The President of the Royal College of Obstetricians and Gynaecologists (RCOG) will today call upon the new Coalition Government to listen and to work with its doctors to change the NHS for the better. This comes on the day the College releases the results of its pre-election member poll at the 32nd British International Congress of Obstetrics and Gynaecology (BICOG) in Belfast.
Prior to the elections, RCOG members were asked for their views on a range of issues concerning the provision of healthcare services within the specialty1. The main findings are as follows:
Generally, RCOG members agreed that a patient-centred NHS should be the main driver for all those involved in the care of women. There was unanimous agreement that an over-managed NHS resulted in an obsession with meeting targets and the bureaucratic culture present in the majority of hospitals. These developments have taken doctors away from what they are there to do (ie. focusing on their patients) and impacted on the quality of care given to women.
According to respondents, the main challenges facing the next Government post-elections are:
- Staffing - the NHS needs more midwives and consultants to run its busy maternity services. There are emerging challenges posed by the need to comply with the European Working Time Directive (EWTD) alongside safety issues from the reduced number of hours that junior doctors are allowed to work.
- Service pressures - financial cutbacks from the recession, a target-driven ethos in the NHS and too many NHS managers were identified as problems.
- Social pressures - the rising birth rate, rising numbers of complex pregnancies and the increase in patient expectations have had an impact on O&G services.
When asked about what RCOG members would like to see change in present NHS O&G services, the common themes that emerged were:
- The focus must be on patients rather than targets.
- There is the need to reduce bureaucracy so that clinicians can get on with their work.
- There were too many NHS managers interfering in clinical matters and not involving clinicians in management decisions.
- The reorganisation of services - there is an acceptance that some centralisation is needed to provide better care. However, there seems to be a split in views about reorganisation. The main view was that reorganisation needs to be done in a case-by-case basis according to local needs.
When asked about how the quality of O&G services can be improved, respondents mentioned that the EWTD had impacted negatively on safety and training. The solutions offered by members included the provision of a consultant-led service, opting out of the EWTD or extending the length of postgraduate medical training so that doctors have the requisite knowledge, skills and competencies by the time they complete their medical training. Respondents also felt that the reduced number of working hours has resulted in service gaps that need to be addressed urgently.
The RCOG was also keen to hear from its membership what they would personally like politicians and policy-makers to do to improve O&G services. Respondents mentioned that politicians need to better understand the pressures which doctors go through and the service needs/demands by engaging with healthcare professionals and professional bodies. Some respondents felt that politicians should cease their meddling in clinical matters and to stop developing policy which is either unrealistic and/or difficult to fulfil without further investment in services (eg. the home birth pledge).
Members were asked to vote what they thought are the most important actions which will result in better care in NHS O&G services over the next year. The top three are:
1. Providing the training that the service requires based on clinical needs
2. Increasing consultant presence in labour wards to enhance supervision
3. Reducing NHS litigation in the specialty by greater investment in staffing
Members were asked to vote on what they thought are the most important public health issues affecting women's healthcare at the moment. The top three are:
1. The increasing incidence of maternal obesity in the population
2. The rising birth rate leading to a redistribution of NHS resources
3. Smoking in the female population
RCOG President Professor Sir Sabaratnam Arulkumaran said, "Over the course of the last year, with the build-up to the elections, there was a lot of talk about which political party had the best policies on various aspects of healthcare.
"There was the feeling amongst healthcare professionals (especially those at the coal-face of service delivery) that some existing policy ideas, though laudable, were impractical at best, misguided at worst. We decided to ask our members what they thought were the pressure points facing obstetric and gynaecological care in the NHS. More importantly, we wanted to know what they thought were the changes needed so that the quality of services improves.
"Safety and patient satisfaction were identified as paramount issues. Most notably, an overwhelming majority of our members stated that the European Working Time Directive (EWTD) is having a negative impact on junior doctor training and there may be a serious knock-on effect on the provision of safe services in years to come. We call upon politicians, policy makers and civil servants to pay heed to these concerns. Develop solutions on your own at your own peril. Instead, work with the Royal Colleges and those involved in service delivery so that you are aware of the appropriate levels of care needed and what can be achieved given our limited resources.
