[Anti-doping Activities and Comprehensive Health Support for Young Athletes].

In this study, we conducted a survey and interviews of young athletes to clarify the actual conditions of medication use and nutritional management (supplement use, etc.) with the aim of enhancing their health support. In addition, a second questionnaire was conducted for pharmacists working at medical institutions to clarify the actual situation of anti-doping (AD) activities by pharmacists, and examined the issues they face to support the health of athletes in the future. The results of the athletes' surveys revealed that the roles of pharmacists in AD activities was not recognized by athletes. In particular, the dissemination of AD education by pharmacists is considered to be critical. In future AD education, it will be necessary not only to provide knowledge of prohibited drugs, but also to provide self-medication support tailored to the individual needs of athletes, such as knowledge of nutrition and health. The results of the pharmacist survey revealed that athletes are treated by pharmacists on a daily basis, but for pharmacists, there are difficulties regarding how to provide information on AD, and it is necessary to enhance AD education at schools of pharmacy as well as in lifelong education seminars. Considering the pharmacists' AD activities as part of health support for athletes, it is considered more effective to collaborate with other health professionals such as sports doctors or nutritionists because it requires a wide range of knowledge such as nutrition.

La superación de la enfermera en la atención integral a la familia con enfermo oncológico / The upgrade of the nurse in the comprehensive care to the family with oncological patients

RESUMEN Introducción: la enfermera que se desempeña en los consultorios de la Atención Primaria de Salud, asume la responsabilidad de propiciar una atención integral al familiar encargado del cuidado del enfermo oncológico. Objetivo: diseñar una propuesta de superación para el perfeccionamiento de la actuación de la enfermera en la atención integral a la familia con enfermo oncológico. Materiales y métodos: se efectuó una investigación de desarrollo en la Facultad de Ciencias Médicas de Matanzas Dr. Juan Guiteras Gener, durante el curso 2018-2019. Se utilizó una muestra de 23 enfermeras de los consultorios de la atención primaria del municipio de Matanzas. Se analizaron los documentos que avalan su desempeño profesional. Se diseñó una encuesta dirigida a la identificación de las necesidades de aprendizaje y una guía de observación para caracterizar el modo de actuación del profesional de Enfermería. Se aplicaron entrevistas a supervisoras y directivos. Resultados: el análisis de las encuestas aplicadas a la muestra seleccionada y las observaciones realizadas a las actividades en el hogar, permitieron detectar las necesidades de aprendizaje para el perfeccionamiento de la atención integral a la familia con enfermo oncológico. Las entrevistas realizadas a supervisoras y directivos corroboraron la necesidad de la propuesta. Conclusiones: se diseñó un curso de posgrado para el perfeccionamiento de la actuación de los profesionales de la Enfermería, relacionado con el cuidado integral a la familia con enfermos oncológicos en la Atención Primaria de Salud (AU).

ABSTRACT Introduction: the nurse who works in the primary health care consultations assumes the responsibility of providing comprehensive care to the relative who takes care of oncological patients. Objective: to design a proposal of upgrading to improve the performance of the nurse in the comprehensive care to the family with an oncological patient. Materials and methods: a development research was conducted in the Faculty of Medical Sciences Dr. Juan Guiteras Gener, of Matanzas, during the school year 2018-2019. The sample was 23 nurses from the primary health care offices of the municipality of Matanzas. The documents that support their professional performance were analyzed. A survey was designed to identify learning needs and also an observation guide to characterize the performance of the nursing professional. Interviews were conducted with supervisors and managers. Results: the analysis of the surveys applied to the chosen sample and the observations made to the activities carried out at home, made it possible to determine the learning needs for the improvement of the comprehensive care to the families with oncological patients. Interviews with supervisors and managers confirmed the necessity of the proposal. Conclusions: a postgraduate course was designed for the improvement of nursing professionals' performance, aimed to the comprehensive care to families with oncological patients in the primary health care (AU).

The effect of comprehensive assessment and multi-disciplinary management for the geriatric and frail patient: A multi-center, randomized, parallel controlled trial.

