scholarly journals Postpartum haemorrhage and synthetic oxytocin dilutions in labour

2021 ◽  
Vol 29 (10) ◽  
pp. 590-596
Author(s):  
Monica Tolofari ◽  
Linn Shepherd
Keyword(s):  
Postpartum Haemorrhage ◽  
Intrapartum Care ◽  
Codes Of Practice ◽  
Legal Obligations ◽  
Oxytocin Receptors ◽  
Improved Outcomes ◽  
Professional Codes ◽  
The Uk ◽  
Synthetic Oxytocin ◽  
Haemorrhage Rate

This study investigated postpartum haemorrhage and historic oxytocin usage, because haemorrhage rates are rising. During the evolution of practice from intravenous bovine post-pituitary extract to synthetic oxytocin, experimental interventions had produced improved outcomes in certain cases and the postpartum haemorrhage rate was low. In this study, current synthetic oxytocin regimes from across the UK were compared with the 1977 (unchanged) licensed instructions for infusion. As a result of the pain-inducing properties of synthetic oxytocin, epidural analgesia prior to infusion is now standard for unlicensed regimes, adding complexity to intrapartum care and greater risks of complex births, as the fetus may be adversely affected by epidural drugs and acidosis. Unlicensed synthetic oxytocin dilutions and increments, the desensitising of oxytocin receptors, and unmeasured error factors in infusion pumps affect labour progress and outcomes. Today's rates of postpartum haemorrhage are associated with these changes to obstetric practice. Failure to inform women of intended unlicensed practices with synthetic oxytocin, or obtain consent for such, or offer licensed practice as standard constitutes neglect of the legal obligations outlined for doctors and midwives by professional Codes of Practice, intended to protect patients from predictable dangers.

scholarly journals Ethical decision-making regarding infant viability: A discussion

2016 ◽  
Vol 25 (7) ◽  
pp. 897-905 ◽  
Author(s):  
Janet Kelly ◽  
Emma Welch
Keyword(s):  
Healthcare Professionals ◽  
Ethical Decision Making ◽  
Healthcare Ethics ◽  
Joint Decision ◽  
Ethical Decisions ◽  
Codes Of Practice ◽  
Knowing That ◽  
Legal Case ◽  
Professional Codes ◽  
The Uk

Background: There are no universally agreed rules of healthcare ethics. Ethical decisions and standards tend to be linked to professional codes of practice when dealing with complex issues. Objectives: This paper aims to explore the ethical complexities on who should decide to give infants born on the borderline of viability lifesaving treatment, parents or the healthcare professionals. Method: The paper is a discussion using the principles of ethics, professional codes of practice from the UK, Nursing Midwifery Council and UK legal case law and statute. Healthcare professionals' experiences that influence parental decision are also considered. Findings & Discussion: There are considerable barriers to an effective discussion taking place in an environment where clinical decisions have to be made quickly once the baby is born. This is compounded by the need and respect for parental autonomy and the difficulties they face when making a best interest's decision knowing that this could cause more harm than good for their infant child and balancing any decision they make with quality of life. Conclusion: On deciding whether to give lifesaving treatment born at the borderline of viability, it should be a joint decision between the parents and the neonatal team.

The RUMA Alliance targets: an overview

Livestock ◽  
2021 ◽  
Vol 26 (4) ◽  
pp. 176-179
Author(s):  
Chris Lloyd
Keyword(s):  
Task Force ◽  
Animal Health ◽  
Antibiotic Use ◽  
Codes Of Practice ◽  
The Government ◽  
The Uk ◽  
Ongoing Support ◽  
The Impact ◽  
Insight Into ◽  
Roll Out

The Responsible Use of Medicines in Agriculture Alliance (RUMA) was established to promote the highest standards of food safety, animal health and animal welfare in the British livestock industry. It has a current focus to deliver on the Government objective of identifying sector-specific targets for the reduction, refinement or replacement of antibiotics in animal agriculture. The creation and roll out of sector specific targets in 2017 through the RUMA Targets Task Force, has helped focus activity across the UK livestock sectors to achieve a 50% reduction in antibiotic use since 2014. This has been realised principally through voluntary multi-sector collaboration, cross sector initiatives, codes of practice, industry body support and farm assurance schemes. This article provides an overview of RUMA's work to date providing insight into the methods used to create the targets, why they are so important, the impact they are having and how ongoing support and robust data are vital components in achieving the latest set of targets.