"The Coalition Government has a unique opportunity here. Many of the health announcements made over the last weeks shows it is determined to start with a clean slate and to make some bold changes. The previous government did much to put maternity back on the agenda. We would urge the new Government to work with us as we make our maternity services one of the best in the world."
For more information about BICOG and to view the programme, please click here.
1 To complement its Election Manifesto, the RCOG undertook an online survey of its UK membership in March and April this year. Members were asked a series of questions on the state of maternity and gynaecological services on the NHS, the external factors impacting on the provision of these services and the areas where improvements can be made.
254 responses were received.
Source:
Royal College of Obstetricians and Gynaecologists
вторник, 25 октября 2011 г.
вторник, 18 октября 2011 г.
Long Island Doctor Shows First '4K' Ultra-High Definition Surgery
Doctors at the annual meeting of the American Society for Reproductive Medicine got a glimpse into the future of women's health with the presentation of endoscopic gynecologic surgery performed for the first time using "4K" technology.
Steven F. Palter, MD, an obstetrician, gynecologist, reproductive endocrinologist and fertility specialist performed the world's first 4K super high-definition (HD) laparoscopy at Syosset Hospital, part of the North Shore-LIJ Health System, and presented images from that surgery on October 20 at the 65th annual meeting of the American Society for Reproductive Medicine (ASRM) at the Georgia World Congress Center in Atlanta.
"The images are the sharpest, most detail-rich and color-correct endoscopic images ever created anywhere," Dr. Palter said. "There is not a more accurate view inside the human body."
Produced in conjunction with RED Digital Cinema Camera Company; Sony Electronics, Inc., an ultrahigh definition projector company; and the University of Southern California Cinema Arts School, the diagnostic images were presented in a specially built digital theater with a projector designed to run "ultra-HD" movies in high-end movie theatres. "It's a prime example of how Hollywood film technology can be used to transform medicine by enabling doctors to see more accurately inside the body to study and treat disease," Dr. Palter said.
Ultra-high resolution digital cameras are transforming the art of cinema. Leading Hollywood directors such as Peter Jackson and Stephen Soderbergh are filming the next generation of cinema blockbusters using cameras with "4K" resolution, four times the resolution of HD with 4,096 lines of resolution to give audiences unprecedented realism.
"Through the use of this digital technology, Hollywood is moving from observation to immersion -- you're not just watching something, you are there," said Dr. Palter, medical and scientific director of Gold Coast IVF in Syosset, NY, who presented the plenary presentation, Film and Medicine: The Technological Transformation of Medicine. "In this session we showed how tomorrow's film technology can apply to laparoscopic surgery, which is all performed using video techniques."
Dr. Palter joined with the Red Digital Cinema Camera Company that manufactures the 4K Red One system to create Hollywood movies of tomorrow, and Sony, the leading ultra-HD theatrical projector company, to perform laparoscopic surgery using the Hollywood camera system.
During the film presentation, the 3,500 reproductive medicine specialists in attendance were able to visualize the surgery as if they were standing in the operating room. However, by combining unprecedented resolution and magnification, the surgical images were beyond what a surgeon would see in traditional surgery. The progress from regular surgical film technology is like comparing sitting in an HD home theater to watching a video on a cell phone," said Dr. Palter.
"Dr. Palter's research and vision of surgery's technological future opened the eyes and minds of the audience to fantastic treatments beyond what can be done today," said R. Dale McClure, MD president of ASRM.
The session also included a projection of the largest HD three-dimensional (3D) surgical images ever. Using the same system as 3D blockbuster Cloudy With a Chance of Meatballs, surgeons felt as if they could "reach out and conduct the operation." These images were enabled by converting Sony's 4K and 3D theatrical systems to show medical footage of what Dr. Palter has called "futurevision." To obtain the images, Dr. Palter and researchers from USC Cinema Arts created a method to attach the Red One 4K camera to a laparoscope. Offhollywood, a leading movie production company converted these images into a 4K digital cinema movie that was projected on $200,000, 700-pound Sony SRX-R220 projectors back to back with 4K Hollywood images of such stars as Tom Cruise, Julia Roberts and Will Smith. RealD 3D lenses projected HD 3D surgery as well as Hollywood images from 3Ality of movies, sports and the rock music band U2.
