The recurring problem of retained swabs and instruments.

Patient safety is one of the most pressing challenges in health care. The promotion of safety requires that all those involved in healthcare realise that the potential for errors exists, and that teamwork and communication are essential for preventing errors. Incidents compromising patient safety, such as unintended retention of swabs or instruments, are regarded as 'never events'. These incidents are considered 'unacceptable and eminently preventable', as pointed out by the Department of Health 'never events list' 2012/2013. One estimate says that one case of a retained item occurs at least once a year in a major hospital where 8000 to 18,000 major cases are carried out each year. All healthcare organisations should take appropriate measures to prevent retention of foreign bodies by consistent application of reliable and standardised processes of care. In this review, we explore the risks and complications associated with retained swabs and instruments, and different ways to prevent such risks to patients.

Laparoscopic management of genital prolapse.

INTRODUCTION: Genital prolapse is one of the most common indications for gynaecological surgery. Surgery is performed traditionally via abdominal, vaginal and laparoscopic approaches. METHODS: A MEDLINE computer search was performed to explore the recent evidence behind laparoscopic surgery for female pelvic organ prolapse. RESULTS: Advances in minimal access surgery have led to an increase in adoption of laparoscopic techniques. Current evidence supports the use of laparoscopy for sacrocolpopexy and colposuspension as an alternative to open surgery. However, the introduction of less invasive midurethral sling procedures for stress incontinence has reserved laparoscopic colposuspension for special indications. The scientific evidence regarding uterosacral suspension procedures and paravaginal and vaginal prolapse repairs are sparse. CONCLUSION: The current evidence supports the outcome of laparoscopic sacrocolpopexy as an alternative to open surgery. Further studies are required on the long-term efficiency in laparoscopic paravaginal repair and vaginal wall prolapse.

The place of ultrasound in urogynaecology clinic.

Urinary incontinence is a silent epidemic severely affecting the quality of life of women. Clinical assessment alone has been shown to be an ineffective way of assessing women with lower urinary tract dysfunction; hence, there is a need for urodynamic studies. Nevertheless, urodynamics cannot explain all the symptoms and is not always available. Ultrasound scan is becoming more useful in the field of urogynaecology. It is safe, non-invasive and acceptable technique for the patients. In this review, we explore the place of modern ultrasound in managing women attending urogynaecology clinic.

Maternity guidelines: aid or hindrance?

This questionnaire survey was performed to explore the attitudes of 295 obstetricians and midwives in a teaching and a district general hospital, towards the maternity directorate guidelines, and to document the possible barriers that may hinder their adherence and suggestions for improvement. The response rate was 61%. There was a tendency in both hospitals to agree that guidelines help learning and improve the quality of care, but make practice defensive, stop innovation, narrow the clinical freedom and do not reduce cost. A significantly higher number in the district hospital valued the guidelines as an aid to use the most up-to-date knowledge. Interestingly, about half of the staff in both hospitals were neutral regarding the role guidelines play in increasing professional satisfaction. The major barrier for lack of adherence was the belief that the individual guidelines were not comprehensive enough to cover daily practice. The trend of the responses was similar in both hospitals with the exception of three areas, where there were significant differences; pressure of time in the teaching hospital, and senior disagreement and lack of resources in the district hospital. Using bullet points for clarity within guidelines, shortening the guidelines, announcing new editions in directorate meetings, and frequent updating were the most common suggestions for improvement. The variations in staff response between the two hospitals highlight the importance of tailoring guidelines to match the working environment and the staff views rather than rigidly dictating practice.