Publications by authors named "Karen Joash"

Purpose: To determine the level of uptake of telemedicine among postgraduate obstetrics and gynaecology (O&G) trainees in London, and how they perceive its impact on their training.

Methods: A mixed-methods survey aimed at exploring trainee perspectives of telemedicine use in clinical practice and its implications for training. Study participants were O&G specialist doctors on the London (UK) training programme.

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Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity on a global scale. Ethnic background is known to be a determinant of variation in the outcomes of women receiving maternity care across the world. Despite free maternity healthcare in the UK National Health Service, women with an ethnic minority background giving birth have an increased risk of PPH, even when other characteristics of the mother, the baby and the care received are considered.

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Background: COVID-19 has created many challenges for women in the perinatal phase. This stems from prolonged periods of lockdowns, restricted support networks and media panic, alongside altered healthcare provision.

Aims: We aimed to review the evidence regarding the psychological impact on new and expecting mothers following changes to antenatal and postnatal service provision within the UK throughout the pandemic.

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Increasing numbers of females are participating in elite sports, with a record number having competed at the Tokyo Olympic Games. Importantly, the ages of peak performance and fertility are very likely to coincide; as such, it is inevitable that pregnancy will occur during training and competition. Whilst there is considerable evidence to promote regular exercise in pregnancy, with benefits including a reduction in hypertensive disorders, gestational diabetes, and reduced rates of post-natal depression, few studies have been conducted which include elite athletes.

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Article Synopsis
  • Preterm birth (PTB) affects 8% of births in the UK, and a specialized clinic manages care for around 1000 women yearly, using regular ultrasound checks for cervical issues.
  • During COVID-19, the NHS adapted by minimizing in-person visits to prevent virus spread, leading to a 54% reduction in face-to-face appointments and a shift to 64% remote consultations.
  • Using quality improvement methods, the clinic implemented a new care pathway that maintained patient satisfaction and safety, with no reported COVID-19 cases among the patients during the study period.
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Article Synopsis
  • A study was conducted to evaluate a virtual reality ultrasound simulator for training in transvaginal ultrasonography among different skill levels (novice, intermediate, expert) in gynaecology and early pregnancy.
  • Participants filled out demographic questionnaires and completed training modules, providing feedback on the simulator’s effectiveness.
  • Results showed that a majority of participants found the simulation useful for training, with experts performing better on assessments and rating the simulator's realism and content positively.
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Objectives: This is a pilot study to investigate the type and severity of emotional distress in women after early pregnancy loss (EPL), compared with a control group with ongoing pregnancies. The secondary aim was to assess whether miscarriage or ectopic pregnancy impacted differently on the type and severity of psychological morbidity.

Design: This was a prospective survey study.

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Starvation ketosis outside pregnancy is rare and infrequently causes a severe acidosis. Placental production of hormones, including glucagon and human placental lactogen, leads to the insulin resistance that is seen in pregnancy, which in turn increases susceptibility to ketosis particularly in the third trimester. Starvation ketoacidosis in pregnancy has been reported and is usually precipitated by a period of severe vomiting.

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Hypertension remains the most commonly encountered medical condition in pregnant women, complicating up to 15% of all pregnancies. It results in frequent hospital admissions, maternal morbidity and mortality and iatrogenic preterm birth with concomitant neonatal morbidity and mortality. Hypertensive disorders of pregnancy comprise a spectrum of severity ranging from a mild elevation of blood pressure to severe pre-eclampsia and hemolysis, elevated liver enzymes and low platelet syndrome that may result in transient or chronic multiorgan failure.

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