Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.983
Filtrar
Mais filtros

Intervalo de ano de publicação
1.
J Med Genet ; 61(8): 727-733, 2024 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-38834294

RESUMO

OBJECTIVE: This document addresses the clinical application of next-generation sequencing (NGS) technologies for prenatal genetic diagnosis and aims to establish clinical practice recommendations in Spain to ensure uniformity in implementing these technologies into prenatal care. METHODS: A joint committee of expert obstetricians and geneticists was created to review the existing literature on fetal NGS for genetic diagnosis and to make recommendations for Spanish healthcare professionals. RESULTS: This guideline summarises technical aspects of NGS technologies, clinical indications in prenatal setting, considerations regarding findings to be reported, genetic counselling considerations as well as data storage and protection policies. CONCLUSIONS: This document provides updated recommendations for the use of NGS diagnostic tests in prenatal diagnosis. These recommendations should be periodically reviewed as our knowledge of the clinical utility of NGS technologies, applied during pregnancy, may advance.


Assuntos
Sequenciamento de Nucleotídeos em Larga Escala , Diagnóstico Pré-Natal , Humanos , Diagnóstico Pré-Natal/métodos , Diagnóstico Pré-Natal/normas , Gravidez , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Sequenciamento de Nucleotídeos em Larga Escala/normas , Feminino , Espanha , Testes Genéticos/métodos , Testes Genéticos/normas , Aconselhamento Genético/métodos , Aconselhamento Genético/normas , Obstetrícia/normas , Obstetrícia/métodos , Ginecologia/normas
2.
Med J Aust ; 220(11): 582-591, 2024 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-38763516

RESUMO

INTRODUCTION: Hypertensive disorders of pregnancy (HDP) affect up to 10% of all pregnancies annually and are associated with an increased risk of maternal and fetal morbidity and mortality. This guideline represents an update of the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) guidelines for the management of hypertensive disorders of pregnancy 2014 and has been approved by the National Health and Medical Research Council (NHMRC) under section 14A of the National Health and Medical Research Council Act 1992. In approving the guideline recommendations, NHMRC considers that the guideline meets NHMRC's standard for clinical practice guidelines. MAIN RECOMMENDATIONS: A total of 39 recommendations on screening, preventing, diagnosing and managing HDP, especially preeclampsia, are presented in this guideline. Recommendations are presented as either evidence-based recommendations or practice points. Evidence-based recommendations are presented with the strength of recommendation and quality of evidence. Practice points were generated where there was inadequate evidence to develop specific recommendations and are based on the expertise of the working group. CHANGES IN MANAGEMENT RESULTING FROM THE GUIDELINE: This version of the SOMANZ guideline was developed in an academically robust and rigorous manner and includes recommendations on the use of combined first trimester screening to identify women at risk of developing preeclampsia, 14 pharmacological and two non-pharmacological preventive interventions, clinical use of angiogenic biomarkers and the long term care of women who experience HDP. The guideline also includes six multilingual patient infographics which can be accessed through the main website of the guideline. All measures were taken to ensure that this guideline is applicable and relevant to clinicians and multicultural women in regional and metropolitan settings in Australia and New Zealand.


Assuntos
Hipertensão Induzida pela Gravidez , Humanos , Gravidez , Feminino , Austrália , Nova Zelândia , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/terapia , Hipertensão Induzida pela Gravidez/prevenção & controle , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/prevenção & controle , Pré-Eclâmpsia/terapia , Sociedades Médicas , Obstetrícia/normas , Anti-Hipertensivos/uso terapêutico , Guias de Prática Clínica como Assunto
3.
BMC Pregnancy Childbirth ; 24(1): 502, 2024 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-39054417

