The New Nigerian Mental Health Act: A Huge Leap Before Looking Closely?

A new Mental Health law was recently enacted in Nigeria to replace the Lunacy Ordinance of 1958. The passage of the new law was a major leap from the old. It was received with excitement because the former law was not only outdated but failed to address core issues such as the promotion of mental health and the protection of the rights of the mentally ill.

Identification of women at risk of depression in pregnancy: using women's accounts to understand the poor specificity of the Whooley and Arroll case finding questions in clinical practice.

Antenatal mental health assessment is increasingly common in high-income countries. Despite lacking evidence on validation or acceptability, the Whooley questions (modified PHQ-2) and Arroll 'help' question are used in the UK at booking (the first formal antenatal appointment) to identify possible cases of depression. This study investigated validation of the questions and women's views on assessment.

Situational awareness and its application in the delivery suite.

The delivery suite is a high-risk environment. Transitions between low-risk and high-risk can be swift, and sentinel events can occur without warning. The prevention of accidents in this environment rests on the vigilance of the individual practitioner at the frontline.

Antenatal mental health referrals: review of local clinical practice and pregnant women's experiences in England.

Objective: to investigate (i) the consistency and completeness of mental health assessment documented at hospital booking; (ii) the subsequent management of pregnant women identified as experiencing, or at risk of, mental health problems; and (iii) women's experiences of the mental health referral process.

Design: mixed methods cohort study

Setting: large, inner-city hospital in the north of England

Participants: women (n=191) booking at their first formal antenatal appointment; mean gestational age at booking 13 weeks.

Methods: women self-completed the routine mental health assessment in the clinical handheld maternity notes, followed by a research pack.

Surrogacy in modern obstetric practice.

Surrogacy is rising in profile and prevalence, which means that perinatal care providers face an increasing likelihood of encountering a case in their clinical practice. Rapidly expanding scientific knowledge (for example, fetal programming) and technological advances (for example, prenatal screening and diagnosis) pose challenges in the management of the surrogate mother; in particular, they could exacerbate conflict between the interests of the baby, the surrogate mother, and the intending parent(s). Navigating these often-tranquil-but-sometimes-stormy waters is facilitated if perinatal care providers are aware of the relevant ethical, legal, and service delivery issues.

The bionomic approach to patient safety and its application in gynaecological surgery.

In the past 2 decades, a gradual shift has taken place from the 'person approach' to patient safety (in which the individual clinician at the sharp end is blamed for any accident) to a 'systems approach' (in which causation of accidents is attributed to loopholes in the organisational defences). Increasingly, however, concern has been expressed that the systems approach risks absolving individuals from responsibility for patient safety, and a balance between the systems and person approaches has been sought. In this paper, resolution of the tension between the person and the systems approaches is advocated through the use of a paradigm that places more emphasis on the relationships between the individual at the sharp end and other components of the system.

Mapping the patient safety footprint: The RADICAL framework.

Numerous interventions to promote patient safety have been proposed. For these to produce demonstrable and positive change, appropriate metrics should be available. Measurements must, however, be comprehensive enough to cover all domains of patient safety.

Risk of placenta previa in second birth after first birth cesarean section: a population-based study and meta-analysis.

Objective: To compare the risk of placenta previa at second birth among women who had a cesarean section (CS) at first birth with women who delivered vaginally.

Methods: Retrospective cohort study of 399,674 women who gave birth to a singleton first and second baby between April 2000 and February 2009 in England. Multiple logistic regression was used to adjust the estimates for maternal age, ethnicity, deprivation, placenta previa at first birth, inter-birth interval and pregnancy complications.

The timing of elective caesarean delivery between 2000 and 2009 in England.

Background: In 2004, the National Institute for Clinical Excellence (NICE) recommended that an elective caesarean section for an uncomplicated pregnancy should not be carried out before 39 completed weeks due to increased risk of respiratory morbidity in newborns. We describe the trends and variation across 63 English NHS trusts in the timing of elective caesarean section (CS) for low-risk singleton deliveries.

Methods: We identified elective CS deliveries between 1st April 2000 and 28th February 2009 in English NHS trusts using the Hospital Episode Statistics.

Non-surgical management of ectopic pregnancy: appropriate risk management must be in place.

Introduction: Advances in technology have facilitated early diagnosis of ectopic pregnancy, which in turn has increased the scope for non-surgical treatment. Unfortunately risks associated with such management, including maternal death, are coming to the fore. This paper highlights the risks and how they could be avoided.

Variation in rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study.

Objective: To determine whether the variation in unadjusted rates of caesarean section derived from routine data in NHS trusts in England can be explained by maternal characteristics and clinical risk factors.

Design: A cross sectional analysis using routinely collected hospital episode statistics was performed. A multiple logistic regression model was used to estimate the likelihood of women having a caesarean section given their maternal characteristics (age, ethnicity, parity, and socioeconomic deprivation) and clinical risk factors (previous caesarean section, breech presentation, and fetal distress).

Risk management issues in postmenopausal health care.

As in other areas of clinical activity, unintended harm to patients may occur in the course of postmenopausal health care, and measures to ensure patient safety should be actively promoted. This paper discusses the application of some basic principles of risk management to postmenopausal health care. To facilitate communication and reduce errors in diagnosis and treatment, risk management should be incorporated in the development of a dedicated menopause service.

Risk management in gynaecology: principles and practice.

The majority of gynaecology patients are fit women receiving relatively straightforward care. However, human error is inevitable. Furthermore, new treatments and technologies are constantly emerging, today's trainees are less experienced than their predecessors, and the need for team work is greater than ever.

Towards safe practice in instrumental vaginal delivery.

Approximately one in ten deliveries in the Western world is an instrumental vaginal delivery. Like other surgical operations, instrumental vaginal delivery has its complications, and the operator is obliged to critically appraise the indication for the procedure and the background risk factors, and communicate effectively with the woman. Also, it calls for team work.

NHS maternity units should not encourage commercial banking of umbilical cord blood.

Storing cord blood at birth as insurance against future disease may sound like a good idea to parents, but it has worrying implications for NHS services and little chance of benefit

Mind over matter: psychological factors and the menstrual cycle.

Purpose Of Review: Increasingly, gynaecologists are becoming aware of the impact of psychosocial factors on women's health generally, and on the menstrual cycle in particular. This review highlights developments in this field in the last triennium.

Recent Findings: Stress impairs the ovarian cycle through activation of the hypothalamus pituitary adrenal axis.