Obstetric Medicine

2020 ◽  
Author(s):  
Charlotte J. Frise ◽  
Sally Collins
Keyword(s):  
Pregnant Women ◽  
Management Strategies ◽  
Chronic Illnesses ◽  
Evidence Based ◽  
Advanced Training ◽  
Medical Problems ◽  
Comprehensive Overview ◽  
Medical Specialties ◽  
Obstetric Medicine ◽  
Maternal Medicine

Pregnant women regularly present with medical problems to many different medical specialties, and as their physiology is changed by the pregnancy, so too is the way in which many chronic illnesses behave. This new specialist handbook, Obstetric Medicine, provides a comprehensive overview of medical conditions in the pregnant woman, and covers the syllabus for both the RCOG Advanced Training Skills Module (ATSM) and sub-specialty training in maternal medicine. This is an essential new addition to the literature for all physicians who work with pregnant women in their practice. It contains links to national and international guidelines, and provides evidence-based management strategies for both chronic and acute illnesses.

scholarly journals Obstetric medical care and training in the United Kingdom

2016 ◽  
Vol 10 (1) ◽  
pp. 40-42 ◽  
Author(s):  
Adam D Jakes ◽  
Ingrid Watt-Coote ◽  
Matthew Coleman ◽  
Catherine Nelson-Piercy
Keyword(s):  
Core Curriculum ◽  
Contributory Factor ◽  
Medical Conditions ◽  
Medical Problems ◽  
Maternal Deaths ◽  
Obstetric Medicine ◽  
Physician Role ◽  
The Uk ◽  
Maternal Medicine ◽  
In Pregnancy

The UK confidential enquiry into maternal deaths identified poor management of medical problems in pregnancy to be a contributory factor to a large proportion of indirect maternal deaths. Maternal (obstetric) medicine is an exciting subspecialty that encompasses caring for both women with pre-existing medical conditions who become pregnant, as well as those who develop medical conditions in pregnancy. Obstetrics and gynaecology trainees have some exposure to maternal medicine through their core curriculum and can then complete an advanced training skills module, subspecialise in maternal–fetal medicine or take time out to complete the Royal College of Physicians membership examination. Physician training has limited exposure to medical problems in pregnancy and has therefore prompted expansion of the obstetric physician role to ensure physicians with adequate expertise attend joint physician–obstetrician clinics. This article describes the role of an obstetric physician in the UK and the different career pathways available to physicians and obstetricians interested in maternal medicine.

scholarly journals Provision of acute medicine services for pregnant women in UK hospitals: Data from the Society for Acute Medicine Benchmarking Audit 2019

2020 ◽  
pp. 1753495X2092950
Author(s):  
Catherine Atkin ◽  
Paarul Prinja ◽  
Anita Banerjee ◽  
Mark Holland ◽  
Dan Lasserson
Keyword(s):  
Pregnant Women ◽  
Medical Problems ◽  
Acute Medicine ◽  
Hospital Size ◽  
Obstetric Medicine ◽  
Provision Of Services ◽  
Timely Access ◽  
The Uk ◽  
Local Guideline ◽  
In Pregnancy

Background Medical problems during pregnancy are the leading cause of maternal mortality in the UK. Pregnant women often present through acute services to the medical team, requiring timely access to appropriate services, physicians trained to manage medical problems in pregnancy, with locally agreed guidance available. Methods Data were collected through the Society for Acute Medicine Benchmarking Audit, a national audit of service delivery and patient care in acute medicine over a 24 hour period. Results One hundred and thirty hospitals participated: 5.5% had an acute medicine consultant trained in obstetric medicine, and 38% of hospitals had a named lead for maternal medicine. This was not related to hospital size (p = 0.313). Sixty-four units had local guidelines for medical problems in pregnancy; 43% had a local guideline for venous thromboembolism in pregnancy. Centres with a named lead had more guidelines (p = 0.019). Conclusion Current provision of services within acute medicine for pregnant women does not meet national recommendations.

