jolyon ford - Academia.edu (original) (raw)

Papers by jolyon ford

BMJ Open, 2021

Background The COVID-19 pandemic has resulted in a range of unprecedented disruptions to maternit... more Background The COVID-19 pandemic has resulted in a range of unprecedented disruptions to maternity care with documented impacts on perinatal outcomes such as stillbirth and preterm birth. Metropolitan Melbourne has endured one of the longest and most stringent lockdowns in globally. This paper presents the protocol for a multicentre study to monitor perinatal outcomes in Melbourne, Australia, during the COVID-19 pandemic. Methods Multicentre observational study analysing monthly deidentified maternal and newborn outcomes from births >20 weeks at all 12 public maternity services in Melbourne. Data will be merged centrally to analyse outcomes and create run charts according to established methods for detecting non-random ‘signals’ in healthcare. Perinatal outcomes will include weekly rates of total births, stillbirths, preterm births, neonatal intensive care admissions, low Apgar scores and fetal growth restriction. Maternal outcomes will include weekly rates of: induced labour, ca...

ABSTRACTBackgroundThe COVID-19 pandemic has resulted in a range of unprecedented disruptions to t... more ABSTRACTBackgroundThe COVID-19 pandemic has resulted in a range of unprecedented disruptions to the delivery of maternity care globally and has been associated with regional changes in perinatal outcomes such as stillbirth and preterm birth. Metropolitan Melbourne endured one of the longest and most stringent lockdowns in 2020. This paper presents the protocol for a collaborative maternity dashboard project to monitor perinatal outcomes in Melbourne, Australia, during the COVID-19 pandemic.MethodsDe-identified maternal and newborn outcomes will be collected monthly from all public maternity services in Melbourne, allowing rapid analysis of a multitude of perinatal indicators. Weekly outcomes will be displayed as run charts according to established methods for detecting non-random ‘signals’ in health care. A pre-pandemic median for all indicators will be calculated for the period of January 2018 to March 2020. A significant shift is defined as ≤ six consecutive weeks, all above or be...

Journal of the Society of Laparoendoscopic Surgeons

Anterior rectal resection is sometimes necessary to treat deeply infiltrating rectovaginal endome... more Anterior rectal resection is sometimes necessary to treat deeply infiltrating rectovaginal endometriosis. We describe a completely laparoscopic approach as a new way of excising rectal endometriosis that can be used without opening any part of the rectum. This avoids opening the abdomen or any risk of fecal spillage. The patient received preoperative oral bowel preparation. Ureteric stents (6 F) were inserted cystoscopically. The peritoneum in the ovarian fossae was opened lateral to any disease and the rectum reflected off the back of the cervix, leaving any endometriosis on the front of the rectum. The pelvic peritoneum was reflected medially, below the level of the ureters. The mesorectum was then dissected off a 6-cm length of rectum by using a Harmonic scalpel. A circular end-to-end anastomosis instrument was passed anally until the outline of the anvil was visible, inside the colon, above the diseased rectum. The anvil was detached and held by a soft grasper before the rectum ...

Outreach obstetrics training in Western Australia improves neonatal outcome and decreases cesarea... more Outreach obstetrics training in Western Australia improves neonatal outcome and decreases cesarean sections.

ABSTRACTObjectivesThe COVID-19 pandemic has been associated with a worsening of perinatal outcome... more ABSTRACTObjectivesThe COVID-19 pandemic has been associated with a worsening of perinatal outcomes in many settings due to the combined impacts of maternal COVID-19 disease, disruptions to maternity care, and overloaded health systems. In 2020, Melbourne endured a unique natural experiment where strict lockdown conditions were accompanied by very low COVID-19 case numbers and the maintenance of health service capacity. The aim of this study was to compare stillbirth and preterm birth rates in women who were exposed or unexposed to lockdown restrictions during pregnancy.DesignRetrospective multi-centre cohort study of perinatal outcomes before and during COVID-19 lockdownSettingBirth outcomes from all 12 public maternity hospitals in metropolitan MelbourneInclusion criteriaSingleton births without congenital anomalies from 24 weeks’ gestation. The lockdown-exposed cohort were those women for whom weeks 20- 40 of gestation would have occurred during the lockdown period of 23 March 202...

