RCOG Workforce Report 2022

Since the last RCOG workforce report in 2018, the O&G profession has faced many challenges. Although the birth rate is falling nationally, there are rising levels of clinical complexity, budget cuts and staffing shortages of doctors, midwives, nurses and other allied professionals. Whilst demand for services in some areas is declining, there are increased requirements in other areas due to demographic shifts, an aging population and rising levels of obesity. All of this has been magnified and compounded by the Covid-19 pandemic which has required health professionals to work differently and adapt services to continue to provide care to women

Practical Classification Guidelines for Diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis.

Differentiating between type 1 and type 2 diabetes is fundamental to ensuring appropriate management of patients, but can be challenging, especially when treating with insulin. The 2010 UK Practical Classification Guidelines for Diabetes were developed to help make the differentiation.This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site.Published (Open Access

Titanium plate artefact mimicking popliteal artery dissection on digital subtraction CT angiography.

Titanium plates used for the internal fixation of long bone fractures cause significant artefact on CT scans but have not been reported to affect digital subtraction CT angiography. We present a patient with clinical suspicion of popliteal artery injury following a high tibial osteotomy. The osteotomy was stabilised with a titanium locking plate. During the digital subtraction process used to produce reconstruction CT angiography, removal of artefact caused by the titanium plate produced CT images mimicking the appearance of a popliteal artery dissection. The imaging inaccuracy was realised prior to the patient undergoing further intervention. We highlight the potential error caused by titanium plates on digital subtraction CT angiography and recommend careful analysis of such images prior to further treatment.This article is freely available via Open Access. Click on the 'Additional Link' above to access the full-text from the publisher's site

Assessment of practical classification guidelines for diabetes in insulin-treated patients

ArticleReplaced by http://hdl.handle.net/10871/21396Background Differentiating between Type 1(T1D) and Type 2 diabetes(T2D) is fundamental for appropriate treatment and management of patients, but can be challenging, especially when patients are insulin-treated. UK Practical Classification Guidelines (using age at diagnosis and time to insulin treatment) were developed, but their accuracy has not been assessed. Aim To assess the diagnostic accuracy of the UK guidelines against “gold-standard” definitions of T1D and T2D based on measured C-peptide levels. Design & Setting 601 adults with insulin-treated diabetes and diabetes duration >5years were recruited in Exeter, Northampton & Leicestershire. Method Baseline information and a home urine sample for urinary C-peptide creatinine ratio (UCPCR, a measure of endogenous insulin production) were collected. “Gold-standard” T1D was defined as continuous insulin treatment within 3 years of diagnosis and absolute insulin deficiency (UCPCR5years post-diagnosis); all other patients classed as T2D. Diagnostic performance of the clinical criteria assessed and other criteria explored using ROC curves. Results UK guidelines correctly classified 86% of participants. Most misclassifications occurred in patients classed as T1D who had significant endogenous insulin levels(57/601;9%); the majority in those diagnosed >35y and treated with insulin from diagnosis(37/66;56% misclassified). Time to insulin and age at diagnosis performed best in predicting long-term endogenous insulin production(ROC AUC=0.904 and 0.871); BMI at diagnosis was a less strong predictor of diabetes type (AUC=0.824). Conclusion Current UK guidelines provide a pragmatic clinical approach to classification that reflects long-term endogenous insulin production; caution is needed in older patients commencing insulin from diagnosis, where misclassification rates are increased