RESUMO

BACKGROUND: Professional societies such as the American College of Obstetricians and Gynecologists (ACOG) promote the idea that postpartum care is an ongoing process where there is adequate opportunity to provide services and support. Nonetheless, in practice, the guidelines ask clinicians to perform more clinical responsibilities than they might be able to do with limited time and resources. METHODS: We conducted an online survey among practicing obstetric clinicians (obstetrician/gynecologists (OB/GYNs), midwives, and family medicine doctors) in California about their priorities and care practices for the first postpartum visit and explored how they prioritize multiple clinical responsibilities within existing time and resources. Between September 2023 and February 2024, 174 out of 229 eligible participants completed the survey, a 76% response rate. From a list of care components, we used descriptive statistics to identify those that were highly prioritized by most clinicians and those that were considered a priority by very few and examined the alignment between prioritized components and recommended care practices. RESULTS: Clinicians were highly invested in the care components that they rated as most important, indicating that they always check these components or assess them when they perceive patient need. Depression and anxiety, breast health/breast feeding issues, vaginal birth complications and family planning counseling were highly ranked components by all clinicians. In contrast, clinicians more often did not assess those care components that infrequently ranked highly among the priority listing, consisting mainly of social drivers of health such as screening and counseling for intimate partner violence, working conditions and food/housing insecurity. In both instances, we found little discordance between priorities and care practices. However, OB/GYNs and midwives differed in some care components that they prioritized highly. CONCLUSIONS: While there is growing understanding of how important professional society recommendations are for maternal-infant health, clinicians face barriers completing all recommendations, especially those components related to social drivers of health. However, what the clinicians do prioritize highly, they are likely to perform. Now that Medi-Cal (Medicaid) insurance is available in California for up to 12 months postpartum, there is a need to understand what care clinicians provide and what gaps remain.


Assuntos
Obstetrícia , Padrões de Prática Médica , Humanos , Feminino , California , Gravidez , Obstetrícia/normas , Adulto , Inquéritos e Questionários , Padrões de Prática Médica/estatística & dados numéricos , Cuidado Pós-Natal/normas , Pessoa de Meia-Idade , Masculino , Tocologia , Atitude do Pessoal de Saúde , Prioridades em Saúde
4.
Clin Obstet Gynecol ; 67(3): 493-498, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-38804168

RESUMO

The Association of Professors of Gynecology and Obstetrics created the Diversity, Equity, and Inclusion Guidelines Task Force to develop best practices to establish a diverse physician workforce and eliminate racism in medical education. Using the guidelines, educators are impacting their communities and, in some areas, leading their institutions toward greater diversity and inclusion. The guidelines are organized by 4 domains: learning environment, grading and assessment, pathway programs, and metrics. This manuscript uses that framework to highlight the work of individual educators who are moving the needle towards racism-free health care and aims to inspire others contemplating incorporation into their programs.


Assuntos
Diversidade Cultural , Educação Médica , Ginecologia , Obstetrícia , Racismo , Humanos , Ginecologia/educação , Racismo/prevenção & controle , Educação Médica/métodos , Educação Médica/normas , Obstetrícia/educação , Obstetrícia/normas , Guias como Assunto , Estados Unidos
5.
J Obstet Gynaecol Can ; 46(8): 102618, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39089469

RESUMO

OBJECTIVE: To summarize the current evidence and to make recommendations for the diagnosis and management of intrahepatic cholestasis of pregnancy. TARGET POPULATION: Pregnant people with intrahepatic cholestasis of pregnancy. OPTIONS: Diagnosing the condition using fasting or non-fasting bile acids, classifying disease severity, determining what treatment to offer, establishing how to monitor for antenatal fetal wellbeing, identifying when to perform elective birth. BENEFITS, HARMS, AND COSTS: Individuals with intrahepatic cholestasis of pregnancy are at increased risk of adverse perinatal outcomes including preterm birth, neonatal respiratory distress and admission to a neonatal intensive care unit, with an increased risk of stillbirth when bile acid levels are ≥100 µmol/L. There is inequity in bile acid testing availability and timely access to results, along with uncertainly of how to treat, monitor. and ultimately deliver these pregnancies. Optimization of diagnostic and management protocols can improve maternal and fetal postnatal outcomes. EVIDENCE: Medline, PubMed, Embase, and the Cochrane Library were searched from inception to March 2023, using medical subject headings (MeSH) and keywords related to pregnancy, intrahepatic cholestasis of pregnancy, bile acids, pruritis, ursodeoxycholic acid, and stillbirth. This document presents an abstraction of the evidence rather than a methodological review. VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations). INTENDED AUDIENCE: Obstetric care providers, including obstetricians, family physicians, nurses, midwives, maternal-fetal medicine specialists, and radiologists. SOCIAL MEDIA ABSTRACT: Intrahepatic cholestasis of pregnancy requires adequate diagnosis with non-fasting bile acid levels which guide optimal management and delivery timing. SUMMARY STATEMENTS: RECOMMENDATIONS.