The Clinical Teacher, 2009

I n a clinical emergency, different professionals are required to work well together to effect th... more I n a clinical emergency, different professionals are required to work well together to effect the best outcome. This article will outline the key factors involved in the development of a new course at a maternity hospital in Western Australia: the IN TIME (INterdisciplinary Teamwork In the Management of Emergencies) course. Three concepts taken into consideration during the development of this course were: the benefits of multidisciplinary study; the use of small groupwork sessions; and a high level of semi-simulation. With these concepts in mind, the course has been implemented to run with three teams, each containing a mix of doctors and midwives. The teams are pre-grouped so that there is a good skill mix within each group. At the beginning of the day everyone is given a badge denoting their team: they are directed to their ‘team table’, and then spend the entire day working together. As meals are also provided, the teams also eat, drink and socialise together. The course program is made up of round-table reflection and revision sessions, clinical emergency drills and practical skills workshops. For each obstetric emergency the subject is revised, skills are practised and then a life-like drill is carried out in the appropriate clinical area.

Gynecological Surgery, 2004

There is increasing evidence that laparoscopic adhesiolysis improves chronic pelvic pain. We perf... more There is increasing evidence that laparoscopic adhesiolysis improves chronic pelvic pain. We performed a long-term review of women after laparoscopic adhesiolysis over the past 4 years. Patients were excluded from the study if they had additional pathology such as endometriosis or required additional procedures other than adhesiolysis. Umbilical insertion of Verress' needle and primary trocar was used except when the patient had had a previous midline laparotomy, in which case Palmer's point was used for entry. Adhesions were divided using Metzenbaum scissors with haemostasis using suction irrigation achieved with a Surgiflex R Wave suction irrigation system with BICAP bipolar diathermy probe (ACMI, USA). Hydroflotation with heparinised saline or 4% icodextrin was used to reduce adhesion recurrence. Patients were sent a postal questionnaire and contacted by telephone. Visual analogue scales were used to record pain scores for dysmenorrhoea (in those women who still had a uterus), dyspareunia, dyschezia and chronic daily pain. An EQ-5D questionnaire was also enclosed to assess quality of life. One hundred and forty-three procedures were identified between September 1998 and July 2002. Having excluded those with additional pathology that required treatment, 90 were eligible for the study. Seventy-six replies were obtained; seven patients had moved away. Sixty-nine replies were analysed. Fifty-one (74%) reported some improvement in their symptoms [12 (17%) pain completely gone, 26 (38%) greatly improved, 13 (19%) a little better]. Patients still had significant pain [scores out of 100 for dysmenorrhoea (45), dyspareunia (28), dyschezia (28) and daily pain (29)]. Overall, quality of life was still lower than national averages (self-rated health status mean =67.0 vs. 82.34, P< 0.05, weighted health state index =0.67 vs. 0.85, P< 0.05), except in the good responders (pain gone or greatly improved, for whom quality of life returned to normal). There was no difference in pain scores, response and quality of life between women who had had their surgery more than 24 months earlier and those who had had surgery more recently. We have found a good response to adhesiolysis, which is comparable with other studies. A good response is associated with a normal quality of life and appears to be long standing.

Gynecological Surgery, 2004

We examined how advanced endometriosis is managed in the United Kingdom, and what support exists ... more We examined how advanced endometriosis is managed in the United Kingdom, and what support exists for the development of centres of excellence. A questionnaire was sent to all 1,447 registered consultants in the United Kingdom. Of the 617 who replied some 505 treated endometriosis, representing 267 of the 341 hospitals listed. Of the consultants 157 (31%) felt that they worked in a centre of excellence, representing 94 of the 267 hospitals. There were 169 consultants who treated rectovaginal disease themselves, but only 66 used excisional procedures. Support was expressed by 429 consultants (84.9%) for the development of centres of excellence for the treatment of advanced endometriosis.

