Trial group excluded pregnant and lactating women from their study. For this reason, once again, it is very difficult to extrapolate the results to the pregnant population. Surgical staging for locally advanced cervical cancer has always been a contentious topic. However, the recent editorial in the International Journal of Gynaecological Cancer reaffirms that surgical staging for locally advanced disease offers no benefit to patients. Once again, we thank you for the interest in our article.
{"title":"Authors’ reply","authors":"Tamara Howe, Katy Lankester, T. Kelly, Ryan D. Watkins, S. Kaushik","doi":"10.1111/tog.12833","DOIUrl":"https://doi.org/10.1111/tog.12833","url":null,"abstract":"Dear Editor, We would like to thank Lowe-Zinola and co-authors for their interest in our article and for the opportunity to respond to the queries raised. We respond to them directly below. Interestingly, you have highlighted the area of treatment for women in pregnancy that we too identified as challenging, i.e. FIGO stage IIA and IB3 (FIGO 2018). It goes without saying that counselling cancer patients in various stages of pregnancy regarding their management decisions is never easy. The paucity of evidence for treatment of all cancers in pregnancy contributes to a distinct lack of guidance and hence leaves treatment options open to discussion, but, most importantly, also allows for individualised care. The randomised controlled trial (RCT) performed by Gupta et al. concluded thatCisplatin-based concomitant chemoradiation resulted in superior disease-free survival (DFS) compared with neoadjuvant chemotherapy followed by radical surgery in locally advanced cervical cancer. This study was designed on the presumption that neoadjuvant chemotherapy would substantially reduce the risk of distant recurrence and facilitate local control when compared with local chemo-radiation. The difference in DFS did not reach statistical significance. Furthermore, the study results did not suggest a difference in Overall Survival between the two groups (OS). As one armof the study includes full pelvic radiotherapy (associated with spontaneous abortion, congenital malformations and paediatric malignancy in pregnancy), extrapolating these results to a pregnant population with locally advanced disease would not be suitable. By the authors’ admission, this study was not powered to definitively assess differences in treatment strategies in operable cervical cancer i.e stage 1B2, 1B3 and stage 2A, which perhaps would have been more relevant to our own practice in the UK. The Uterus-11 Trial group excluded pregnant and lactating women from their study. For this reason, once again, it is very difficult to extrapolate the results to the pregnant population. Surgical staging for locally advanced cervical cancer has always been a contentious topic. However, the recent editorial in the International Journal of Gynaecological Cancer reaffirms that surgical staging for locally advanced disease offers no benefit to patients. Once again, we thank you for the interest in our article.","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44481557","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}
CPD credits can be claimed for the following questions online via the TOG CPD submission system in the RCOG CPD ePortfolio. You must be a registered CPD participant of the RCOG CPD programme (available in the UK and worldwide) in order to submit your answers. Completion of TOG true/false questions can be claimed as a Specific Learning Event. Participants can claim two credits per set of questions if at least 70% of questions have been answered correctly. CPDparticipants are advised to considerwhether the articles are still relevant for their CPD, in particular if there are more recent articles on the same topic available and if clinical guidelines have been updated since publication. Please direct all questions or problems to the CPD Office. Tel: +44 (0)20 7772 6307 or email: cpd@rcog.org.uk. The blue symbol denotes which source the questions refer to including the RCOG journals, TOG and BJOG, and RCOG guidance, such as Green-top Guidelines (GTGs) and Scientific Impact Papers (SIPs). All of the above sources are available to RCOG Members and Fellows via the RCOG website. RCOG Members, Fellows and Associates have full access to TOG content via the Wiley Online Library app (available for iOS and Android).
