College Statement Research Articles

Compliance with clinical guidelines increases the safety of vacuum-assisted delivery.

Vacuum-assisted delivery (VAD) is a common and safe obstetric procedure. However, occasionally serious complications may occur. Clinical guidelines and College Statements have been developed to reduce the risk of serious adverse events. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) College Statement C-Obs 16 has not been evaluated to see if advice improves outcomes. The aim was to evaluate whether compliance with RANZCOG College Statement C-Obs 16 advice reduced the risk of serious adverse outcomes, specifically clinically significant subgaleal haemorrhage and major birth trauma. Retrospective audit of VADs in a level five hospital (NSW Maternity and Neonatal capability framework) from January 2020 to 2021. There were 1960 women who delivered in the study period, of whom 252 (12.8%) delivered by vacuum, and complete data were available from 241 cases. Statement compliance was observed in 81%. The main deviation from Statement compliance was pulls exceeding three. Statement compliance was associated with a significant reduction in the incidence of subgaleal haemorrhage (0% vs 11%, P= 0.0002), major birth trauma (3% vs 22%, P= 0.0001), requirement for neonatal resuscitation (14% vs 35%, P= 0.0026) and Apgar scores at oneminute less than six (5% vs 22% P= 0.0006). Statement compliance was associated with a significant reduction in maternal blood loss at delivery (388 mL vs 438 mL, P= 0.01). Noncompliance with Statement advice was observed significantly more often in pregnancy complicated by gestational diabetes (3% vs 15%, P= 0.02) and birth requiring instrument change (4% vs 13% P= 0.031). Compliance with a College Statement is associated with lower rates of subgaleal haemorrhage and major neonatal trauma. The main deviation from compliance was pulls in excess of three. Keyword: birth trauma, clinical guidelines, quality and safety in healthcare, subgaleal haemorrhage, vacuum delivery.

Re: The RANZCOG College Statement on prophylactic oophorectomy in older women undergoing hysterectomy for benign disease: Is the evidence sufficient to change practice?

Re: The RANZCOG College Statement on prophylactic oophorectomy in older women undergoing hysterectomy for benign disease: Is the evidence sufficient to change practice?

Obstetric Ethics

The American College of Obstetricians and Gynecologists (the College) Committee Opinion, "Planned Home Birth," invokes two core concepts of obstetric ethics, the right of a woman to make a medically informed decision about delivery and the informed consent process. We set out a framework for obstetric ethics that empowers the autonomy of pregnant women by focusing on when, in beneficence-based clinical judgment, clinical management should be offered, should be recommended, and should be recommended against in the informed consent process. Using this ethical framework, we show that the College statement does not provide adequate guidance to obstetricians in fulfilling their ethical obligations in the informed consent process with pregnant women who express an interest in, or preference for planned home birth. Obstetricians have an ethical obligation to disclose the increased risks of perinatal and neonatal mortality and morbidity from planned home birth in the context of American healthcare and should recommend against it. Obstetricians should recommend hospital-based delivery and respond to refusal of these recommendations with respectful persuasion. As a matter of beneficence-based professional integrity, obstetricians should not participate in planned home birth. At the same time, obstetricians have a beneficence-based obligation to continue to provide prenatal and emergency obstetric care. The obstetric profession should continuously strive to make hospital births more humane and support home-birth-like environments in the hospital as well as continuously improve safety for both pregnant and fetal patients.

The RANZCOG College Statement on prophylactic oophorectomy in older women undergoing hysterectomy for benign disease: Is the evidence sufficient to change practice?

In 2009, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) published College Statement C-Gyn 25: "Prophylactic oophorectomy at the time of hysterectomy for benign gynaecological disease, which recommended that caution should be exercised in performing bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy for benign disease in women younger than 65 years of age." The aims of the study were to assess current practice with regard to prophylactic oophorectomy in this setting and to assess knowledge about the College Statement. We also sought to review the evidence behind the Statement. An anonymous email survey of all consultant gynaecologists and gynaecology registrars in Sydney West Area Health Service (SWAHS) was conducted. The response rate was 52%. The survey found that there was an increasing tendency to remove ovaries with increasing patient age, and over 60% of gynaecologists would routinely recommend removal of ovaries during a hysterectomy for benign disease in a 60 year old woman. The survey also revealed a lack of knowledge as to the existence or content of the College Statement. A review of the literature found that evidence suggesting benefit in retention of ovaries in postmenopausal women has been extrapolated from a modelling study, observational studies or from data on premenopausal oophorectomy. A survey of gynaecologists revealed that few currently appear to adhere to the College Statement regarding prophylactic oophorectomy at the time of hysterectomy for benign disease. High quality evidence regarding either harm or benefit following retention of ovaries after menopause is lacking. Nevertheless, dialogue between clinicians and patients on this topic is important.

For the last time!