Source: North Shore-LIJ Health System
Steven F. Palter, MD, an obstetrician, gynecologist, reproductive endocrinologist and fertility specialist performed the world's first 4K super high-definition (HD) laparoscopy at Syosset Hospital, part of the North Shore-LIJ Health System, and presented images from that surgery on October 20 at the 65th annual meeting of the American Society for Reproductive Medicine (ASRM) at the Georgia World Congress Center in Atlanta.
"The images are the sharpest, most detail-rich and color-correct endoscopic images ever created anywhere," Dr. Palter said. "There is not a more accurate view inside the human body."
Produced in conjunction with RED Digital Cinema Camera Company; Sony Electronics, Inc., an ultrahigh definition projector company; and the University of Southern California Cinema Arts School, the diagnostic images were presented in a specially built digital theater with a projector designed to run "ultra-HD" movies in high-end movie theatres. "It's a prime example of how Hollywood film technology can be used to transform medicine by enabling doctors to see more accurately inside the body to study and treat disease," Dr. Palter said.
Ultra-high resolution digital cameras are transforming the art of cinema. Leading Hollywood directors such as Peter Jackson and Stephen Soderbergh are filming the next generation of cinema blockbusters using cameras with "4K" resolution, four times the resolution of HD with 4,096 lines of resolution to give audiences unprecedented realism.
"Through the use of this digital technology, Hollywood is moving from observation to immersion -- you're not just watching something, you are there," said Dr. Palter, medical and scientific director of Gold Coast IVF in Syosset, NY, who presented the plenary presentation, Film and Medicine: The Technological Transformation of Medicine. "In this session we showed how tomorrow's film technology can apply to laparoscopic surgery, which is all performed using video techniques."
Dr. Palter joined with the Red Digital Cinema Camera Company that manufactures the 4K Red One system to create Hollywood movies of tomorrow, and Sony, the leading ultra-HD theatrical projector company, to perform laparoscopic surgery using the Hollywood camera system.
During the film presentation, the 3,500 reproductive medicine specialists in attendance were able to visualize the surgery as if they were standing in the operating room. However, by combining unprecedented resolution and magnification, the surgical images were beyond what a surgeon would see in traditional surgery. The progress from regular surgical film technology is like comparing sitting in an HD home theater to watching a video on a cell phone," said Dr. Palter.
"Dr. Palter's research and vision of surgery's technological future opened the eyes and minds of the audience to fantastic treatments beyond what can be done today," said R. Dale McClure, MD president of ASRM.
The session also included a projection of the largest HD three-dimensional (3D) surgical images ever. Using the same system as 3D blockbuster Cloudy With a Chance of Meatballs, surgeons felt as if they could "reach out and conduct the operation." These images were enabled by converting Sony's 4K and 3D theatrical systems to show medical footage of what Dr. Palter has called "futurevision." To obtain the images, Dr. Palter and researchers from USC Cinema Arts created a method to attach the Red One 4K camera to a laparoscope. Offhollywood, a leading movie production company converted these images into a 4K digital cinema movie that was projected on $200,000, 700-pound Sony SRX-R220 projectors back to back with 4K Hollywood images of such stars as Tom Cruise, Julia Roberts and Will Smith. RealD 3D lenses projected HD 3D surgery as well as Hollywood images from 3Ality of movies, sports and the rock music band U2.
Source: North Shore-LIJ Health System
вторник, 11 октября 2011 г.
The GRACE Study Has Significant Implications For Inclusion Of Women In Clinical Trials
Data from the GRACE (Gender, Race And Clinical Experience) study will be published in the September 21st issue of the Annals of Internal Medicine. GRACE is the largest-ever study of treatment-experienced adult women with HIV-1 to examine gender differences in response to HIV therapy. Sponsored by Tibotec Therapeutics Clinical Affairs, a division of Centocor Ortho Biotech Services, LLC, the GRACE study enrolled 67 percent women, demonstrating that it is possible to recruit large numbers of women into U.S.-based HIV treatment studies. The company has launched TheGraceStudy to share learnings from the GRACE study and other information for women living with HIV.
