Best practice & research. Clinical obstetrics & gynaecology
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An epidemic of obesity is affecting growing numbers of women in their childbearing years increasing their risk of obstetric complications including diabetes, hypertension, pre-eclampsia, some malformations, macrosomia and the need for obstetric intervention. There is growing evidence that maternal obesity may increase the risk of obesity and diabetes in the offspring. ⋯ Limiting gestational weight gain to 5-9 kg among pregnant obese women is likely to improve obstetric outcomes, but how to achieve this remains an active area of research. If gestational diabetes develops, there is good evidence that clinical management reduces the risk of adverse pregnancy outcomes.
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Best Pract Res Clin Obstet Gynaecol · Feb 2011
ReviewInsulin during pregnancy, labour and delivery.
Optimal glycaemic control is of the utmost importance to achieve the best possible outcome of a pregnancy complicated by diabetes. This holds for pregnancies in women with preconceptional type 1 or type 2 diabetes as well as for pregnancies complicated by gestational diabetes. Glycaemic control is conventionally expressed in the HbA1c value but the HbA1c value does not completely capture the complexity of glycaemic control. ⋯ Continuous glucose monitoring can offer better insights into the glycaemic profile than self-monitoring of blood glucose levels by the patients but the place of these new monitoring techniques has yet to be established more clearly. Insulin therapy during labour means short-acting insulin adjusted to achieve glucose levels between 4 and 8 mmol l(-1) to prevent neonatal hypoglycaemia as much as possible. After delivery, glycaemic control must be relaxed to prevent hypoglycaemia, especially in women who breastfeed.
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Best Pract Res Clin Obstet Gynaecol · Dec 2010
Recertification and continuing professional development: The way ahead.
The arguments in favour of recertification have been made cogently. Doctors in the UK on the whole continue to enjoy the trust and respect of their patients and the general public, but the Shipman enquiry led by Dame Janet Smith questioned the validity of the existing system. Following a lengthy discussion, the Chief Medical Officer of England published his proposal for professional regulation: Trust, assurance and safety - the regulation of health professionals in the 21st century¹ was published in February 2007. ⋯ The Royal Colleges have been delegated to set these standards, and approved by the GMC. Recertification will take place every five years. Recertification will be underpinned by enhanced appraisal, multi source feedback, and a robust continuing professional development programme.
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Best Pract Res Clin Obstet Gynaecol · Dec 2010
The development of a new speciality training programme in obstetrics and gynaecology in the UK.
In 2004, the Royal College of Obstetricians and Gynaecologists (RCOG) established a working group of experienced Fellows, Members, trainees and educationalists, who were responsible for writing and coordinating the development of a new curriculum in obstetrics and gynaecology. The curriculum would underpin the new 7-year speciality training programme. In December 2006, the UK Postgraduate Medical Education and Training Board approved the curriculum. ⋯ Successful progress is achieved by meeting the requirements at designated waypoints defined within the programme. The curriculum outlines not only the knowledge and technical clinical skill requirements, but also the professional skills and attitudes that must consistently be adopted by health-care professionals in a modern health service. The curriculum was originally benchmarked against the General Medical Council's Good Medical Practice criteria: (1) Good clinical care; (2) Good medical practice; (3) Successful relationships with patients; (4) Working with colleagues; (5) Teaching and training; (6) Probity; (7) Health.
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Best Pract Res Clin Obstet Gynaecol · Dec 2010
Evaluating the utility of workplace-based assessment tools for speciality training.
Workplace assessment has been incorporated into speciality training in the UK following changes in the training and work patterns within the National Health Service (NHS). There are various types of assessment tools that have been adopted to assess the clinical competence of trainees. ⋯ This review provides a theoretical background of workplace assessment and the educational framework that may be adopted to evaluate their effectiveness. It summarises current evidence for the utility of these tools with regard to reliability, validity, acceptability, educational impact and cost.