Best practice & research. Clinical obstetrics & gynaecology
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Best Pract Res Clin Obstet Gynaecol · Jun 2006
Access to safe abortion within the limits of the law.
The World Health Organization defines unsafe abortion as a procedure for terminating an unintended pregnancy carried out by people lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both. The Programme of Action of the International Conference on Population and Development recommends that 'In circumstances where abortion is not against the law, such abortion should be safe'. ⋯ This chapter reviews the magnitude of the problem, its consequences for women's health, the barriers to access to safe abortion, including its legal status, the effect of the law on the rate and the consequences of abortion, the human rights implications and the current evidence on methods to perform safe abortion. This chapter concludes with an analysis of what can be done to change the current situation.
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Best Pract Res Clin Obstet Gynaecol · Jun 2006
What is the relevance of women's sexual and reproductive rights to the practising obstetrician/gynaecologist?
Women's sexual and reproductive rights are an integral part of daily practice for obstetricians/gynaecologists and the key to the survival and health of women around the world. Women's sexual and reproductive health is often compromised because of infringements of their basic human rights, not the lack of medical knowledge. ⋯ Obstetricians/gynaecologists are natural advocates for women's health, yet may be lacking in their understanding of relevant laws or the limits of conscientious objection. This chapter outlines the framework for sexual and reproductive rights, and explores its relevance to the practising clinician.
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Modern perioperative care is complex and involves a large number of staff from multiple disciplines. Patient outcomes depend on well-designed processes, consistent clinical practice, and effective communication. Perioperative care should be a unified process of multiple coordinated steps. ⋯ For many common clinical challenges, there is a range of accepted management regimes. Institutionally consistent clinical practice is necessary to optimise patient outcome. Postoperative management should be based on standardised observations and care protocols, prevention strategies targeted at common problems, and rapid response by high-level teams to early physiological signs of complications.
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Best Pract Res Clin Obstet Gynaecol · Feb 2006
ReviewTraining, assessment and competency in gynaecologic surgery.
The trainee gynaecologist requires specific teaching to achieve competency in gynaecological surgery. Basic skills such as knot tying and suturing should be acquired outside the operating theatre. They can be learned on simulations, including bench models, using synthetic materials, life-like models and animal tissue. ⋯ Surgical skills training models should be reliable and valid, and can be incorporated into an objective structured clinical examination, which could be used to assess individual development and allow progression through a training programme. Simulation training does translate into improved operative performance. Supervised operating experience on patients is crucial to training and should be assessed regularly using a global rating form with constructive feedback to facilitate improvement.
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Best Pract Res Clin Obstet Gynaecol · Aug 2005
ReviewAmbulatory gynaecological surgery: risk and assessment.
Assessment of patients undergoing elective surgical procedures on an outpatient basis carries risks that range from mortality through non-lethal injuries to costs incurred for inappropriate testing. Ambulatory surgery accounts for over 60% of elective surgical procedures for most areas of the USA, Canada and Australia and a growing proportion of procedures in Europe and Asia. However, data to determine the true risk of these procedures are difficult to find due to standardized criteria for risk assessment and management. ⋯ Assessment of patients undergoing these procedures must take into consideration the nature of the medical and surgical conditions. Diagnostic testing is only performed if the results might change the management of the patient. At present, the American Society of Anesthesiology (ASA) classification system and the ASA guidelines for pre-anesthesia evaluation serve as the most current examples of risk assessments and algorithms that can be used for appropriate management of patients undergoing elective surgical procedures.