scholarly journals Assessment of the quality, content and perceived utility of local maternity guidelines in hospitals in England implementing the saving babies’ lives care bundle to reduce stillbirth

2020 ◽  
Vol 9 (2) ◽  
pp. e000756
Author(s):  
Yu Zhen Lau ◽  
Kate Widdows ◽  
Stephen A Roberts ◽  
Sheher Khizar ◽  
Gillian L Stephen ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Stakeholder Involvement ◽  
Care Bundle ◽  
Intrapartum Care ◽  
National Guidelines ◽  
Department Of Health ◽  
The Uk

IntroductionThe UK Department of Health have targeted a reduction in stillbirth by 50% by 2025; to achieve this, the first version of the Saving Babies’ Lives Care Bundle (SBLCB) was developed by NHS England in 2016 to improve four key areas of antenatal and intrapartum care. Clinical practice guidelines are a key means by which quality improvement initiatives are disseminated to front-line staff.MethodsSeventy-five clinical practice guidelines covering the four areas of antenatal and intrapartum care in the first version of SBLCB were obtained from 19 maternity providers. The content and quality of guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Maternity health professionals in participating organisations were invited to participate in an anonymous survey to determine perceptions toward and experiences of the use of clinical practice guidelines using a series of Likert scales.ResultsUnit guidelines showed considerable variation in quality with median scores of 50%–58%. Only 4 (5.6%) guidelines were recommended for use in clinical practice without modifications, 54 (75.0%) were recommended for use subject to modifications and 12 (16.7%) were not recommended for use. The lowest scoring domains were ‘rigour of development’, ‘stakeholder involvement’ and ‘applicability’. A significant minority of unit guidelines omitted recommendations from national guidelines. The majority of staff believed that clinical practice guidelines standardised and improved the quality of care but over 30% had insufficient time to use them and 24% stated they were unable to implement recommendations.ConclusionTo successfully implement initiatives such as the SBLCB change is needed to local clinical practice guidelines to reduce variation in quality and to ensure they are consistent with national recommendations . In addition, to improve clinical practice, adequate time and resources need to be in place to deliver and evaluate care recommended in the SBLCB.

Developments and controversies in maxillofacial trauma: Repair of facial injuries

2010 ◽  
Vol 1 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Michael Perry
Keyword(s):  
Functional Disability ◽  
Motor Vehicle ◽  
Sports Injuries ◽  
High Energy ◽  
Aetiological Factor ◽  
Rigid Fixation ◽  
Form And Function ◽  
Improved Outcomes ◽  
The Uk ◽  
And Function

Craniofacial trauma remains a common health problem throughout many areas of the UK. Although the ‘combination of alcohol and testosterone’ is often regarded as a major aetiological factor, a significant number of injuries are not related to either. Motor vehicle collisions and equine-related sports injuries in particular can result in devastating injuries to the skull and face and are frequently seen.Over the last few decades, management has moved away from closed methods to open exposure, anatomical reduction and internal ‘rigid’ fixation of facial fractures, with significant improvements in outcomes. Nevertheless, current management of ‘high energy’ or complex fractures can still result in residual functional disability and cosmetic deformity.Today’s challenge is to restore patients back to their pre-injury form and function, consistently, but this is not always possible. Greater understanding and a number of developments have significantly improved outcomes, although controversy still exists in some areas. Some of these will be discussed.

Placing sustainable development at the heart of government in the UK: the role of law in the evolution of sustainable development as the central organising principle of government

Legal Studies ◽  
2002 ◽  
Vol 22 (4) ◽  
pp. 578-601 ◽  
Author(s):  
Victoria Jenkins
Keyword(s):  
Sustainable Development ◽  
Audit Committee ◽  
Legal Framework ◽  
Legal Obligations ◽  
Statutory Duty ◽  
The Government ◽  
The Uk ◽  
Clear Statement ◽  
Close Investigation

The government has made a commitment to ensure that sustainable development is placed at the heart of decision-making. The UK's strategy has primarily involved the development of voluntary measures to achieve sustainable development in policy-making. These measures are monitored by a Sustainable Development Commission and, most importantly, a parliamentary Environmental Audit Committee. However, a number of public bodies also have a statutory duty in respect of sustainable development. These duties do not create enforceable legal obligations, but may have significant value as a clear statement of policy on the achievement of sustainable development – providing political leadership at the highest level. It is essential to this aim that the government provides a clear message regarding the objective of sustainable development. However, close investigation of these duties reveals not only a partial legal framework, but a number of inconsistencies in the government's approach to the achievement of sustainable development.