Assuntos
Colestase Intra-Hepática , Complicações na Gravidez , Humanos , Colestase Intra-Hepática/diagnóstico , Colestase Intra-Hepática/terapia , Feminino , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Canadá , Ácidos e Sais Biliares/sangue , Obstetrícia/normas
6.
J Obstet Gynaecol Res ; 50(7): 1073-1094, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38627197

RESUMO

Twelve years after the first edition of The Guideline for Gynecological Practice, which was jointly edited by The Japan Society of Obstetrics and Gynecology and The Japan Association of Obstetricians and Gynecologists, the 5th Revised Edition was published in 2023. The 2023 Guidelines includes 5 additional clinical questions (CQs), which brings the total to 103 CQ (12 on infectious disease, 30 on oncology and benign tumors, 29 on endocrinology and infertility and 32 on healthcare for women). Currently, a consensus has been reached on the Guidelines, and therefore, the objective of this report is to present the general policies regarding diagnostic and treatment methods used in standard gynecological outpatient care that are considered appropriate. At the end of each answer, the corresponding Recommendation Level (A, B, C) is indicated.


Assuntos
Ginecologia , Obstetrícia , Humanos , Japão , Feminino , Ginecologia/normas , Obstetrícia/normas , Sociedades Médicas/normas , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/terapia , Obstetra , Ginecologista
7.
J Obstet Gynaecol Res ; 50 Suppl 1: 42-48, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39473042

RESUMO

Cervical cancer poses a significant health burden, particularly in low- and middle-income countries, where access to screening and treatment remains limited. Asia Oceania Federation of Obstetrics and Gynecology (AOFOG)'s response, guided by the World Health Organization's global strategy, emphasizes three key targets: achieving high HPV vaccination coverage among girls, ensuring widespread screening with high-performance tests, and guaranteeing timely treatment for precancerous and cancerous lesions. AOFOG supports member countries through initiatives such as educational campaigns, guidelines development, and collaboration with local and international partners. Variations in screening methods across AOFOG member countries reflect diverse socioeconomic contexts and healthcare infrastructures, ranging from HPV testing in countries like Australia and Malaysia to cytology and visual inspection methods in others. Innovations such as HPV self-testing and AI-enhanced screening are emerging to improve accessibility and accuracy, addressing barriers like stigma and resource scarcity. Despite challenges, AOFOG remains committed to reducing cervical cancer incidence and mortality through coordinated regional efforts, aiming for equitable access to preventive measures and treatment across the diverse landscape of the Asia-Pacific region.


Assuntos
Detecção Precoce de Câncer , Ginecologia , Neoplasias do Colo do Útero , Humanos , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/diagnóstico , Feminino , Ásia/epidemiologia , Ginecologia/normas , Obstetrícia/normas , Vacinas contra Papillomavirus/administração & dosagem , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/diagnóstico , Oceania , Sociedades Médicas
8.
J Obstet Gynaecol Res ; 50 Suppl 1: 95-102, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39473048

RESUMO

Cervical cancer remains a disease burden in Asia. The Asia and Oceania Federation of Obstetrics and Gynecology envisages a need to produce a set of recommendations on the implementation of human papilloma virus vaccination program for both lower-middle-income countries (LMICs) and high-income countries (HICs), with an attempt to harmonize the practices yet allow flexibility to cater for different cultures, religions, needs and background of individual countries/cities. International guidelines and literature were sought, and recommendations were made in seven selected areas, including (i) the target groups for vaccination, (ii) the doses of vaccination including the use of single-dose vaccination, (iii) the types of vaccines, (iv) suggestions for special populations including those with previous HPV infection, human immunodeficiency virus carriers, and lesbian, gay, bisexual, transgender, questioning/queer group, (v) inter-changeability and the need of revaccination/booster, (vi) novel technologies and vaccines, and (vii) public education.


Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero , Humanos , Vacinas contra Papillomavirus/administração & dosagem , Infecções por Papillomavirus/prevenção & controle , Feminino , Ásia , Neoplasias do Colo do Útero/prevenção & controle , Vacinação/normas , Obstetrícia/normas , Ginecologia , Sociedades Médicas , Papillomavirus Humano
9.
Am J Perinatol ; 41(15): 2072-2081, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38653452

