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The COVID-19 pandemic led to unprecedented demand on NHS infrastructure. Virtual wards (VW) were created in response, using technology to monitor patients remotely. Their implementation required new systems of staffing, escalation, risk management and information governance. The Norfolk and Norwich University Hospitals Foundation Trust offered an example of a highly successful VW. It cared for 852 patients in its first year of operation, providing 24/7 nursing cover, supported by pharmacists and junior doctors, daily consultant-led ward rounds and virtual visits. The remote care platform collected continuous vital sign observations and generated custom alarms. The care team triaged, then escalated to nurse-specialists or consultants as required. Patients reported increased confidence and relief at earlier discharge. Staff highlighted the benefits of working from home, even if isolating or shielding. Challenges included developing awareness of the new service, overcoming concerns around increased workload and transitioning from emergency to long-term funding. The ward subsequently expanded from COVID-19 to nine other use cases.

Objective To review the available literature on the effect of cannabis-based products on the female reproductive system and establish if there is any evidence that they benefit or harm patients with endometriosis and therefore if there is sufficient evidence to recommend them. Data sources An electronic-based search was performed in PubMed, Embase and the Cochrane Database. Reference lists of articles retrieved were reviewed and a grey literature search was also performed. Methods of study selection The original database search yielded 264 articles from PubMed, Embase and the Cochrane Database, of which forty-one were included. One hundred and sixty-one studies relating to gynaecological malignancy, conditions unrelated to endometriosis or therapies unrelated to cannabis-based products were excluded. Twelve articles were included from a grey literature search and review of references. Results The majority of available evidence is from laboratory studies aiming to simulate the effects of cannabis-based products on preclinical endometriosis models. Some show evidence of benefit with cannabis-based products. However, results are conflicting and the impact in humans cannot necessarily be extrapolated from this data. Few studies exist looking at the effect of cannabis or its derived products in women with endometriosis - the majority are in the form of surveys and are affected by bias. National guidance was also reviewed: at present this dictates that cannabis-based products can only be prescribed for conditions where there is clear published evidence of benefit and only when all other treatment options have been exhausted. Conclusion Current treatment options for endometriosis often affect fertility and/or have undesirable side effects that impede long-term management. Cannabis-based products have been suggested as a novel therapeutic option that may circumvent these issues. However, there is a paucity of well-designed, robust studies and randomised controlled trials looking at their use in the treatment of endometriosis. In addition, cannabis use has a potential for harm in the long term; with a possible association with 'cannabis use disorder', psychosis and mood disturbances. At present, national guidance cannot recommend cannabis-based products to patients in the UK due to lack of clear evidence of benefit. More comprehensive research into the impact of endocannabinoids in the context of endometriosis is required before their use can be recommended or prescribed.

The Royal College of Obstetricians and Gynaecologists (RCOG) launched the Each Baby Counts (EBC) project in 2015. The aim of the project is to reduce the number of stillbirths, early neonatal deaths and severe brain injuries in term babies born following labour by 50% by the year 2020. The first full report focussed on the quality of local reviews, fetal monitoring, individual human factors and neonatal care. For this article we have not focussed on the neonatal issues but have summarized the main points from each chapter. The aim of EBC will be achieved by focusing on three themes: (i) improving the quality of reviews of these babies, prompting local units to address their systematic failings that led to the outcome; (ii) development of toolkits and resources to support units to implement the recommendations in the report; (iii) improving care by establishing a platform for shared learning between units in order to adopt a more proactive approach to reducing babies who are harmed during labour.