Psychiatric illness and driving: Irish psychiatrists' documentation practices

2009 ◽  
Vol 26 (1) ◽  
pp. 16-19 ◽  
Author(s):  
Camilla Langan
Keyword(s):  
Psychiatric Illness ◽  
Medication Compliance ◽  
Potential Effect ◽  
Driving Ability ◽  
Second Phase ◽  
Clinical Notes ◽  
Anonymous Questionnaire ◽  
Legal Obligations ◽  
Legal Duty ◽  
The Uk

AbstractObjective: Psychiatric illness and the use of psychotropic medication are recognised as factors that may impair driving ability. Clinicians in the UK have a legal duty to advise patients on the effects of illness and prescribed medication on driving ability. Although clinicians in Ireland have no equivalent legal obligations, good medical practice suggests that doctors should be aware of whether patients are active drivers, and issue appropriate advice, supported by adequate documentation in clinical notes.Method: The initial phase of the study analysed 44 outpatient records and 48 discharge records to ascertain the level of documentation regarding driving status, and advice given to patients regarding the effect of illness or medication on driving ability. The second phase involved distribution of an anonymous questionnaire to 18 psychiatrists employed in the acute psychiatric unit setting.Results: Although there was minimal documentation regarding the potential effect of illness on driving ability, more than 50% of case notes revealed documented advice to patients regarding side-effects of medication and driving ability. Over 50% of case notes contained advice about medication compliance, but none contained cautionary advice about operating machinery. All psychiatrists admitted not being aware of the driving status of every patient they reviewed. Over 50% admitted to advising patients of the effect of illness or medication on driving ability, but fewer reported documenting this advice on every occasion. All psychiatrists reported that they would benefit from training in this area.Conclusion: This study suggests that there is underdocumentation of advice given to patients regarding the effect of their symptoms or medication on driving ability. Clinicians need to improve their awareness of patients' driving status, in addition to receiving training on what their responsibilities are in this regard.

Penetrating abdominal injury: UK military experience from the Afghanistan conflict

2016 ◽  
Vol 102 (2) ◽  
pp. 90-94 ◽  
Author(s):  
MJ Leong ◽  
I Edgar ◽  
M Terry
Keyword(s):  
Injury Severity ◽  
Abdominal Injury ◽  
Anatomical Distribution ◽  
New Injury Severity Score ◽  
Medical Treatment Facility ◽  
Improved Outcomes ◽  
Penetrating Abdominal Injury ◽  
The Uk ◽  
Hepatic Injuries ◽  
Military Patients

AbstractAimsTo identify the prevalence, injury patterns and mortality of penetrating abdominal injury in patients treated at the UK Role 3 Medical Treatment Facility (MTF) in Camp Bastion, Afghanistan.MethodsAll patients with a penetrating abdominal injury were identified from the UK Joint Theatre Trauma Registry (JTTR). Demographics, predicted survival and observed mortality were compared. Sub-group analyses of UK military patients were conducted, comparing changes in survival as the campaign progressed and identifying the anatomical distribution of abdominal injuries.ResultsBetween June 2006 and June 2013, 1331 of the 8558 (16%) patients recorded on the JTTR had a penetrating abdominal injury; 393 were UK military, of whom 175 (45%) survived. 71% of UK military fatalities had the maximum New Injury Severity Score (NISS) of 75 compared to 4.6% of UK military survivors. The survival rate of UK military patients increased in the later stages of the campaign. Fatal injury in UK military patients was associated with significant vascular or hepatic injuries.ConclusionsThis study has defined the epidemiology of penetrating abdominal injury in a modern conflict. Continued training and further research into injury prevention and management will help to ensure that the improved outcomes observed in Afghanistan continue on future operations.

Occupational safety

2020 ◽  
pp. 1652-1656
Author(s):  
Lawrence Waterman
Keyword(s):  
Occupational Safety ◽  
Safety Management ◽  
Good Practice ◽  
Health And Safety ◽  
Working Environment ◽  
Legal Obligations ◽  
Work Health ◽  
Minor Injuries ◽  
The Uk ◽  
Serious Injuries

Any approach to occupational health must acknowledge that accidents in the workplace result in many injuries. Construction, agriculture, and primary extraction are the main causes of fatalities and serious injuries, but many more minor injuries result from all types of work. Health and safety law has developed with an emphasis on accident prevention that is based on designing and managing the working environment. Establishing this approach to safety management begins with an organization committing itself to a policy influenced by legal obligations and current good practice. While this chapter draws heavily on the UK situation, where there has been considerable experience and development of approaches to health and safety, it is incumbent on any physician to consider the work environment and whether changes to the workplace might improve not only the lot of their patients, but others potentially at risk in the workplace.

scholarly journals Personalisation schemes in social care and inequality: review of the evidence and early theorising

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Gemma Carey ◽  
Brad Crammond ◽  
Eleanor Malbon
Keyword(s):  
Social Services ◽  
Social Inequalities ◽  
Meta Analysis ◽  
Aged Care ◽  
Service Market ◽  
Policy Paradigm ◽  
Improved Outcomes ◽  
The Uk ◽  
And Control ◽  
The Impact

Abstract Background Personalisation is a growing international policy paradigm that aims to create both improved outcomes for individuals, and reduce fiscal pressures on government, by giving greater choice and control to citizens accessing social services. In personalisation schemes, individuals purchase services from a ‘service market’ using individual budgets or vouchers given to them by governments. Personalisation schemes have grown in areas such as disability and aged care across Europe, the UK and Australia. There is a wealth of evidence in public health and health care that demonstrates that practically all forms of social services, programs and interventions produce unequal benefit depending on socio-economic position. Research has found that skills required to successfully negotiate service systems leads to disproportionate benefit to the ‘middle class. With an unprecedented emphasis on individual skills, personalisation has even greater potential to widen and entrench social inequalities. Despite the increase in numbers of people now accessing services through such schemes, there has been no examination of how different social groups benefit from these schemes, how this widens and entrenches social inequities, and – in turn – what can be done to mitigate this. Methods This article presents a meta-review of the evidence on personalisation and inequality. A qualitative meta-analysis was undertaking of existing research into personalisation schemes in social services to identify whether and how such schemes are impacting different socio-economic groups. Results No research was identified which seeks to understand the impact of personalisation schemes on inequality. However, a number of ‘proxies’ for social class were identified, such as education, income, and employment, which had a bearing on outcome. We provide a theoretical framework for understanding why this is occurring, using concepts drawn from Bourdieu. Conclusion Personalisation schemes are likely to be entrenching, and potentially expanding, social inequalities. More attention needs to be given to this aspect of personal budgets by policymakers and researchers.

scholarly journals Newspaper Reporting on a Cluster of Suicides in the UK

Crisis ◽  
2017 ◽  
Vol 38 (1) ◽  
pp. 17-25 ◽  
Author(s):  
Ann John ◽  
Keith Hawton ◽  
David Gunnell ◽  
Keith Lloyd ◽  
Jonathan Scourfield ◽  
...  
Keyword(s):  
Poor Quality ◽  
Cluster Method ◽  
Sources Of Information ◽  
Quality Reporting ◽  
Codes Of Practice ◽  
Newspaper Reporting ◽  
Before And After ◽  
Suicide Clusters ◽  
The Uk ◽  
High Level

Abstract. Background: Media reporting may influence suicide clusters through imitation or contagion. In 2008 there was extensive national and international newspaper coverage of a cluster of suicides in young people in the Bridgend area of South Wales, UK. Aims: To explore the quantity and quality of newspaper reporting during the identified cluster. Method: Searches were conducted for articles on suicide in Bridgend for 6 months before and after the defined cluster (June 26, 2007, to September 16, 2008). Frequency, quality (using the PRINTQUAL instrument), and sensationalism were examined. Results: In all, 577 newspaper articles were identified. One in seven articles included the suicide method in the headline, 47.3% referred to earlier suicides, and 44% used phrases that guidelines suggest should be avoided. Only 13% included sources of information or advice. Conclusion: A high level of poor-quality and sensationalist reporting was found during an ongoing suicide cluster at the very time when good-quality reporting could be considered important. A broad awareness of media guidelines and expansion and adherence to press codes of practice are required by journalists to ensure ethical reporting.

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