Study the Anatomy and Physiology of Body's Urinary System and Fibromyalgia Syndrome (FMS) for the Design an Intelligent Alarm System for Monitoring of FMS

2019 ◽  
Vol 1 (1) ◽  
pp. 72-81
Author(s):  
Hamidreza Shirzadfar ◽  
Narsis Gordoghli
Keyword(s):  
Chronic Pain ◽  
International Association ◽  
Continuous Process ◽  
Well Being ◽  
Chronic Illnesses ◽  
World Health ◽  
Definitive Treatment ◽  
Psychological Consequences ◽  
Medical Problems ◽  
Health Organization

In recent years, chronic medical problems have become increasingly prevalent. Chronic ‎illnesses challenge the view of life as a regular and continuous process, a challenge that has ‎important psychological consequences. The long duration of people suffering from these ‎diseases, the long process of treatment and the fact that there is no proper and definitive ‎treatment for most of these diseases and their associated complications have made chronic ‎diseases a detrimental factor in public health. According to the World Health Organization ‎‎(2006), the prevalence of chronic and non-communicable diseases is increasing in all countries, ‎especially developing countries, so that the major challenge for the health system in the present ‎century, is not living people, but better adapted to chronic illnesses and maintaining their ‎mental and social health and well-being Ed's life-threatening chronic physical illness.‎ Chronic pain is a pain that lasts longer than usual, and according to the criteria of the ‎International Association of Pain, this time is defined as at least 3 months to 6 months. Chronic ‎pain is such that not only faced the sick person whit the pressure of the pain but also with many ‎other pressure that affect different parts of her life. Fibromyalgia is one of the most rheumatologic disorders and one of the most resistant chronic ‎pain syndromes. Fibromyalgia is one of the most common musculoskeletal disorders in adults ‎and chronic pain is one of the most common complaints in this group of patients.

An evaluation of a shoulder rehabilitation class in a UK hospital following evidence-based modifications

2021 ◽  
pp. 1-8
Author(s):  
Emily Kell ◽  
John A. Hammond ◽  
Sophie Andrews ◽  
Christina Germeni ◽  
Helen Hingston ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Shoulder Pain ◽  
Management Strategies ◽  
Cost Effective ◽  
Rehabilitation Programme ◽  
Patient Specific ◽  
Satisfaction Survey ◽  
Evidence Based ◽  
Patient Satisfaction Survey ◽  
Significant Difference

OBJECTIVES: Shoulder pain is a common musculoskeletal disorder, which carries a high cost to healthcare systems. Exercise is a common conservative management strategy for a range of shoulder conditions and can reduce shoulder pain and improve function. Exercise classes that integrate education and self-management strategies have been shown to be cost-effective, offer psycho-social benefits and promote self-efficacy. This study aimed to examine the effectiveness of an 8-week educational and exercise-based shoulder rehabilitation programme following the introduction of evidence-based modifications. METHODS: A retrospective evaluation of a shoulder rehabilitation programme at X Trust was conducted, comparing existing anonymised Shoulder Pain and Disability Index (SPADI) and Patient-Specific Functional Scale (PSFS) scores from two cohorts of class participants from 2017-18 and 2018-19 that were previously collected by the physiotherapy team. Data from the two cohorts were analysed separately, and in comparison, to assess class efficacy. Descriptive data were also analysed from a patient satisfaction survey from the 2018-19 cohort. RESULTS: A total of 47 patients completed the 8-week shoulder rehabilitation programme during the period of data collection (2018-2019). The 2018-19 cohort showed significant improvements in SPADI (p 0.001) and PSFS scores (p 0.001). No significant difference was found between the improvements seen in the 2017-18 cohort and the 2018-19 cohort. 96% of the 31 respondents who completed the patient satisfaction survey felt the class helped to achieve their goals. CONCLUSION: A group-based shoulder rehabilitation class, which included loaded exercises and patient education, led to improvements in pain, disability and function for patients with rotator cuff related shoulder pain (RCRSP) in this outpatient setting, but anticipated additional benefits based on evidence were not observed.

scholarly journals How Physicians Manage Medical Uncertainty: A Qualitative Study and Conceptual Taxonomy

2021 ◽  
pp. 0272989X2199234
Author(s):  
Paul K. J. Han ◽  
Tania D. Strout ◽  
Caitlin Gutheil ◽  
Carl Germann ◽  
Brian King ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Qualitative Study ◽  
Management Strategies ◽  
Acute Care Hospital ◽  
Uncertainty Management ◽  
Care Hospital ◽  
Convenience Sample ◽  
Medical Specialties ◽  
Tolerance Of Uncertainty ◽  
Medical Uncertainty