Gynecological Surgery, 2011

BJOG: An International Journal of Obstetrics and Gynaecology, 2004

Objective To determine the long term response, quality of life and levels of pain following the r... more Objective To determine the long term response, quality of life and levels of pain following the radical excision of rectovaginal endometriosis. Design A cohort study. Setting A tertiary referral centre for the management of advanced endometriosis. Sample All patients who had undergone radical resection. Methods Case note review and patient questionnaire. Main outcome measures Surgical complications. Overall improvement. Dysmenorrhoea, dyspareunia, dyschezia and chronic pain were measured using a visual analogue scale. Quality of life was measured using the EQ-5D questionnaire. Results Twelve radical resections were performed by laparotomy, 48 by laparoscopy. Ten patients had a hysterectomy. Forty-eight patients underwent shaving of the pre-rectal fascia, two had a disc resection of the rectum, 10 had an anterior rectal resection. Two patients required a colostomy and two needed subsequent dilation of a stenosed anastomosis. Forty-four of the first 46 patients replied. The median follow up period was 12 months (range 2 to 22 months) and 86% (38/44) reported an improvement or whom 27 (61%) had a good response (pain completely gone or greatly improved). Patients having a hysterectomy or a disc or segmental resection of the rectum reported a good response and had a normal quality of life. Quality of life scores in the study group overall were lower than the background population. Conclusions Radical resection is an effective treatment for rectovaginal endometriosis. Hysterectomy and rectal resection were associated with a better response and quality of life.

BJOG: An International …, 2004

The Clinical Teacher, 2009

I n a clinical emergency, different professionals are required to work well together to effect th... more I n a clinical emergency, different professionals are required to work well together to effect the best outcome. This article will outline the key factors involved in the development of a new course at a maternity hospital in Western Australia: the IN TIME (INterdisciplinary Teamwork In the Management of Emergencies) course. Three concepts taken into consideration during the development of this course were: the benefits of multidisciplinary study; the use of small groupwork sessions; and a high level of semi-simulation. With these concepts in mind, the course has been implemented to run with three teams, each containing a mix of doctors and midwives. The teams are pre-grouped so that there is a good skill mix within each group. At the beginning of the day everyone is given a badge denoting their team: they are directed to their ‘team table’, and then spend the entire day working together. As meals are also provided, the teams also eat, drink and socialise together. The course program is made up of round-table reflection and revision sessions, clinical emergency drills and practical skills workshops. For each obstetric emergency the subject is revised, skills are practised and then a life-like drill is carried out in the appropriate clinical area.

BMJ Open, 2021

Background The COVID-19 pandemic has resulted in a range of unprecedented disruptions to maternit... more Background The COVID-19 pandemic has resulted in a range of unprecedented disruptions to maternity care with documented impacts on perinatal outcomes such as stillbirth and preterm birth. Metropolitan Melbourne has endured one of the longest and most stringent lockdowns in globally. This paper presents the protocol for a multicentre study to monitor perinatal outcomes in Melbourne, Australia, during the COVID-19 pandemic. Methods Multicentre observational study analysing monthly deidentified maternal and newborn outcomes from births >20 weeks at all 12 public maternity services in Melbourne. Data will be merged centrally to analyse outcomes and create run charts according to established methods for detecting non-random ‘signals’ in healthcare. Perinatal outcomes will include weekly rates of total births, stillbirths, preterm births, neonatal intensive care admissions, low Apgar scores and fetal growth restriction. Maternal outcomes will include weekly rates of: induced labour, ca...

ABSTRACTBackgroundThe COVID-19 pandemic has resulted in a range of unprecedented disruptions to t... more ABSTRACTBackgroundThe COVID-19 pandemic has resulted in a range of unprecedented disruptions to the delivery of maternity care globally and has been associated with regional changes in perinatal outcomes such as stillbirth and preterm birth. Metropolitan Melbourne endured one of the longest and most stringent lockdowns in 2020. This paper presents the protocol for a collaborative maternity dashboard project to monitor perinatal outcomes in Melbourne, Australia, during the COVID-19 pandemic.MethodsDe-identified maternal and newborn outcomes will be collected monthly from all public maternity services in Melbourne, allowing rapid analysis of a multitude of perinatal indicators. Weekly outcomes will be displayed as run charts according to established methods for detecting non-random ‘signals’ in health care. A pre-pandemic median for all indicators will be calculated for the period of January 2018 to March 2020. A significant shift is defined as ≤ six consecutive weeks, all above or be...