RESUMO

OBJECTIVE: To evaluate the reliability of three artificial intelligence (AI) chatbots (ChatGPT, Google Bard, and Chatsonic) in generating accurate references from existing obstetric literature. STUDY DESIGN: Between mid-March and late April 2023, ChatGPT, Google Bard, and Chatsonic were prompted to provide references for specific obstetrical randomized controlled trials (RCTs) published in 2020. RCTs were considered for inclusion if they were mentioned in a previous article that primarily evaluated RCTs published by the top medical and obstetrics and gynecology journals with the highest impact factors in 2020 as well as RCTs published in a new journal focused on publishing obstetric RCTs. The selection of the three AI models was based on their popularity, performance in natural language processing, and public availability. Data collection involved prompting the AI chatbots to provide references according to a standardized protocol. The primary evaluation metric was the accuracy of each AI model in correctly citing references, including authors, publication title, journal name, and digital object identifier (DOI). Statistical analysis was performed using a permutation test to compare the performance of the AI models. RESULTS: Among the 44 RCTs analyzed, Google Bard demonstrated the highest accuracy, correctly citing 13.6% of the requested RCTs, whereas ChatGPT and Chatsonic exhibited lower accuracy rates of 2.4 and 0%, respectively. Google Bard often substantially outperformed Chatsonic and ChatGPT in correctly citing the studied reference components. The majority of references from all AI models studied were noted to provide DOIs for unrelated studies or DOIs that do not exist. CONCLUSION: To ensure the reliability of scientific information being disseminated, authors must exercise caution when utilizing AI for scientific writing and literature search. However, despite their limitations, collaborative partnerships between AI systems and researchers have the potential to drive synergistic advancements, leading to improved patient care and outcomes. KEY POINTS: · AI chatbots often cite scientific articles incorrectly.. · AI chatbots can create false references.. · Responsible AI use in research is vital..


Assuntos
Inteligência Artificial , Humanos , Obstetrícia/normas , Ensaios Clínicos Controlados Aleatórios como Assunto , Publicações Periódicas como Assunto , Processamento de Linguagem Natural , Reprodutibilidade dos Testes
10.
Arch Gynecol Obstet ; 310(5): 2425-2437, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-39103621

RESUMO

PURPOSE: To investigate the capacity of chat-generative pre-trained transformer (Chat-GPT) to understand the S2k guideline of the German Society for Gynecology and Obstetrics on intrauterine growth restriction. METHODS: The German-language free Chat-GPT version was used to test the ability of Chat-GPT to understand the definition of small for gestational age and intrauterine growth restriction, to indicate the correct time and place of delivery and to evaluate ist ability to recommend a spontaneous delivery versus a primary caesarean section in accordance with the guideline recommendations. In order to objectively evaluate the suggestions a simple three-color 'traffic light' evaluation system was employed. RESULTS: Almost all Chat-GPT's suggestions in the context of definition of small for gestational age/intrauterine growth restriction as well as correct time of delivery were adequate, whereas more than half of the suggestions made in terms of correct delivery mode needed reformulation or even correction. CONCLUSION: Chat-GPT appears to be a valuable form of artificial intelligence that could be integrated into everyday clinical practice.


Assuntos
Retardo do Crescimento Fetal , Obstetrícia , Guias de Prática Clínica como Assunto , Humanos , Feminino , Gravidez , Alemanha , Obstetrícia/normas , Ginecologia/normas , Sociedades Médicas , Recém-Nascido Pequeno para a Idade Gestacional , Parto Obstétrico/normas , Parto Obstétrico/métodos , Inteligência Artificial , Cesárea
11.
Curr Opin Anaesthesiol ; 37(3): 213-218, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38391030

RESUMO

PURPOSE OF REVIEW: The worldwide leading cause of maternal death is severe maternal hemorrhage. Maternal hemorrhage can be profound leading to an entire loss of blood volume. In the past two decades, Patient Blood Management has evolved to improve patient's care and safety. In surgeries with increased blood loss exceeding 500 ml, the use of cell salvage is strongly recommended in order to preserve the patient's own blood volume and to minimize the need for allogeneic red blood cell (RBC) transfusion. In this review, recent evidence and controversies of the use of cell salvage in obstetrics are discussed. RECENT FINDINGS: Numerous medical societies as well as national and international guidelines recommend the use of cell salvage during maternal hemorrhage. SUMMARY: Intraoperative cell salvage is a strategy to maintain the patient's own blood volume and decrease the need for allogeneic RBC transfusion. Historically, cell salvage has been avoided in the obstetric population due to concerns of iatrogenic amniotic fluid embolism (AFE) or induction of maternal alloimmunization. However, no definite case of AFE has been reported so far. Cell salvage is strongly recommended and cost-effective in patients with predictably high rates of blood loss and RBC transfusion, such as women with placenta accreta spectrum disorder. However, in order to ensure sufficient practical experience in a multiprofessional obstetric setting, liberal use of cell salvage appears advisable.