Among patients who completed the study, there were no significant differences in treatment responses between men and women who were given PREZISTA® (darunavir) 600 mg coadministered with 100 mg ritonavir twice daily, as part of combination therapy. The GRACE study was designed in partnership with the HIV community and used unique strategies to encourage women living with HIV to participate in the trial. However, even with its novel enrollment strategies, the study showed a higher discontinuation rate among female study participants - making the overall response rate lower among women than among men, and shedding light on the need for additional efforts to retain diverse populations in clinical studies.
"Better representation of women in clinical trials is essential for generating accurate information on the efficacy and safety of medicines and, ultimately, guiding treatment decisions," said Judith Currier, MD, Professor of Medicine, Associate Division Chief, Division of Infectious Diseases, University of California, Los Angeles, Director of the Clinical Trials Unit, UCLA Center for Clinical AIDS Research and Education (CARE),and primary investigator in the GRACE study. "The GRACE study has the potential to shape how future studies are conducted because it addressed the social and economic barriers that historically have prevented women from participating in clinical research. It also showed that we have a long way to go before we can fully overcome these barriers."
In the United States, women account for an increasing proportion of people living with HIV/AIDS, including more than one quarter of new diagnoses. Yet despite their growing numbers, women have been under-represented in HIV treatment studies. This may be due to recruitment and retention challenges including family commitments, time constraints with jobs, and other socioeconomic factors. These observations have been noted in clinical trials of other therapeutic areas, including heart disease and cancer, suggesting that difficulties in recruiting women are not specific to HIV clinical trials. As a result of having a low number of women in these studies, gender-based conclusions are limited, and there remains a gap in clinical data.
"Unlike most studies of HIV medicines, GRACE was specifically designed and powered to assess gender differences in response to treatment," said Dr. Currier. "We took steps that have never before been used to make sure our study population was reflective of the demographics of women with HIV in the United States."
GRACE Study Design and Results
GRACE was a multi-center (65 sites), open-label Phase 3b trial that compared the efficacy, safety, and tolerability of the protease inhibitor PREZISTA (600 mg) boosted with a low dose of ritonavir (100 mg) twice a day, in combination with an investigator-selected optimized background regimen for 48 weeks in men (n=142) and women (n=287).
The study was designed to enroll a high proportion of North American, treatment-experienced women that was reflective of the distribution and demographics of women with HIV in the United States. Trial sites were selected to correspond with the geographic distribution of women with HIV, with the majority of sites located in the Northeastern (16 sites) and Southeastern (29 sites) United States. Study sites were initially required to enroll three women before enrolling a man, and thereafter, each site was required to maintain at least 70 percent female enrollment. Men could only be enrolled if their addition did not compromise the 70 percent female quota.
GRACE participants also received support to cover costs associated with study participation, including assistance for travel, childcare and food vouchers, and study sites could access grants for patient support activities such as lunch-and-learn sessions and patient support groups for ongoing education and camaraderie.
At the end of the study period, there were no statistically significant differences in virologic response (defined as a viral load of
Among patients who completed the study, there were no significant differences in treatment responses between men and women who were given PREZISTA® (darunavir) 600 mg coadministered with 100 mg ritonavir twice daily, as part of combination therapy. The GRACE study was designed in partnership with the HIV community and used unique strategies to encourage women living with HIV to participate in the trial. However, even with its novel enrollment strategies, the study showed a higher discontinuation rate among female study participants - making the overall response rate lower among women than among men, and shedding light on the need for additional efforts to retain diverse populations in clinical studies.
"Better representation of women in clinical trials is essential for generating accurate information on the efficacy and safety of medicines and, ultimately, guiding treatment decisions," said Judith Currier, MD, Professor of Medicine, Associate Division Chief, Division of Infectious Diseases, University of California, Los Angeles, Director of the Clinical Trials Unit, UCLA Center for Clinical AIDS Research and Education (CARE),and primary investigator in the GRACE study. "The GRACE study has the potential to shape how future studies are conducted because it addressed the social and economic barriers that historically have prevented women from participating in clinical research. It also showed that we have a long way to go before we can fully overcome these barriers."