This will be my last Editorial for ANZJOG. Four years seem to have gone very quickly, but I can look back over this time with a great deal of satisfaction. As I foreshadowed at the end of the last Editorial, the Impact Factor (IF) has risen again to 1.316 and the journal has also increased its ranking to 46 of 69. This is a great achievement given the nature of our journal and the types of articles that we publish, focussing very much on general O&G with clinical research being at the forefront. Impact factors are calculated based on the numbers of citations over the last year for articles published in the two previous years. In some branches of medicine, there is often very rapid translation into numerous citations. Also, with some highly specialised journals, there is a large amount of ‘self-citing’ as the field is very narrow and a much higher likelihood that a related article will cite one previously published. A general journal will sometimes publish articles that will be cited for many years into the future, but which will not be taken into account when the IF is calculated. We do still have some way to go to reach the average IF of Wiley-Blackwell’s journals, which currently stands at 2.05. The annual report for ANZJOG tells us that last year we published 162 articles (including Case Reports and Letters) out of well over 500 submitted, which represents an acceptance rate of about 28%. There were over 86 000 full text downloads of articles, and over 459 000 abstracts were accessed! These articles came from 29 different countries, reflecting the truly international nature of ANZJOG. Australian & New Zealand authors contributed 108 articles (66.5%). There has been a significant shift in the time that I have been in this position. When I started, it was proving quite hard to fill each issue with publishable material. Now, it is getting much easier and in some cases, the time to publication is longer than I would like. Unfortunately, this means that we do now have to reject many articles that are of a publishable standard as a result of lack of space. Contrary to a popular view that I have heard expressed from many quarters, we do not have any publication bias towards local material, nor should we. All articles are considered on their merits regardless of where they originate, and from which professional group they have come. I have chosen another article myself for this issue. It is the turn of the first decade of this century and I have selected one from right at the beginning of the decade. One of the co-authors is Caroline Crowther from Adelaide who remains one of our most prolific O&G academics with a truly international profile. The article is not one which changed practice, but is certainly of important historical interest as it reflects the views of the Fellowship on screening for group B streptococcus (GBS) at that time. This survey shows that the Fellowship was almost split down the middle in favour of either screening or a ‘treat by risk factors’ approach. Even today, despite two very definite College statements, it is evident that the screening approach is not by any means universal, and in some cases, treatment does not follow in the face of risk factors. The problem of what to do about GBS remains one of the vexed questions in modern obstetrics. Finally, I thank all the people who have helped to make this venture a success. My Editorial Board (past and present) are invaluable and I thank them personally for all their hard work. The staff of College House and those at Wiley-Blackwell who turn my decisions into published material have all been wonderful. Finally, I thank all the reviewers who do this as a ‘labour of love’. We have a very small pool to select from and I am conscious that I am often asking people who are already over-committed to take on just one more thing! Your work is very much appreciated and I hope that all of you will continue to support our new Editor-in-Chief, Professor Jan Dickinson, to whom I wish every success in her new role.

Research training in the 21st century: the part time MSc

T he government is committed to increasing consultant numbers to meet national service framework targets and comply with the European Working Time Directive. Consultant training has had to adapt and shorten. One consequence of this is that it is now unusual for trainees to undertake two or three years' full time research leading to an MD or PhD; until recently this was almost a requirement in many hospital specialties. Those opting for a competitive research career still need to make a commitment to research early on—but what about the majority of trainees, those who are not going to pursue a career in research. Would they benefit from research training? The view of the Royal College of Physicians is that knowledge of research is a vital component of clinical training. We agree strongly with the college's statement that “research awareness training should be mandatory for all physicians.” But what …

College Statement on Covert Administration of Medicines

College Statement on Covert Administration of Medicines

Iatrogenic Dependency Disorder

To argue for the direct election of RANZCP officials as a means of ensuring that College statements and political activities correspond as closely as possible to the opinions and interests of the average psychiatrist. The case to abolish item 319 and restore 5 day-per-week sessions is out of touch with political reality. It wastes limited political capital by the College, or other psychiatric organizations, that would be better used for other purposes.

College Statement ‐ The Royal Australasian College of Physicians

College Statement ‐ The Royal Australasian College of Physicians

Psychiatric Bulletin readership survey

The Psychiatric Bulletin was launched in October 1971 as a separate news and notes supplement to the British Journal of Psychiatry. At first, the Bulletin confined itself to publishing College statements, the details of divisional meetings, lists of fellows, and forthcoming events. Over the years, the Bulletin has undergone an ambitious expansion in the range of subjects covered. A special emphasis has been placed on publication of studies of practical clinical management, including the Mental Health Act, audit and training matters. There has also been an increase in papers on cultural, historical and media topics related to psychiatry. Other regular sections include interviews, usually with the elder statesmen of psychiatry, obituaries, conference reports and correspondence. The Bulletin also publishes educational articles, such as those on computing or good practice guidelines.

Benzodiazepines and Dependence: A College Statement

There is increasing concern, both among doctors and the lay public, on the potential for dependence of the benzodiazepine group of drugs. In order that the Royal College of Psychiatrists could publish a view on this contentious topic, a consensus meeting was arranged on 10 June 1987 by the Programmes and Meetings Committee (see list of participants). The following statement has now been approved by the College.