Assuntos
Recuperação de Sangue Operatório , Humanos , Gravidez , Feminino , Recuperação de Sangue Operatório/métodos , Recuperação de Sangue Operatório/efeitos adversos , Hemorragia Pós-Parto/terapia , Transfusão de Eritrócitos/métodos , Transfusão de Eritrócitos/efeitos adversos , Transfusão de Eritrócitos/normas , Transfusão de Sangue Autóloga/métodos , Transfusão de Sangue Autóloga/efeitos adversos , Transfusão de Sangue Autóloga/normas , Perda Sanguínea Cirúrgica/prevenção & controle , Embolia Amniótica/terapia , Embolia Amniótica/diagnóstico , Obstetrícia/métodos , Obstetrícia/tendências , Obstetrícia/normas
12.
Wiad Lek ; 77(5): 971-979, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39008585

RESUMO

OBJECTIVE: Aim: Development of an algorithm of management actions for the formation of a resilient system of quality of medical care in health care institutions of obstetric and gynecological profile and formalization of its closed structural and logical scheme. PATIENTS AND METHODS: Materials and Methods: A set of theoretical approaches of social medicine and methods of business process reengineering is used, taking into account the dominant ones: systemic and integrated approach and alarm and process approaches; the concept of resilience; quality of medical care; reproductive health care using business ecosystem methods. RESULTS: Results: The algorithm of management actions for the formation of a resilient system of quality of medical care in obstetric and gynecological health care institutions, which is formalized in nine stages: analysis of needs and identification of problems; substantiation of performance requirements; development of a health care quality strategy; involvement of stakeholders; formation of a system of relative indicators; development of an action plan; implementation of a set of measures; monitoring and evaluation; improving the quality of health care. CONCLUSION: Conclusions: The results made it possible: construction of a closed structural and logical scheme of management actions, taking into account the combination of factors of influence, harmonized with the main functions of the resilient system, which determine the peculiarities of its functioning; justification of the boundaries of managerial and social responsibility of management entities according to the binary components of the medical and social justification of the process of improving the quality of medical care.


Assuntos
Algoritmos , Qualidade da Assistência à Saúde , Humanos , Atenção à Saúde/normas , Atenção à Saúde/organização & administração , Ginecologia/organização & administração , Ginecologia/normas , Obstetrícia/normas , Obstetrícia/organização & administração , Feminino
13.
Acta Clin Croat ; 62(Suppl1): 85-90, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38746607

RESUMO

Anatomic and physiologic changes during pregnancy make it more difficult to establish a safe airway in pregnant women in case of the need for surgery under general anesthesia than in the non-obstetric population. The inability to ventilate and oxygenate is one of the most common causes of morbidity and mortality associated with general anesthesia for cesarean section. The aim of this paper is to present and analyze modern guidelines and algorithms for the management of difficult airway in obstetrics as an important segment of anesthesiology practice. Modern difficult airway management guidelines for pregnant women describe the procedure of difficult facemask ventilation, difficult airway management by using supraglottic devices, difficult endotracheal intubation, and emergency cricothyrotomy or tracheotomy in a situation where oxygenation and ventilation are impossible. Algorithms describe the procedures and equipment for each variant of difficult airway and decision-making strategies in situations when neither airway nor adequate oxygenation can be provided. Croatian anesthesiologists in most obstetric departments have appropriate equipment, as well as necessary experience in difficult airway management for pregnant women, and modern algorithms from the most developed countries can be adopted and accommodated to our daily practice, as well as incorporated into the training curricula of residents.


Assuntos
Manuseio das Vias Aéreas , Guias de Prática Clínica como Assunto , Humanos , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/normas , Gravidez , Feminino , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Algoritmos , Anestesia Obstétrica/métodos , Obstetrícia/educação , Obstetrícia/normas
14.
Trop Med Int Health ; 26(5): 535-545, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33529436

RESUMO

OBJECTIVES: Variable and inadequate quality of maternity care is a critical factor in persistently high rates of maternal and neonatal mortality in Uganda. We investigated whether provider quality of care deviates from knowledge and the factors associated with these 'know-do gaps' in Ugandan maternity facilities. METHODS: Data were collected from 109 providers in 40 facilities. Quality was measured using direct observations of intrapartum care, and scores were based on the percentage of essential care actions provided out of a 20-item validated quality index. Knowledge was measured based on the percentage of items that providers reported knowing to do using vignette surveys. The know-do gap was the difference between knowledge and quality. Multivariable models were used to assess the association between provider- and facility-level characteristics and knowledge, quality and know-do gaps. RESULTS: The average quality score was 45%, with quality varying widely within and across providers. The mean knowledge score was 70%, yielding a mean know-do gap of 25%. Know-do gaps were largest for practices related to infection control, vitals monitoring, and prevention of postpartum haemorrhage. The association between quality and knowledge scores was positive but small (P = 0.08), so know-do gaps were largest for providers with the highest knowledge scores. Greater provider training was positively associated with knowledge (P = 0.005) but not with quality (P = 0.60). Having 10 or more years of work experience was associated with higher quality scores (5.3, 95%CI: 0.6 to 10.1), while higher patient volumes were associated with lower quality scores (-2.2, 95%CI: -3.7 to - 0.07). None of the factors of provider motivation, cadre, availability of essential medicines and supplies or facility staffing were associated with quality or know-do gaps. CONCLUSIONS: Our results indicate that, in Uganda, gaps between knowledge and quality do not appear to be explained by factors such as lack of motivation, education, training or supplies. Gaps are particularly large for essential practices related to prevention of postpartum haemorrhage, a leading cause of maternal mortality in Uganda and similar settings.