BACKGROUND: A comprehensive geriatric assessment (CGA) of elderly patients is useful for detecting the patients vulnerabilities. Exercise and early rehabilitation, nutritional intervention, traditional Chinese medicine (TCM), standardized medication guidance, and patient education can, separately, improve and even reverse the physical frailty status. However, the effect of combining a CGA and multi-disciplinary management on frailty in elderly patients remains unclear. The present study assessed the effects of a CGA and multi-disciplinary management on elderly patients with frailty in China. METHODS: In this study, 320 in patients with frailty ≥70 years old will be randomly divided into an intervention group and a control group. The intervention group will be given routine management, a CGA and multi-disciplinary management involving rehabilitation exercise, diet adjustment, multi-drug evaluation, acupoint massage in TCM and patient education for 12 months, and the control group will be followed up with routine management for basic diseases. The primary outcomes are the Fried phenotype and short physical performance battery (SPPB). The secondary outcomes are the clinical frailty scale (CFS), non-elective hospital readmission, basic activities of daily living (BADL), 5-level European quality of life 5 dimensions index (EQ-5D), nutrition risk screening-2002 (NRS-2002), medical insurance expenses, fall events, and all-cause mortality. In addition, a cost-effectiveness study will be carried out. DISCUSSION: This paper outlines the protocol for a randomized, single-blind, parallel multi-center clinical study. This protocol, if beneficial, will demonstrate the interaction of various intervention strategies, will help improve elderly frailty patients, and will be useful for clinicians, nurses, policymakers, public health authorities, and the general population. TRIAL REGISTRATION: Chinese Clinical Trials Register, ChiCTR1900022623. Registered on April 19, 2019, http://www.chictr.org.cn/showproj.aspx?proj=38141.

Evaluation of a National Comprehensive Cancer Network Guidelines-Based Decision Support Tool in Patients With Non-Small Cell Lung Cancer: A Nonrandomized Clinical Trial.

Importance: The association of guideline-based decision support with the quality of care in patients with non-small cell lung cancer (NSCLC) is not known. Objective: To evaluate the association of exposure to the National Comprehensive Cancer Center (NCCN) guidelines with guideline-concordant care and patients' decisional conflict. Design, Setting, and Participants: A nonrandomized clinical trial, conducted at a tertiary care academic institution, enrolled patients from February 23, 2015, to September 28, 2017. Data analysis was conducted from July 19, 2019, to April 22, 2020. A cohort of 76 patients with NSCLC seen at diagnosis or disease progression and a retrospective cohort of 157 patients treated before the trial were included. Adherence to 6 NCCN recommendations were evaluated: (1) smoking cessation counseling, (2) adjuvant chemotherapy for patients with stage IB to IIB NSCLC after surgery, (3) pathologic mediastinal staging in patients with stage III NSCLC before surgery, (4) pathologic mediastinal staging in patients with stage III NSCLC before nonsurgical treatment, (5) definitive chemoradiotherapy for patients with stage III NSCLC not having surgery, and (6) molecular testing for epidermal growth factor receptor and anaplastic lymphoma kinase alterations for patients with stage IV NSCLC. Subgroup analysis was conducted to compare the rates of guideline concordance between the prospective and retrospective cohorts. Secondary end points included decisional conflict and satisfaction. Interventions: An online tool customizing the NCCN guidelines to patients' clinical and pathologic features was used during consultation, facilitated by a trained coordinator. Main Outcomes and Measures: Concordance of practice with 6 NCCN treatment recommendations on NSCLC and patients' decisional conflict. Results: Of the 76 patients with NSCLC, 44 were men (57.9%), median age at diagnosis was 68 years (interquartile range [IQR], 41-87 years), and 59 patients (77.6%) had adenocarcinoma. In the retrospective cohort, 91 of 157 patients (58.0%) were men, median age at diagnosis was 66 years (IQR, 61-65 years), and 105 patients (66.9%) had adenocarcinoma. After the intervention, patients received more smoking cessation counseling (4 of 5 [80.0%] vs 1 of 24 [4.2%], P < .001) and less adjuvant chemotherapy (0 of 7 vs 7 of 11 [63.6%]; P = .012). There was no significant change in mutation testing of non-squamous cell stage IV disease (20 of 20 [100%] vs 48 of 57 [84.2%]; P = .10). There was no significant change in pathologic mediastinal staging or initial chemoradiotherapy for patients with stage III disease. After consultation with the tool, decisional conflict scores improved by a median of 20 points (IQR, 3-34; P < .001). Conclusions and Relevance: The findings of this study suggest that exposure to the NCCN guidelines is associated with increased guideline-concordant care for 2 of 6 preselected recommendations and improvement in decisional conflict. Trial Registration: ClinicalTrials.gov Identifier: NCT03982459.

Association of Palliative Care Use and Setting With Health-care Utilization and Quality of Care at the End of Life Among Patients With Advanced Lung Cancer.

