Best practice & research. Clinical obstetrics & gynaecology
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Best Pract Res Clin Obstet Gynaecol · Aug 2007
Assessing and credentialing standards of care: the UK Clinical Negligence Scheme for Trusts (CNST, Maternity).
The Clinical Negligence Scheme for Trusts (CNST) provides NHS trusts with a set of risk management standards for maternity services. These standards are designed to act as a framework, bringing focus to the clinical risk management procedures adopted by maternity services, and to contribute to the development and implementation of clinical governance, thereby improving patient care. Both the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) have endorsed the standards because of their potential to benefit clinical care. ⋯ Assessments against the CNST Maternity Clinical Risk Management Standards are currently conducted by Det Norske Veritas Ltd (DNV) on behalf of the NHS Litigation Authority (NHSLA) to ensure that members' contributions reflect their standards of clinical risk management. Although the claims data have not been collected on a consistent basis and are too immature to provide conclusions in an area notorious for its long tail, it does indicate that there has been a fall in the number and cost of maternity claims as a percentage of total clinical negligence claims reported to the NHSLA since the inception of CNST. This chapter examines whether there is evidence that the standards have had a measurable effect on clinical negligence claims.
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Best Pract Res Clin Obstet Gynaecol · Aug 2007
Voluntary review of quality of care peer review for patient safety.
Voluntary Review of Quality of Care (VRQC) is a confidential, voluntary, consultative peer review service offered to healthcare institutions by the American College of Obstetricians and Gynecologists (ACOG). Institutions may request ACOG's VRQC team of practicing, Board-certified obstetricians and gynecologists to visit the institution in order to evaluate the degree to which practice patterns are consistent with published guidelines, and to suggest possible avenues for improvement. ⋯ Issues identified in the VRQC reviews can serve as needs assessment for designing Continuing Medical Education activities. Services such as VRQC provided by national medical specialty organizations may assist institutions to implement practice guidelines, performance standards, quality improvement and patient safety initiatives.
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Best Pract Res Clin Obstet Gynaecol · Aug 2007
Embedding quality improvement and patient safety at Liverpool Women's NHS Foundation Trust.
The provision of safe high-quality care in obstetrics and gynaecology is a key target in the UK National Health Service (NHS), in part because of the high cost of litigation in this area. Good risk management processes should improve safety and reduce the cost of litigation to the NHS. ⋯ This encompasses building a safety culture, leading and supporting staff, integrating risk management activity, promoting reporting, involving and communicating with patients and the public, learning and sharing safety lessons, and implementing solutions to prevent harm. Examples from the Liverpool Women's NHS Foundation Trust are used to illustrate these steps, including how they were developed, what obstacles had to be overcome, ongoing challenges, and whether good risk management has translated into better, safer health care.
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Best Pract Res Clin Obstet Gynaecol · Apr 2007
ReviewPerimenopause and depression: strength of association, causal mechanisms and treatment recommendations.
Perimenopause represents a significant transition in a woman's life. The evidence to support an association between perimenopause and depression is mixed, yet recent prospective studies have provided stronger evidence to support such an association. Interpretation of study data are complicated by methodological issues, such as a lack of standard definition for perimenopause or depression, reducing comparability. ⋯ Physicians should consider initiating dialogue about menopause and symptom relief at age 40 and screening perimenopausal women for depressive symptoms. Selective serotonin reuptake inhibitors are a first line of treatment for depression, but hormone therapy could be considered for women experiencing menopausal symptoms unless there are contraindications. Future research should focus on establishing temporality and studying these potential relationships among women of different ethnicities.
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Best Pract Res Clin Obstet Gynaecol · Dec 2006
ReviewHealth technology assessment of surgical therapies for benign gynaecological disease.
This chapter summarises the evidence of the benefits and harm of surgical therapies for benign gynaecological disease. We have limited the discussion in this chapter to three gynaecological conditions - menorrhagia, endometriosis and benign ovarian tumours - with a further section on the different surgical approaches for performing a hysterectomy for menorrhagia due to dysfunctional uterine bleeding and pelvic masses such as fibroids and benign adnexal masses. The currently available evidence suggests that there is little to choose between the four first-generation endometrial destruction techniques - laser ablation, transcervical resection of endometrium, vaporisation ablation and rollerball ablation - in terms of clinical efficacy and patient satisfaction. ⋯ With regards to the surgical approach for performing a hysterectomy for menorrhagia and benign pelvic masses, vaginal hysterectomy should be performed over laparoscopic and abdominal hysterectomy when possible. Where it is not possible to perform the hysterectomy vaginally, then laparoscopic hysterectomy can be employed instead of abdominal hysterectomy to avoid a laparotomy scar. There appears to be no significant advantage in performing a subtotal hysterectomy instead of the total removal of the uterine corpus and cervix.