Assuntos
Serviços de Saúde Materno-Infantil/normas , Obstetrícia/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos Transversais , Feminino , Instalações de Saúde/normas , Humanos , Recém-Nascido , Gravidez , População Rural/estatística & dados numéricos , Uganda
15.
Ultrasound Obstet Gynecol ; 58(5): 732-737, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33634915

RESUMO

OBJECTIVE: The Nuchal Translucency Quality Review (NTQR) program has provided standardized education, credentialing and epidemiological monitoring of nuchal translucency (NT) measurements since 2005. Our aim was to review the effect on NT measurement of provider characteristics since the program's inception. METHODS: We evaluated the distribution of NT measurements performed between January 2005 and December 2019, for each of the three primary performance indicators of NT measurement (NT median multiples of the median (MoM), SD of log10 NT MoM and slope of NT with respect to crown-rump length (CRL)) for all providers within the NTQR program with more than 30 paired NT/CRL results. Provider characteristics explored as potential sources of variability included: number of NT ultrasound examinations performed annually (annual scan volume of the provider), duration of participation in the NTQR program, initial credentialing by an alternative pathway, provider type (physician vs sonographer) and number of NT-credentialed providers within the practice (size of practice). Each of these provider characteristics was evaluated for its effect on NT median MoM and geometric mean of the NT median MoM weighted for the number of ultrasound scans, and multiple regression was performed across all variables to control for potential confounders. RESULTS: Of 5 216 663 NT measurements from 9340 providers at 3319 sites, the majority (75%) of providers had an NT median MoM within the acceptable range of 0.9-1.1 and 85.5% had NT median MoM not statistically significantly outside this range. Provider characteristics associated with measurement within the expected range of performance included higher volume of NT scans performed annually, practice at a site with larger numbers of other NT-credentialed providers, longer duration of participation in the NTQR program and alternative initial credentialing pathway. CONCLUSIONS: Annual scan volume, duration of participation in the NTQR program, alternative initial credentialing pathway and number of other NT-credentialed providers within the practice are all associated with outcome metrics indicating quality of performance. It is critical that providers participate in ongoing quality assessment of NT measurement to maintain consistency and precision. Ongoing assessment programs with continuous feedback and education are necessary to maintain quality care. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.


Assuntos
Medição da Translucência Nucal/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Adulto , Estatura Cabeça-Cóccix , Feminino , Humanos , Medição da Translucência Nucal/normas , Obstetrícia/normas , Gravidez , Avaliação de Programas e Projetos de Saúde , Fatores de Tempo , Estados Unidos
16.
Ultrasound Obstet Gynecol ; 58(4): 561-567, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34021947

RESUMO

OBJECTIVE: The aim of this national study was to examine the incidence of preterm pre-eclampsia (PE) and the proportion of women with risk factors for PE, according to the criteria suggested by the National Institute for Health and Care Excellence (NICE) and the American College of Obstetricians and Gynecologists (ACOG), during a 10-year period in Denmark. METHODS: Data from The Danish National Patient Registry and the Danish Medical Birth Registry were used to obtain the incidence of preterm PE with delivery < 37 weeks' gestation and risk factors for PE for all deliveries in Denmark from 1 January 2008 to 31 December 2017. The proportion of women with at least one high-risk factor and/or at least two moderate-risk factors for PE, according to the NICE and ACOG criteria, and the detection rate for preterm PE were examined. Race, socioeconomic status and the woman's weight at birth were not available from the registries used, and information on Type-2 diabetes was found to be invalid. RESULTS: Of the 597 492 deliveries during the study period, any PE was registered in 3.2%, preterm PE < 37 weeks in 0.7% and early-onset PE < 34 weeks' gestation in 0.3%. These proportions remained largely unchanged from 2008 to 2017. Overall, the NICE criteria were fulfilled in 7.5% of deliveries and the ACOG criteria in 17.3%. In the total population, the NICE criteria identified 47.6% of those with preterm PE and the ACOG criteria identified 60.5%. The current criteria for offering aspirin treatment in Denmark largely correspond to having at least one NICE high-risk factor. In 2017, a total of 3.5% of deliveries had at least one NICE high-risk factor, which identified 28.4% of cases that later developed preterm PE. CONCLUSIONS: The incidence of preterm PE remained largely unchanged in Denmark from 2008 to 2017. Prediction of PE according to high-risk maternal factors could be improved by addition of moderate-risk factors. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.