{"title":"CPD questions for volume 24 issue 4","authors":"J. Konje","doi":"10.1111/tog.12840","DOIUrl":"https://doi.org/10.1111/tog.12840","url":null,"abstract":"CPD credits can be claimed for the following questions online via the TOG CPD submission system in the RCOG CPD ePortfolio. You must be a registered CPD participant of the RCOG CPD programme (available in the UK and worldwide) in order to submit your answers. Completion of TOG true/false questions can be claimed as a Specific Learning Event. Participants can claim two credits per set of questions if at least 70% of questions have been answered correctly. CPDparticipants are advised to considerwhether the articles are still relevant for their CPD, in particular if there are more recent articles on the same topic available and if clinical guidelines have been updated since publication. Please direct all questions or problems to the CPD Office. Tel: +44 (0)20 7772 6307 or email: cpd@rcog.org.uk. The blue symbol denotes which source the questions refer to including the RCOG journals, TOG and BJOG, and RCOG guidance, such as Green-top Guidelines (GTGs) and Scientific Impact Papers (SIPs). All of the above sources are available to RCOG Members and Fellows via the RCOG website. RCOG Members, Fellows and Associates have full access to TOG content via the Wiley Online Library app (available for iOS and Android).","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43539191","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}
{"title":"Scientific Impact Paper No. 70: Subclinical Hypothyroidism and Antithyroid Autoantibodies in Women with Subfertility or Recurrent Pregnancy Loss","authors":"","doi":"10.1111/tog.12843","DOIUrl":"https://doi.org/10.1111/tog.12843","url":null,"abstract":"","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45559120","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 am delighted to be writing the editorial to this special edition of the Journal of Couple and Family Psychoanalysis focusing on relationship endings, particularly as 2021 marks the fiftieth anniversary of the implementation of the 1969 Divorce Reform Act, legislation that provided a route out of marriage without having to prove that a “matrimonial offence” had been committed. The ending of the commitment that comprised two intertwined lives, soaked through with romanticism and love, hope and societal approbation, calls for the creation of new ways of working for the clinician. The seven new articles contained within this issue illustrate, from different practices, countries, and orientations, the how and why of helping couples and families face the unimaginable; to shake themselves loose of the history that binds them and garner enough agency to conceive a new life as two separate individuals with no shared couple space between them, with the exception of their children. This issue starts with Avi Shmueli’s description of the Divorce and Separation Consultation Service (DSCS), based at Tavistock Relationships, a timely psychoanalytic article describing the extension of “normal” couple psychotherapy, taking into account the catastrophe on many levels that affects many couples faced with separation. Shmueli begins with a reminder that separation and divorce is a product of a couple’s original unconscious dynamic that can no longer contain them. Whilst contemplating therapeutic technique, we are reminded of the intense pressure facing therapists trying to support two people dealing with unprecedented and simultaneous levels of change, the “who am I, where am I, what have I done and where and how do I live” questions that assault couples caught up divorce. The couple’s projective system, defending against reality, exerts intense pressure both on them and their therapist, and countertransference can batter the clinician just as the splitting of blame, shame, and responsibility ricochets between the separating partners, demanding an availability of mind that will not appeal to all couple therapists. Shmueli and his team in the DSCS work to promote deeper understanding and containment to counter couple distress as these huge changes are absorbed. Clinicians symbolise the hope that life will continue beyond the unimagined losses that separating couples and their families find themselves caught up in. The second article moves to California, the family law system in the United States, and Dana Iscoff’s way of working with narcissistically organised, highconflict, separating and divorcing couples. Such couples will be identifiable Couple and Family Psychoanalysis 11(1) vii–x
{"title":"Editorial","authors":"Kate Harding","doi":"10.1111/tog.12841","DOIUrl":"https://doi.org/10.1111/tog.12841","url":null,"abstract":"I am delighted to be writing the editorial to this special edition of the Journal of Couple and Family Psychoanalysis focusing on relationship endings, particularly as 2021 marks the fiftieth anniversary of the implementation of the 1969 Divorce Reform Act, legislation that provided a route out of marriage without having to prove that a “matrimonial offence” had been committed. The ending of the commitment that comprised two intertwined lives, soaked through with romanticism and love, hope and societal approbation, calls for the creation of new ways of working for the clinician. The seven new articles contained within this issue illustrate, from different practices, countries, and orientations, the how and why of helping couples and families face the unimaginable; to shake themselves loose of the history that binds them and garner enough agency to conceive a new life as two separate individuals with no shared couple space between them, with the exception of their children. This issue starts with Avi Shmueli’s description of the Divorce and Separation Consultation Service (DSCS), based at Tavistock Relationships, a timely psychoanalytic article describing the extension of “normal” couple psychotherapy, taking into account the catastrophe on many levels that affects many couples faced with separation. Shmueli begins with a reminder that separation and divorce is a product of a couple’s original unconscious dynamic that can no longer contain them. Whilst contemplating therapeutic technique, we are reminded of the intense pressure facing therapists trying to support two people dealing with unprecedented and simultaneous levels of change, the “who am I, where am I, what have I done and where and how do I live” questions that assault couples caught up divorce. The couple’s projective system, defending against reality, exerts intense pressure both on them and their therapist, and countertransference can batter the clinician just as the splitting of blame, shame, and responsibility ricochets between the separating partners, demanding an availability of mind that will not appeal to all couple therapists. Shmueli and his team in the DSCS work to promote deeper understanding and containment to counter couple distress as these huge changes are absorbed. Clinicians symbolise the hope that life will continue beyond the unimagined losses that separating couples and their families find themselves caught up in. The second article moves to California, the family law system in the United States, and Dana Iscoff’s way of working with narcissistically organised, highconflict, separating and divorcing couples. Such couples will be identifiable Couple and Family Psychoanalysis 11(1) vii–x","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43200728","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}
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