Background Medical uncertainty is a pervasive and important problem, but the strategies physicians use to manage it have not been systematically described. Objectives To explore the uncertainty management strategies employed by physicians practicing in acute-care hospital settings and to organize these strategies within a conceptual taxonomy that can guide further efforts to understand and improve physicians’ tolerance of medical uncertainty. Design Qualitative study using individual in-depth interviews. Participants Convenience sample of 22 physicians and trainees (11 attending physicians, 7 residents [postgraduate years 1–3), 4 fourth-year medical students), working within 3 medical specialties (emergency medicine, internal medicine, internal medicine–pediatrics), at a single large US teaching hospital. Measurements Semistructured interviews explored participants’ strategies for managing medical uncertainty and temporal changes in their uncertainty tolerance. Inductive qualitative analysis of audio-recorded interview transcripts was conducted to identify and categorize key themes and to develop a coherent conceptual taxonomy of uncertainty management strategies. Results Participants identified various uncertainty management strategies that differed in their primary focus: 1) ignorance-focused, 2) uncertainty-focused, 3) response-focused, and 4) relationship-focused. Ignorance- and uncertainty-focused strategies were primarily curative (aimed at reducing uncertainty), while response- and relationship-focused strategies were primarily palliative (aimed at ameliorating aversive effects of uncertainty). Several participants described a temporal evolution in their tolerance of uncertainty, which coincided with the development of greater epistemic maturity, humility, flexibility, and openness. Conclusions Physicians and physician-trainees employ a variety of uncertainty management strategies focused on different goals, and their tolerance of uncertainty evolves with the development of several key capacities. More work is needed to understand and improve the management of medical uncertainty by physicians, and a conceptual taxonomy can provide a useful organizing framework for this work.

scholarly journals A behaviour change intervention to reduce home exposure to second hand smoke during pregnancy in India and Bangladesh: a theory and evidence-based approach to development

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Veena A. Satyanarayana ◽  
Cath Jackson ◽  
Kamran Siddiqi ◽  
Prabha S. Chandra ◽  
Rumana Huque ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Behaviour Change ◽  
Delphi Survey ◽  
Behaviour Change Techniques ◽  
Evidence Based ◽  
Behaviour Change Intervention ◽  
Behaviour Change Interventions ◽  
Modified Delphi ◽  
Qualitative Interview Study ◽  
At Home

Abstract Background Home exposure to secondhand smoke (SHS) is highly prevalent amongst pregnant women in low- and middle-income countries like India and Bangladesh. The literature on the efficacy of behaviour change interventions to reduce home exposure to SHS in pregnancy is scarce. Methods We employed a theory and evidence-based approach to develop an intervention using pregnant women as agents of change for their husband’s smoking behaviours at home. A systematic review of SHS behaviour change interventions led us to focus on developing a multicomponent intervention and informed selection of behaviour change techniques (BCTs) for review in a modified Delphi survey. The modified Delphi survey provided expert consensus on the most effective BCTs in reducing home exposure to SHS. Finally, a qualitative interview study provided context and detailed understanding of knowledge, attitudes and practices around SHS. This insight informed the content and delivery of the proposed intervention components. Results The final intervention consisted of four components: a report on saliva cotinine levels of the pregnant woman, a picture booklet containing information about SHS and its impact on health as well strategies to negotiate a smoke-free home, a letter from the future baby to their father encouraging him to provide a smoke-free home, and automated voice reminder and motivational messages delivered to husbands on their mobile phone. Intervention delivery was in a single face-to-face session with a research assistant who explained the cotinine report, discussed key strategies for ensuring a smoke-free environment at home and practised with pregnant women how they would share the booklet and letter with their husband and supportive family members. Conclusion A theory and evidence-based approach informed the development of a multicomponent behaviour change intervention, described here. The acceptability and feasibility of the intervention which was subsequently tested in a pilot RCT in India and Bangladesh will be published later.

scholarly journals Exploring the impact of a decision support algorithm to improve clinicians’ chemotherapy-induced peripheral neuropathy assessment and management practices: a two-phase, longitudinal study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Robert Knoerl ◽  
Emanuele Mazzola ◽  
Fangxin Hong ◽  
Elahe Salehi ◽  
Nadine McCleary ◽  
...  
Keyword(s):  
Decision Support ◽  
Peripheral Neuropathy ◽  
Management Practices ◽  
Management Strategies ◽  
Clinic Visit ◽  
Evidence Based ◽  
Two Phase ◽  
Assessment Index ◽  
Patient Reported ◽  
The Impact