Journal of the Society of Laparoendoscopic Surgeons

Anterior rectal resection is sometimes necessary to treat deeply infiltrating rectovaginal endome... more Anterior rectal resection is sometimes necessary to treat deeply infiltrating rectovaginal endometriosis. We describe a completely laparoscopic approach as a new way of excising rectal endometriosis that can be used without opening any part of the rectum. This avoids opening the abdomen or any risk of fecal spillage. The patient received preoperative oral bowel preparation. Ureteric stents (6 F) were inserted cystoscopically. The peritoneum in the ovarian fossae was opened lateral to any disease and the rectum reflected off the back of the cervix, leaving any endometriosis on the front of the rectum. The pelvic peritoneum was reflected medially, below the level of the ureters. The mesorectum was then dissected off a 6-cm length of rectum by using a Harmonic scalpel. A circular end-to-end anastomosis instrument was passed anally until the outline of the anvil was visible, inside the colon, above the diseased rectum. The anvil was detached and held by a soft grasper before the rectum ...

Outreach obstetrics training in Western Australia improves neonatal outcome and decreases cesarea... more Outreach obstetrics training in Western Australia improves neonatal outcome and decreases cesarean sections.

ABSTRACTObjectivesThe COVID-19 pandemic has been associated with a worsening of perinatal outcome... more ABSTRACTObjectivesThe COVID-19 pandemic has been associated with a worsening of perinatal outcomes in many settings due to the combined impacts of maternal COVID-19 disease, disruptions to maternity care, and overloaded health systems. In 2020, Melbourne endured a unique natural experiment where strict lockdown conditions were accompanied by very low COVID-19 case numbers and the maintenance of health service capacity. The aim of this study was to compare stillbirth and preterm birth rates in women who were exposed or unexposed to lockdown restrictions during pregnancy.DesignRetrospective multi-centre cohort study of perinatal outcomes before and during COVID-19 lockdownSettingBirth outcomes from all 12 public maternity hospitals in metropolitan MelbourneInclusion criteriaSingleton births without congenital anomalies from 24 weeks’ gestation. The lockdown-exposed cohort were those women for whom weeks 20- 40 of gestation would have occurred during the lockdown period of 23 March 202...

The Clinical Teacher, 2009

I n a clinical emergency, different professionals are required to work well together to effect th... more I n a clinical emergency, different professionals are required to work well together to effect the best outcome. This article will outline the key factors involved in the development of a new course at a maternity hospital in Western Australia: the IN TIME (INterdisciplinary Teamwork In the Management of Emergencies) course. Three concepts taken into consideration during the development of this course were: the benefits of multidisciplinary study; the use of small groupwork sessions; and a high level of semi-simulation. With these concepts in mind, the course has been implemented to run with three teams, each containing a mix of doctors and midwives. The teams are pre-grouped so that there is a good skill mix within each group. At the beginning of the day everyone is given a badge denoting their team: they are directed to their ‘team table’, and then spend the entire day working together. As meals are also provided, the teams also eat, drink and socialise together. The course program is made up of round-table reflection and revision sessions, clinical emergency drills and practical skills workshops. For each obstetric emergency the subject is revised, skills are practised and then a life-like drill is carried out in the appropriate clinical area.

Gynecological Surgery, 2004

There is increasing evidence that laparoscopic adhesiolysis improves chronic pelvic pain. We perf... more There is increasing evidence that laparoscopic adhesiolysis improves chronic pelvic pain. We performed a long-term review of women after laparoscopic adhesiolysis over the past 4 years. Patients were excluded from the study if they had additional pathology such as endometriosis or required additional procedures other than adhesiolysis. Umbilical insertion of Verress' needle and primary trocar was used except when the patient had had a previous midline laparotomy, in which case Palmer's point was used for entry. Adhesions were divided using Metzenbaum scissors with haemostasis using suction irrigation achieved with a Surgiflex R Wave suction irrigation system with BICAP bipolar diathermy probe (ACMI, USA). Hydroflotation with heparinised saline or 4% icodextrin was used to reduce adhesion recurrence. Patients were sent a postal questionnaire and contacted by telephone. Visual analogue scales were used to record pain scores for dysmenorrhoea (in those women who still had a uterus), dyspareunia, dyschezia and chronic daily pain. An EQ-5D questionnaire was also enclosed to assess quality of life. One hundred and forty-three procedures were identified between September 1998 and July 2002. Having excluded those with additional pathology that required treatment, 90 were eligible for the study. Seventy-six replies were obtained; seven patients had moved away. Sixty-nine replies were analysed. Fifty-one (74%) reported some improvement in their symptoms [12 (17%) pain completely gone, 26 (38%) greatly improved, 13 (19%) a little better]. Patients still had significant pain [scores out of 100 for dysmenorrhoea (45), dyspareunia (28), dyschezia (28) and daily pain (29)]. Overall, quality of life was still lower than national averages (self-rated health status mean =67.0 vs. 82.34, P< 0.05, weighted health state index =0.67 vs. 0.85, P< 0.05), except in the good responders (pain gone or greatly improved, for whom quality of life returned to normal). There was no difference in pain scores, response and quality of life between women who had had their surgery more than 24 months earlier and those who had had surgery more recently. We have found a good response to adhesiolysis, which is comparable with other studies. A good response is associated with a normal quality of life and appears to be long standing.