Assuntos
Obstetrícia/normas , Pré-Eclâmpsia/diagnóstico , Nascimento Prematuro/diagnóstico , Diagnóstico Pré-Natal/estatística & dados numéricos , Medição de Risco/estatística & dados numéricos , Adulto , Aspirina/uso terapêutico , Dinamarca/epidemiologia , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/prevenção & controle , Valor Preditivo dos Testes , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle , Diagnóstico Pré-Natal/normas , Sistema de Registros , Medição de Risco/normas , Fatores de Risco
17.
BMC Endocr Disord ; 21(1): 182, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488736

RESUMO

BACKGROUND: Obesity is associated with the development of polycystic ovary syndrome (PCOS) and contributes substantially to metabolic abnormalities in women with PCOS. The study aimed to describe and compare the practices of physicians in the diagnosis, evaluation, and treatment of obesity in patients with PCOS. METHODS: Reproductive endocrinologists (Repro-Endo) and obstetrician-gynecologists (non-reproductive medicine specialty, OB-Gyn) in China participated in a survey, and their responses were analyzed using χ2 tests, Fisher exact tests, and multivariable logistic regression analysis. RESULTS: The study analyzed 1318 survey responses (85.8% OB-Gyn; 97.3% women). Body mass index was the most common diagnostic criterion for obesity; only 1.3% of participants measured waist circumference to identify abdominal obesity. More Repro-Endo participants (25% of all participants) enquired about the psychological problems of patients with obesity than OB-Gyn participants, and 42.5% of participants reported ordering both a lipid profile and oral glucose tolerance test (OGTT) for patients with obesity and PCOS. Multivariable analysis, that included physician's specialty, age, hospital grade, and number of patients with PCOS seen annually, revealed that OB-Gyn participants were less likely to order OGTT (OR, 0.3; 95% CI, 0.2-0.4) and lipid profile (OR, 0.2; 95% CI, 0.1-0.3) than Repro-Endo participants. The most common treatments for patients with PCOS were lifestyle modification (> 95%) and metformin (> 80%). More Repro-Endo participants prescribed metformin at a dose of 1.5 g/day compared with OB-Gyn (47.6% vs. 26.3%), and more OB-Gyn participants reported being unclear about the appropriate dosage of metformin for patients with obesity and PCOS (8.9% vs. 1.6%). CONCLUSION: Our survey identified knowledge gaps in metabolic screening for patients with obesity and PCOS and a disparity in the evaluation and treatment of obesity in PCOS among different specialties. Similarly, it highlights the need to improve obesity management education for physicians caring for women with PCOS.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Síndrome Metabólica/prevenção & controle , Manejo da Obesidade/normas , Obesidade/terapia , Síndrome do Ovário Policístico/prevenção & controle , Padrões de Prática Médica/normas , Adolescente , Adulto , Índice de Massa Corporal , China , Endocrinologistas/normas , Feminino , Seguimentos , Ginecologia/normas , Humanos , Estilo de Vida , Masculino , Síndrome Metabólica/etiologia , Síndrome Metabólica/metabolismo , Síndrome Metabólica/patologia , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Obstetrícia/normas , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/metabolismo , Síndrome do Ovário Policístico/patologia , Prognóstico , Reprodução , Inquéritos e Questionários , Adulto Jovem
18.
BMC Pregnancy Childbirth ; 21(1): 703, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666718