Abstract Background Chemotherapy-induced peripheral neuropathy (CIPN) negatively affects physical function and chemotherapy dosing, yet, clinicians infrequently document CIPN assessment and/or adhere to evidence-based CIPN management in practice. The primary aims of this two-phase, pre-posttest study were to explore the impact of a CIPN clinician decision support algorithm on clinicians’ frequency of CIPN assessment documentation and adherence to evidence-based management. Methods One hundred sixty-two patients receiving neurotoxic chemotherapy (e.g., taxanes, platinums, or bortezomib) answered patient-reported outcome measures on CIPN severity and interference prior to three clinic visits at breast, gastrointestinal, or multiple myeloma outpatient clinics (n = 81 usual care phase [UCP], n = 81 algorithm phase [AP]). During the AP, study staff delivered a copy of the CIPN assessment and management algorithm to clinicians (N = 53) prior to each clinic visit. Changes in clinicians’ CIPN assessment documentation (i.e., index of numbness, tingling, and/or CIPN pain documentation) and adherence to evidence-based management at the third clinic visit were compared between the AP and UCP using Pearson’s chi-squared test. Results Clinicians’ frequency of adherence to evidence-based CIPN management was higher in the AP (29/52 [56%]) than the UCP (20/46 [43%]), but the change was not statistically significant (p = 0.31). There were no improvements in clinicians’ CIPN assessment frequency during the AP (assessment index = 0.5440) in comparison to during the UCP (assessment index = 0.6468). Conclusions Implementation of a clinician-decision support algorithm did not significantly improve clinicians’ CIPN assessment documentation or adherence to evidence-based management. Further research is needed to develop theory-based implementation interventions to bolster the frequency of CIPN assessment and use of evidence-based management strategies in practice. Trial registration ClinicalTrials.Gov, NCT03514680. Registered 21 April 2018.

scholarly journals Anxiety in autistic individuals who speak few or no words: A qualitative study of parental experience and anxiety management

Autism ◽  
2020 ◽  
pp. 136236132096236
Author(s):  
Joanne Tarver ◽  
Effie Pearson ◽  
Georgina Edwards ◽  
Aryana Shirazi ◽  
Liana Potter ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intellectual Disability ◽  
Language Use ◽  
Management Strategies ◽  
Assessment Tools ◽  
Evidence Based ◽  
Structured Interviews ◽  
Verbal Language ◽  
Parental Recognition

Anxiety is a common co-occurring condition in autism and impacts quality of life of autistic individuals and their families; autistic individuals who speak few or no words represent an under-researched group. This qualitative study aimed to understand more about parental recognition and management of anxiety in autistic individuals who speak few or no words. Semi-structured interviews were conducted with parents/carers of 17 autistic individuals (mage = 14.29) recruited from an existing participant database and social media adverts. Using thematic analysis, 15 themes were placed under three a-priori grand themes: parental recognition of anxiety; parental management of anxiety; and anxiety impact on the autistic individual and their family. Due to reduced verbal language use and overlap with other behaviours, parents described difficulties recognising anxiety in their child. However, they also described use of a number of management strategies, including some which overlap with components of evidence-based interventions for emotional and behavioural problems in autistic individuals (e.g. exposure/sensory calming). Despite this, parents reported that anxiety continues to have significant impact on quality of life. The findings of this study can help to inform the development of targeted intervention and assessment measures for anxiety in autistic individuals who speak few or no words. Lay abstract Anxiety is a common condition in autistic individuals, including those who also have an intellectual disability. Despite this, autistic individuals who have severe to profound intellectual disability, or use few or no words, are often excluded from autism research. There are also very few assessment tools and interventions with known effectiveness for autistic individuals with intellectual disability. In this study, we aimed to learn more about parent/carers experiences of recognising and managing anxiety in autistic individuals who use few or no words. We conducted semi-structured interviews with parents and carers to address three research questions: (1) what techniques and management strategies do parents describe for anxiety-related behaviour in their child; (2) how do communication difficulties impact parental understanding and management of anxiety provoking situations and behaviours; (3) what is the impact of anxiety-related behaviours on the quality of life of autistic individuals and their families? During the interviews, parents described difficulties recognising anxiety in their child, mostly due to reduced verbal language use and anxiety behaviours overlapping with other behaviours (e.g. autism characteristics). However, parents also described use of a number of management strategies, including some which overlap with components of evidence-based interventions for emotional and behavioural problems in autistic individuals (e.g. exposure/sensory calming). Despite this, parents reported that anxiety continues to have significant impact on quality of life. We will use the findings of this study to inform future research to develop assessment tools and interventions for anxiety in autistic individuals who use few or no words.

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