Gynecological Surgery, 2004

We examined how advanced endometriosis is managed in the United Kingdom, and what support exists ... more We examined how advanced endometriosis is managed in the United Kingdom, and what support exists for the development of centres of excellence. A questionnaire was sent to all 1,447 registered consultants in the United Kingdom. Of the 617 who replied some 505 treated endometriosis, representing 267 of the 341 hospitals listed. Of the consultants 157 (31%) felt that they worked in a centre of excellence, representing 94 of the 267 hospitals. There were 169 consultants who treated rectovaginal disease themselves, but only 66 used excisional procedures. Support was expressed by 429 consultants (84.9%) for the development of centres of excellence for the treatment of advanced endometriosis.

Gynecological Surgery, 2011

BJOG: An International Journal of Obstetrics and Gynaecology, 2004

Objective To determine the long term response, quality of life and levels of pain following the r... more Objective To determine the long term response, quality of life and levels of pain following the radical excision of rectovaginal endometriosis. Design A cohort study. Setting A tertiary referral centre for the management of advanced endometriosis. Sample All patients who had undergone radical resection. Methods Case note review and patient questionnaire. Main outcome measures Surgical complications. Overall improvement. Dysmenorrhoea, dyspareunia, dyschezia and chronic pain were measured using a visual analogue scale. Quality of life was measured using the EQ-5D questionnaire. Results Twelve radical resections were performed by laparotomy, 48 by laparoscopy. Ten patients had a hysterectomy. Forty-eight patients underwent shaving of the pre-rectal fascia, two had a disc resection of the rectum, 10 had an anterior rectal resection. Two patients required a colostomy and two needed subsequent dilation of a stenosed anastomosis. Forty-four of the first 46 patients replied. The median follow up period was 12 months (range 2 to 22 months) and 86% (38/44) reported an improvement or whom 27 (61%) had a good response (pain completely gone or greatly improved). Patients having a hysterectomy or a disc or segmental resection of the rectum reported a good response and had a normal quality of life. Quality of life scores in the study group overall were lower than the background population. Conclusions Radical resection is an effective treatment for rectovaginal endometriosis. Hysterectomy and rectal resection were associated with a better response and quality of life.

BJOG: An International …, 2004

The Clinical Teacher, 2009

I n a clinical emergency, different professionals are required to work well together to effect th... more I n a clinical emergency, different professionals are required to work well together to effect the best outcome. This article will outline the key factors involved in the development of a new course at a maternity hospital in Western Australia: the IN TIME (INterdisciplinary Teamwork In the Management of Emergencies) course. Three concepts taken into consideration during the development of this course were: the benefits of multidisciplinary study; the use of small groupwork sessions; and a high level of semi-simulation. With these concepts in mind, the course has been implemented to run with three teams, each containing a mix of doctors and midwives. The teams are pre-grouped so that there is a good skill mix within each group. At the beginning of the day everyone is given a badge denoting their team: they are directed to their ‘team table’, and then spend the entire day working together. As meals are also provided, the teams also eat, drink and socialise together. The course program is made up of round-table reflection and revision sessions, clinical emergency drills and practical skills workshops. For each obstetric emergency the subject is revised, skills are practised and then a life-like drill is carried out in the appropriate clinical area.