In the United States, women account for an increasing proportion of people living with HIV/AIDS, including more than one quarter of new diagnoses. Yet despite their growing numbers, women have been under-represented in HIV treatment studies. This may be due to recruitment and retention challenges including family commitments, time constraints with jobs, and other socioeconomic factors. These observations have been noted in clinical trials of other therapeutic areas, including heart disease and cancer, suggesting that difficulties in recruiting women are not specific to HIV clinical trials. As a result of having a low number of women in these studies, gender-based conclusions are limited, and there remains a gap in clinical data.
"Unlike most studies of HIV medicines, GRACE was specifically designed and powered to assess gender differences in response to treatment," said Dr. Currier. "We took steps that have never before been used to make sure our study population was reflective of the demographics of women with HIV in the United States."
GRACE Study Design and Results
GRACE was a multi-center (65 sites), open-label Phase 3b trial that compared the efficacy, safety, and tolerability of the protease inhibitor PREZISTA (600 mg) boosted with a low dose of ritonavir (100 mg) twice a day, in combination with an investigator-selected optimized background regimen for 48 weeks in men (n=142) and women (n=287).
The study was designed to enroll a high proportion of North American, treatment-experienced women that was reflective of the distribution and demographics of women with HIV in the United States. Trial sites were selected to correspond with the geographic distribution of women with HIV, with the majority of sites located in the Northeastern (16 sites) and Southeastern (29 sites) United States. Study sites were initially required to enroll three women before enrolling a man, and thereafter, each site was required to maintain at least 70 percent female enrollment. Men could only be enrolled if their addition did not compromise the 70 percent female quota.
GRACE participants also received support to cover costs associated with study participation, including assistance for travel, childcare and food vouchers, and study sites could access grants for patient support activities such as lunch-and-learn sessions and patient support groups for ongoing education and camaraderie.
At the end of the study period, there were no statistically significant differences in virologic response (defined as a viral load of
вторник, 4 октября 2011 г.
Abstinence-Only Sex Education Debate Has High Financial Stakes, Washington Times Opinion Piece Says
By proposing to reduce funding for abstinence-only sex education programs, "the Obama administration has reignited America's sex education debate," Washington Times columnist Cheryl Wetzstein writes in an opinion piece. She says that the "usual answers" she receives from abstinence-only opponents when she asks about their criticism of the programs is that abstinence-only education "doesn't work, it leaves kids ignorant about how to use birth control, it doesn't serve gay kids, and (off the record) it's just a return to the bad old days when unenlightened, sex-hating harpies ran sex education." According to Wetzstein, some proponents of abstinence-only programs believe that another factor -- which is "never mentioned" in the sex education debate -- "is how sexually active youth are part of the market for certain commercial sex- and disease-related products, and abstinent behavior reduces that market share."
Wetzstein reports that she recently spoke with Pam Mullarkey, founder of Project SOS, who is "furious" that Presdient Obama's budget proposal would reduce funding for abstinence-only programs and increase money for teen pregnancy prevention. Mullarkey claims that abstinence-only opponents "have spent so much money trying to destroy abstinence education" because "it directly costs them big bucks" if teens abstain. Wetzstein writes that she has "dim hopes for the survival of abstinence education as we've know it," concluding, "But should Congress decide to 'follow the money,' as Mrs. Mullarkey suggests, who knows what might turn up" (Wetzstein, Washington Times, 5/19).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
Wetzstein reports that she recently spoke with Pam Mullarkey, founder of Project SOS, who is "furious" that Presdient Obama's budget proposal would reduce funding for abstinence-only programs and increase money for teen pregnancy prevention. Mullarkey claims that abstinence-only opponents "have spent so much money trying to destroy abstinence education" because "it directly costs them big bucks" if teens abstain. Wetzstein writes that she has "dim hopes for the survival of abstinence education as we've know it," concluding, "But should Congress decide to 'follow the money,' as Mrs. Mullarkey suggests, who knows what might turn up" (Wetzstein, Washington Times, 5/19).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
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