Benzodiazepines and Dependence: A College Statement

Benzodiazepines and Dependence: A College Statement

The College's Statement on Hospital Closures

At its meeting on 26 October 1979 Council heard of the threatened closure of a number of psychiatric units and related departments and expressed great concern that the current economic situation might seriously threaten the maintenance and development of essential services for the mentally ill and the mentally handicapped. We wish to stress the need for the closest consultation at all levels between administrators and members of the College so that cuts can be made which are effective economically with the least danger of reducing the services to patients. This is particularly important where ‘temporary’ closures are being considered where the normal consultative processes may be by-passed. Our specialty is recognized as still being relatively under-provided in comparison with other areas of medicine. Furthermore, it relies heavily on manpower and not on expensive apparatus, costly drugs or other resources besides personnel.

TRAINING for research.

THE annual dinner of the Association of British Chemical Manufacturers on October 12 was notable for two speeches in which the question of the relations between industry and the universities, particularly in regard to research, was discussed from the industrial point of view. They are thus complementary to recent discussions, in the Nuffield College Statement and the report of the University Grants Committee, where the academic aspect was dominant. Sir Robert Robinson, after a passing reference to the importance to chemical industry of the duty on light hydrocarbon oils, in which he advocated not only its retention but also extension of the duty and the refund scheme to cover solvents as well, reviewed the question of research in the universities. Sir Robert's opinion that the main function of the universities and colleges is the training of students cannot be taken as implying that research is only a secondary function. In this speech he reiterated the view that academic research should be basic and general in character and not, as is usual in industrial research, directed to limited and specific objectives.

Second Thoughts on University Expansion

THE almost simultaneous publication of the Nuffield College Statement "The Problem Facing British Universities" and the symposium on "Entry and Careers" in The Universities Quarterly for August provides valuable material for further discussion on the expansion of the universities. The former Statement brings together much useful statistical information as well as collecting in its chapters on the demand for university graduates estimates of intake to the professions which are not otherwise conveniently accessible. Moreover, in the further chapter on the flow from the schools the Statement does something to meet a point made by Dr. Eric James, high master of the Manchester Grammar School, at the British Association conference on "The Place of Universities in the Community" last year, as well as to supply a factual background to Dr. J. F. Mountford and Mr. James Hemming‘s contribution to the symposium. Indeed, the Statement contains so much factual information that it is not easy to see the wood for the trees, and the conclusions seem, to indicate that the members of the Nuffield Committee have not been entirely sure of themselves for that reason.

THE HUMAN FACTOR IN SCIENTIFIC RESEARCH

NO one could claim that the Conference on Scientific Research and Industrial Planning held by the Division for the Social and International Relations of Science of the British Association (see p. 8) in London on December 7 and 8 broke fresh ground or threw up any new ideas. One of its most interesting features was rather the evidence it afforded of the way in which ideas once regarded as impractical or revolutionary are permeating the whole field of science and industry, and indeed of Government itself. Already it is clear that principles advocated in the Barlow Report on scientific staff, in the Nuffield College Statement on Problems of Scientific and Industrial Research and in reports from the Parliamentary and Scientific Committee, the Association of Scientific Workers and the Federation of British Industries, to mention only a few, have found widespread acceptance. Speaker after speaker, whether from the industrial, the academic or the Government side, referred to the importance of such factors as the interchange and mobility of staff, freedom in the publication of results, the importance of status and the like in attracting the right type of mind and in encouraging creative and original thinking. The lessons of teamwork demonstrated so convincingly during the War are being taken to heart, and it is realized that such co-operation and team-work must above all be based on conditions of employment which both attract the right type of man in sufficient numbers and stimulate him to give of his best.

Science in the Universities

THE report "Science in the Universities" submitted by the Association of Scientific Workers to the University Grants Committee, March 1944, which has now been published, covers very little ground that has not already been dealt with by the reports from the Parliamentary and Scientific Committee, the Association of University Teachers, or the Nuffield College statements. It is limited to consideration of the physical and biological sciences and the applied sciences immediately related to them such as are normally taught in universities, with some attention to the social sciences; within these limits, it is one of the best guides that has appeared to the ways in which the rapid expansion of scientific knowledge and its application are affecting the universities, and to the measures required to deal with the immediate problems. Among the recommendations may be mentioned those stressing practical work in the vacations as part of the training of all scientific workers, not merely those training for industry; the emphasis on the education and training of laboratory technicians, and also on the technique of teaching.

CONSUMER NEEDS IN ECONOMIC STABILITY

AN admirable report on “The Transition from War to Peace”* prepared by the Delegation on Economic Depressions, of which Sir Frederick Phillips is chairman, has recently been issued by the League of Nations. Although it has received singularly little notice officially, it provides the essential background in the discussions on employment policy which have been stimulated by the Beveridge Report, the Unilever paper, the Nuffield College statement and other publications on that subject ; further, it underlines the recommendations already advanced, that we must think out our policies and measures well in advance, and that we should utilize whatever is possible among the international agencies established to further co-operation during the War. No previous official document has set out so clearly the relations between immediate post-war measures, such as international relief, the removal of industrial controls, rationing and the lowering of taxation, and the larger economic policies for the maintenance of full employment and economic stability.