RESUMO

BACKGROUND: In maternity services, as in other areas of healthcare, increasing emphasis is placed on improving "efficiency" or "productivity". The first step in any efficiency and productivity analysis is the selection of relevant input and output measures. Within healthcare quantifying what is produced (outputs) can be difficult. The aim of this paper is to identify a potential output measure, that can be used in an assessment of the efficiency and productivity of labour and birth in-hospital care in Australia and to assess the extent to which it reflects the principles of woman-centred care. METHODS: This paper will survey available perinatal and maternal datasets in Australia to identify potential output measures; map identified output variables against the principles of woman-centred care outlined in Australia's national maternity strategy; and based on this, create a preliminary composite outcome measure for use in assessing the efficiency and productivity of Australian maternity services. RESULTS: There are significant gaps in Australia's maternity data collections with regard to measuring how well a maternity service is performing against the values of respect, choice and access; however safety is well measured. Our proposed composite measure identified that of the 63,215 births in Queensland in 2014, 67% met the criteria of quality outlined in our composite measure. CONCLUSIONS: Adoption in Australia of the collection of woman-reported maternity outcomes would substantially strengthen Australia's national maternity data collections and provide a more holistic view of pregnancy and childbirth in Australia beyond traditional measure of maternal and neonate morbidity and mortality. Such measures to capture respect, choice and access could complement existing safety measures to inform the assessment of productivity and efficiency in maternity care.


Assuntos
Eficiência , Serviços de Saúde Materna/normas , Obstetrícia/normas , Avaliação de Resultados em Cuidados de Saúde , Assistência Centrada no Paciente/normas , Conjuntos de Dados como Assunto , Feminino , Guias como Assunto , Humanos , Serviços de Saúde Materna/organização & administração , Obstetrícia/organização & administração , Queensland
19.
J Obstet Gynaecol Can ; 43(3): 372-375, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32962967

RESUMO

The University of Toronto launched a longitudinal integrated clerkship (LIC) pilot project in 2014. Our aim was to evaluate LIC student outcomes in obstetrics and gynaecology compared with those of traditional block students. LIC and block students underwent identical evaluations, including written and oral exams, as well as clinical assessments from the ward. LIC student scores in each domain were compared with those of the traditional block students over 4 years. There were no differences in overall pass/fail status between LIC and block students. Thus, our LIC design could be appropriately modeled at other teaching institutions contemplating introducing an LIC stream.


Assuntos
Estágio Clínico/normas , Currículo/normas , Ginecologia/educação , Obstetrícia/educação , Educação de Graduação em Medicina , Avaliação Educacional , Ginecologia/normas , Humanos , Obstetrícia/normas , Projetos Piloto , Melhoria de Qualidade , Estudantes de Medicina
20.
Reprod Health ; 18(1): 50, 2021 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-33639966

RESUMO

BACKGROUND: We aim to assess competencies (knowledge, skills and attitudes) of midwifery care providers as well as their experiences and perceptions of in-service training in the four study countries; Benin, Malawi, Tanzania and Uganda as part of the Action Leveraging Evidence to Reduce perinatal mortality and morbidity in sub-Saharan Africa project (ALERT). While today more women in low- and middle-income countries give birth in health care facilities, reductions in maternal and neonatal mortality have been less than expected. This paradox may be explained by the standard and quality of intrapartum care provision which depends on several factors such as health workforce capacity and the readiness of the health system as well as access to care. METHODS: Using an explanatory sequential mixed method design we will employ three methods (i) a survey will be conducted using self-administered questionnaires assessing knowledge, (ii) skills drills assessing basic intrapartum skills and attitudes, using an observation checklist and (iii) Focus Group Discussions (FGDs) to explore midwifery care providers' experiences and perceptions of in-service training. All midwifery care providers in the study facilities are eligible to participate in the study. For the skills drills a stratified sample of midwifery care providers will be selected in each hospital according to the number of providers and, professional titles and purposive sampling will be used for the FGDs. Descriptive summary statistics from the survey and skills drills will be presented by country. Conventional content analysis will be employed for data analysis of the FGDs. DISCUSSION: We envision comparative insight across hospitals and countries. The findings will be used to inform a targeted quality in-service training and quality improvement intervention related to provision of basic intrapartum care as part of the ALERT project. TRIAL REGISTRATION: PACTR202006793783148-June 17th, 2020.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Tocologia , Obstetrícia/normas , Qualidade da Assistência à Saúde , Adulto , Benin/epidemiologia , Lista de Checagem , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Parto Obstétrico/enfermagem , Parto Obstétrico/normas , Parto Obstétrico/estatística & dados numéricos , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/normas , Humanos , Cuidado do Lactente/normas , Cuidado do Lactente/estatística & dados numéricos , Recém-Nascido , Malaui/epidemiologia , Tocologia/educação , Tocologia/normas , Tocologia/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Gravidez , Inquéritos e Questionários , Tanzânia/epidemiologia , Uganda/epidemiologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA