Standards for the provision of antenatal care for patients with inflammatory bowel disease: guidance endorsed by the British Society of Gastroenterology and the British Maternal and Fetal Medicine Society

BackgroundPregnant women with inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes. Comprehensive guidelines on medical management have been published; yet, there is limited guidance on service set-up and minimum standards of care for pregnant women with IBD.AimTo develop a position statement on service set-up and minimum standards of care in the UK.MethodsA working group consisting of 16 gastroenterologists, obstetricians, obstetric physician, IBD specialist nurses and midwives was assembled. Initial draft statements were produced and a modified Delphi process with two rounds of voting applied. Statements were modified according to voters’ feedback after each round. Statements with ≥80% agreement were accepted.ResultsAll 15 statements met criteria for inclusion. To facilitate optimal care, regular and effective communication between IBD and obstetric teams is required. There should be nominated link clinicians for IBD in obstetric units and for pregnancy in IBD units. Preconception counselling should be available for all women with IBD. All pregnant women should be advised on the safety of IBD medication during pregnancy and breast feeding, the optimal mode of delivery, the management of biologics (where applicable) and safety of childhood vaccinations. Regular audit of pregnancy outcomes and documentation of advice given is recommended.ConclusionPosition statements have been developed that advise on the importance of joined-up multidisciplinary care, proactive decision-making with clear documentation and communication to the woman and other healthcare practitioners.

Raynaud’s Phenomenon, Candidiasis, and Nipple Pain Strategies for Differential Diagnosis and Care

Breastfeeding pain is the second most common reason women stop breastfeeding (Strong, 2011); therefore it should be recognized early and treated promptly. Often pain from primary Raynaud’s Phenomenon of the Nipple (RP-n) imitates Candidiasis, misleading providers who prescribe antifungal medications. Unfortunately, the correct diagnosis comes after multiple doses of medication and no improvement in breastfeeding pain. Antifungals can further complicate diagnosis because they can cause nipple vasospasm as a side-effect of treatment (Bonyata, 2011). This article presents a case study of RP-n mistaken for Candidiasis. Evidenced-based treatment strategies, education, and close follow-up are minimum standards of care for women with breastfeeding pain. Fragmented healthcare systems can interfere with coordinated, evidence-based care. Raynaud’s and Candidiasis can present in very similar manners resulting in a clinical dilemma for providers. However, excellent systematic clinical assessment focusing on the characteristics of the pain can help to differentiate between the two conditions. An algorithm to assist providers in differentiating between the two has been developed.

Guidelines for Providing Acupuncture Treatment for Cancer Patients – a Peer-Reviewed Sample Policy Document

Clinical guidelines are statements that have been systematically developed and which aim to assist clinicians in making decisions about treatment for specific conditions, and promote best practice. They are linked to evidence and are meant to facilitate good medical practice. We are not aware of any guidelines for the safe practice of acupuncture in a conventional healthcare setting, yet they are necessary as acupuncture may be performed in a variety of settings and by a variety of healthcare professionals: doctors, nurses, physiotherapists, midwives, and non medically trained practitioners. These guidelines were developed for use in cancer patients, mainly for pain but also for some non-pain indications such as hot flushes. They are presented here as a template for other acupuncturists who are requested to provide policies for acupuncture treatment for cancer patients. This article includes a general review of the evidence on mechanisms, effectiveness and safety of acupuncture that is intended to be used in conjunction with the guidelines; and the guidelines themselves. An appendix includes instructions for self acupuncture. The guidelines contain sections on roles and responsibilities, criteria for acupuncture practice, indications for acupuncture, contraindications and cautions, acupuncture treatment, and review and audit. These guidelines set basic, minimum standards of care, and need reassessment and ongoing validation as further data and evidence accumulate.

Avoiding Civil Liability Under OBRA 1990: Documentation is the Key

The Omnibus Budget Reconciliation Act of 1990 (OBRA 90) and the various state regulations enacted in response to that act have already required a substantial change in the daily activities of pharmacists while performing their professional duties. OBRA 90 requires pharmacists to engage in patient counseling efforts and sets forth specific topics that pharmacists must discuss with the patient or primary caregiver. From a civil liability perspective, however, OBRA 90 requires pharmacists to do far more than counsel patients with regard to those patients' pharmaceutical care. It is anticipated that the requirements of OBRA 90 will establish minimum standards of care which must be met by all pharmacists. Courts will likely view a pharmacist's failure to adhere to the requirements of OBRA 90 as a failure to meet the standard of care applicable to pharmacists. Such failure to meet the applicable standard of care may lead to civil liability under the tort theories of ordinary negligence and negligence per se. Although OBRA 90 mandates that certain records be created and maintained, the prudent pharmacist in today's litigious world must develop a more comprehensive, accurate, and detailed system for documentation of the various counseling activities in which he or she engages. Because most pharmacies employ more than one pharmacist, and because memories of both patients and pharmacists can fail, creating and maintaining accurate records that exceed the documentation requirements of OBRA 90 and are admissible in court may well be the key to avoiding civil liability for an alleged failure to comply with the requirements of OBRA 90. Copyright © 1995 by W.B. Saunders Company