BACKGROUND: Palliative care is associated with improved survival and quality of life among patients with lung cancer; however, its influence on health-care utilization and quality of care is unclear. RESEARCH QUESTION: Is palliative care, and the setting in which it occurs, associated with health-care resource utilization and quality of care among patients with advanced lung cancer? STUDY DESIGN AND METHODS: This was a retrospective cohort study of 23,142 patients with stage IIIB/IV lung cancer in the Veterans Affairs HealthCare System between 2007 and 2013. Exposures included the receipt of specialist-delivered palliative care, and the setting of the initial palliative care encounter (inpatient or outpatient) received after cancer diagnosis. Primary outcomes included rates of ED visits, along with rates of hospitalization and odds of ICU admission within the last 30 days of life. Secondary outcomes included any health-care utilization (ED, hospital, or ICU) related to chemotherapy toxicity. We used propensity score methods to perform Poisson and logistic regression modeling. RESULTS: Among the 23,142 patients, 57% received palliative care, and 36% of initial palliative care encounters were outpatient. Compared with no palliative care, initial palliative care encounter in the outpatient setting was associated with reduced rates of ED visits (adjusted incidence rate ratio [aIRR], 0.86; 95% CI, 0.77-0.96) and hospitalizations in the last 30 days of life (aIRR, 0.64; 95% CI, 0.59-0.70). Initial palliative care encounters in both inpatient (adjusted OR [aOR], 0.63; 95% CI, 0.53-0.75) and outpatient (aOR, 0.42; 95% CI, 0.35-0.52) settings were associated with reduced odds of ICU admission in the last 30 days of life. Palliative care was also associated with reduced health-care utilization related to chemotherapy toxicity (aOR, 0.88; 95% CI, 0.82-0.95). INTERPRETATION: Palliative care (particularly in outpatient settings) is associated with reduced health-care utilization at the end of life and may improve the quality of care among patients with advanced lung cancer. These findings support the role of palliative care as an important component of comprehensive cancer care and highlight the potential benefits of outpatient palliative care services.

OPEN ARCH: integrated care at the primary-secondary interface for the community-dwelling older person with complex needs.

Optimal care of community-dwelling older Australians with complex needs is a national imperative. Suboptimal care that is reactive, episodic and fragmented, is costly to the health system, can be life threatening to the older person and produces unsustainable carer demands. Health outcomes would be improved if services (health and social) are aligned towards community-based, comprehensive and preventative care. Integrated care is person-focussed in outlook and defies a condition-centric approach to healthcare delivery. Integration is a means to support primary care, with the volume and complexity of patient needs arising from an ageing population. Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) is a targeted model of care that improves access to specialist assessment and comprehensive care for older persons at risk of functional decline, hospitalisation or institutionalised care. OPEN ARCH was developed with primary care as the central integrating function and is built on four values of quality care: preventative health care provided closer to home; alignment of specialist and generalist care; care coordination and enablement; and primary care capacity building. Through vertical integration at the primary-secondary interface, OPEN ARCH cannot only improve the quality of care for clients, but improves the capacity of primary care to meet the needs of this population.

A patient-centered medical home model for comprehensive sickle cell care in infants and young children.

BACKGROUND: The patient-centered medical home (PCMH) has been proposed as a model for comprehensive care coordination and delivery for children with sickle cell disease (SCD), yet little is known regarding the implementation of PCMH core concepts on adherence to preventative care measures, health care utilization, and parent satisfaction. PROCEDURE: We implemented the newborn cohort clinic (NCC) to explore the application of the PCMH model for infants and children with SCD from birth to age 3 years in 2011. In July 2017, we conducted a retrospective chart review to evaluate subjects currently or previously followed in the clinic. We surveyed parents in the NCC to assess their satisfaction with their experience. RESULTS: A total of 112 patients have been managed in the NCC. All patients received penicillin prophylaxis, while 70% and 73% of patients, respectively, received the 23-valent pneumococcal vaccine and an initial transcranial Doppler by age 36 months. Most (92 of 112) of the subjects utilized the emergency department (569 encounters), with 86% of encounters for fever or other sickle cell-related complications. The majority of parents indicated satisfaction with the clinic, with 71% saying clinic providers always or usually spent enough time with their child, listened carefully to them (81%) and were sensitive to family values and customs (77%). CONCLUSIONS: A comprehensive sickle cell clinic as a component of a PCMH is feasible and can achieve high levels of preventative care. Parents are largely satisfied with this model of care.

Oral status of HIV-infected children aged 12 years or younger who attended a Paediatric Infectious Diseases Clinic in Cape Town.

BACKGROUND: Children continue to suffer from the impact of the human immunodeficiency virus-acquired immunodeficiency syndrome (HIV/AIDS) pandemic. In Cape Town, these children receive medical care including antiretroviral therapy from facilities like Tygerberg Hospital's Paediatric Infectious Diseases Clinic. HIV-infected children may experience an increased caries experience when compared with their healthy peers. AIM: The aim of this study was to determine the oral health status of HIV-infected children younger than 12 years receiving antiviral drugs at the Paediatric Infectious Diseases Clinic. DESIGN: A cross-sectional survey was conducted among children aged between 2 and 12 years presenting at this clinic. Caregivers were interviewed to obtain information regarding health seeking behaviour, oral hygiene practices and dietary habits. A single clinician undertook a standardized clinical intraoral examination according to the World Health Organization guidelines, with modifications. RESULTS: Sixty-six children were recruited. A high prevalence of dental caries (78.8%) and an unmet treatment need of 90.4% were recorded among the participants. Most children had never visited the dentist, and those who did had mainly received emergency dental care. CONCLUSION: The high prevalence of severe dental caries in this population highlights the need for oral health awareness and the inclusion of oral health care in the comprehensive care of children with HIV. WHY THIS PAPER IS IMPORTANT TO PAEDIATRIC DENTISTS: The study highlights the importance of collaborating with health professions outside of dentistry. Doctors and nurses are often the first health professionals to come into contact with children with special needs. They should therefore be made aware of the early signs of decay so that these patients can be referred for dental treatment timeously. Holistic management of children with special healthcare needs is essential to improve their overall well-being.

Comprehensive Care in Cerebral Palsy.

Children with cerebral palsy (CP) will be cared for at some point by all pediatricians and many pediatric subspecialists due to this condition being the most common motor disability of childhood. Comprehensive care of the child with CP requires individuals with specialized training, and these children benefit from an interdisciplinary team approach to care. CP is heterogeneous due to varied causes, which necessitates individualized treatment plans. The CP specialist must be prepared to support the needs of the child with CP holistically and must dialogue regularly with members of the team and involve the family in decision-making.

Patient and Caregiver Benefit From a Comprehensive Dementia Care Program: 1-Year Results From the UCLA Alzheimer's and Dementia Care Program.

BACKGROUND/OBJECTIVES: Persons with Alzheimer disease and related dementias (ADRDs) require comprehensive care that spans health systems and community-based organizations. This study examined the clinical outcomes of a comprehensive dementia care program and identified subgroups who were more likely to benefit. DESIGN: Observational, baseline and 1 year after intervention. SETTING: Urban, academic medical center. PARTICIPANTS: A total of 554 persons with dementia and their caregivers who had 1-year follow-up evaluations and data on clinical outcomes. INTERVENTION: Health system-based comprehensive dementia care management program using nurse practitioner dementia care managers. MEASUREMENTS: Patient measures included the Mini-Mental State Examination (MMSE), the Functional Activities Questionnaire, Basic and Instrumental Activities of Daily Living scales, the Cornell Scale for Depression in Dementia, and the Neuropsychiatric Inventory Questionnaire (NPI-Q) Severity. Caregiver measures included the Modified Caregiver Strain Index, the Patient Health Questionnaire-9, NPI-Q Distress, and the Dementia Burden Scale-Caregiver). We used established minimal clinically important differences and lowest tertiles of baseline symptoms to define improving symptoms and maintaining low symptoms as clinical benefit for patients and caregivers. RESULTS: At year 1, persons with ADRD improved on all scales, except MMSE and functional status measures; caregivers improved on all scales. Using validated instruments, 314/543 (58%) of patients, 282/447 (63%) of caregivers, and 376/501 (75%) of patients or caregivers demonstrated clinical benefit. In adjusted multivariate models, at year 1, more behavioral symptoms and fewer depression symptoms at baseline were associated with patient improvement; and fewer baseline depression symptoms were associated with maintaining low behavioral symptoms. Male caregiver sex, higher baseline caregiver burden, and caring for patients with fewer baseline depression symptoms were associated with caregiver improvement. Male caregiver sex and patients with fewer depression symptoms, fewer behavioral symptoms, and more functional impairment at baseline were associated with caregivers maintaining low burden at 1 year. CONCLUSIONS: Health system-based comprehensive dementia care management is a promising approach to improving clinical outcomes, with benefits for both patients and caregivers. J Am Geriatr Soc 67:2267-2273, 2019.

Comprehensive Care for Cuban Children in the First 1000 Days of Life.

The first 1000 days of life constitute a short and exceptionally important period when the foundation is established for children's growth, development and lifelong health. Cuba has a comprehensive care system for this population that aims to promote the best start in life so that children can reach their highest development potential. This is carried out through the national public health and education systems and also includes elements of health protection, prevention of harm and disease and social welfare for children.

[The Pharmacy Combining Convenience Store with Care Consulting Services].

The primary pharmacy system and health support pharmacy system were established in 2016. However, local pharmacies need to get closer to the community. To this end, each pharmacy is making efforts to contribute locally. Here, we introduce various initiatives in our region. Akakabe Pharmacy has 66 stores in Osaka Prefecture, mainly in the northeastern part of Osaka, where the elderly population is growing. We are implementing a dominant strategy: cooperation with the city and administration is strong, and we hold many related events directed towards the public. For example, two thousand participants gathered in an event sponsored by the city aimed at the improvement of beauty and health. At such events, participants can easily consult with pharmacists. Dispensing pharmacy stores-pharmacies that combine the features of a convenience store with care consulting services-were established in 2016. Care consultations are potentially highly advantageous to the users. In the consultation space of a pharmacy, a care worker conducts various events every month, such as on dementia prevention, body composition measurement, and more. We believe that this type of combined pharmacy and convenience store has the potential to become a regional comprehensive care center. We intend to share the possibility of a new pharmacy system, centered on this pharmacy/store/consultation model, as a basis to revamp the pharmacy industry.

Patient and provider perceptions of a comprehensive care program for HIV-positive adults over 50 years of age: The formation of the Golden Compass HIV and aging care program in San Francisco.

OBJECTIVE: People living with HIV (PLWH) are living longer and developing comorbidities and aging-related syndromes. New care models are needed to address the combined burden and complexity of HIV and its comorbidities in this group. The goal of this study is to describe qualitative data from patients and providers that informed the development of a comprehensive care model for older PLWH. METHODS: Patient and provider perspectives on the clinical care and service needs of patients living and aging with HIV were explored via surveys and focus groups at a safety net HIV clinic in San Francisco. We surveyed 77 patients and 26 providers and conducted separate focus groups of older patients living with HIV (n = 31) and staff (n = 20). Transcripts were analyzed using thematic analysis. Themes for a care program were additionally explored using findings from the literature on HIV and aging. FINDINGS: Themes from surveys and focus groups emphasized (a) the need for knowledge expertise in HIV and aging, (b) focus on medical conditions and determinants of health of particular import (e.g. marginal housing) among older PLWH, (c) co-locating specialty services (e.g. cardiology, geriatrics) with primary care, and (d) addressing social isolation. Findings informed the design of a comprehensive, multidisciplinary care model for PLWH called the Golden Compass program composed of four "points": Heart and Mind (North), Bones and Strength (East), Network and Navigation (South), and Dental, Hearing, and Vision (West). CONCLUSION: Based on patient and clinic staff perspectives from surveys and focus groups, we designed a multidisciplinary program of integrated primary and specialty care, as well as housing and social support, to address the needs of older PLWH within a safety-net infrastructure. Golden Compass launched in 2017 for PLWH older than 50 years. Future research to evaluate the effectiveness of this care program in improving patient outcomes and satisfaction is ongoing.

Nursing Education: Review of Assessment, Clinical Care, and Implications for Practice Regarding Older Adult Patients With Cancer.

BACKGROUND: As the population of older adults continues to increase, the healthcare system must adapt to respond to their unique and complicated health needs. More than half of all patients diagnosed with cancer in America are aged 65 years or older. The appropriate care for older adult patients with cancer requires a holistic approach with careful coordination of interprofessional providers. OBJECTIVES: This article aims to describe the components of the comprehensive geriatric assessment, summarize the importance of exercise in older adults, discuss the harms of polypharmacy, and evaluate the initiatives to improve geriatric nursing education. METHODS: The literature was reviewed and summarized to provide information on comprehensive geriatric assessment, exercise, polypharmacy, and geriatric nursing education. FINDINGS: Numerous assessment tools can help guide the care of older adult patients with cancer. Because many nurses have little formal geriatric-specific training, there is a growing need for targeted education to ensure best practices.

Comprehensive Infant Clinic for Sickle Cell Disease: Outcomes and Parental Perspective.

INTRODUCTION: Comprehensive care for children with sickle cell disease (SCD) includes penicillin prophylaxis, pneumococcal immunization, hydroxyurea therapy, and transcranial Doppler screening for stroke prevention. Along with caregiver education, these strategies have been shown to be effective in reducing early morbidity and mortality in this population. The subspecialty Infant Sickle Cell Clinic was initiated to improve access, education, patient outcomes, and family satisfaction. METHOD: Telephone surveys were conducted with parents to assess satisfaction with the Infant Sickle Cell Clinic, compliance with guidelines, and comfort level with managing their child's SCD. RESULTS: This quality improvement project reported high levels of parent satisfaction and improved outcomes with the proposed approach but also presents areas for improvement. DISCUSSION: Our report presents a unique model of providing care to families with infants newly diagnosed with SCD. The group format serves as a useful model to allow families an interactive educational session with guest speakers.

Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents.

As a traditionally underserved population that faces numerous health disparities, youth who identify as transgender and gender diverse (TGD) and their families are increasingly presenting to pediatric providers for education, care, and referrals. The need for more formal training, standardized treatment, and research on safety and medical outcomes often leaves providers feeling ill equipped to support and care for patients that identify as TGD and families. In this policy statement, we review relevant concepts and challenges and provide suggestions for pediatric providers that are focused on promoting the health and positive development of youth that identify as TGD while eliminating discrimination and stigma.

El parto humanizado como necesidad para la atención integral a la mujer / Humanized Childbirth:Vital Need for Comprehensive Care of Women

Introducción: Desde el siglo XX, comienza el interés respecto a la forma en que los seres humanos eran traídos al mundo. Autores cubanos en 2014 propusieron brindar una atención de salud con calidad, con elevado nivel de satisfacción de las mujeres y familias. Al tomar como referencia este tema para ser dirigirlo al equipo de salud que atiende a la mujer durante el proceso del parto. Objetivo: Reforzar el conocimiento teórico del equipo de salud sobre la humanización al parto, que transforme, en la práctica asistencial, la atención integral a la mujer. Métodos: Se realizó una revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo del contenido de documentos. La búsqueda fue realizada en las bases de datos SciELO y Google académico de mayo a julio del 2016. Tras la identificación de los estudios pre-seleccionados, se llevó a cabo la lectura de los títulos, resúmenes y palabras clave, comprobando la pertinencia con el estudio. Conclusión: Se realizó un análisis histórico de la humanización del parto. Este acercamiento reforzará los aportes al equipo de salud que atiende a la mujer durante este proceso al ofrecer un material que transita desde los orígenes de las corrientes humanistas hasta la importancia de este enfoque para la mujer y el equipo de salud durante el proceso de parto(AU)

Introduction: In 2014, Cuban authors proposed offering quality health care with a high level of satisfaction for women and families, taking this issue as a reference and treating it with the health team that attends to the woman during the birth process. Objective: Reinforce the theoretical knowledge of the health team on the humanization of birth so that transforms comprehensive care to women at clinical practice. Methods: We carried out a systematic literature review to develop a reflexive critical analysis of the documents. We worked with SciELO and Google academic databases from May to July 2016. After the identification of the pre-selected studies, we carefully read titles, abstracts and keywords verifying the pertinence with the study. Conclusion: A historical analysis of the evolution of labor and its humanization was carried out. This approach will reinforce the contributions to the health team that cares for women during the delivery process by offering a material that covers the origins of the humanist currents in childbirth care and the importance of this approach for women and the team health during the childbirth process(AU)

A comprehensive care plan that reduces readmissions after acute exacerbations of COPD.

BACKGROUND: "Transitions of care" have been the focus of readmission reduction strategies for acute exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD). Wake Forest Baptist Medical Center (WFBMC) implemented a comprehensive care plan for AECOPD admissions in 2014 that also seeks to improve the diagnosis/treatment of COPD, strives for the optimal management of co-morbidities, and emphasizes hospice/palliative care in appropriate patients. METHODS: A retrospective, electronic health record (EHR) based, observational cohort study was used to evaluate AECOPD admissions between 5/12/2014 to 6/28/2016. An existing AECOPD registry was used to determine care plan status, readmissions were identified from the EHR, and mortality information was obtained from the state of North Carolina. Propensity weighted, multiple logistic regression was used to compare the care plan (n = 597) versus usual care (n = 677) on readmission and mortality outcomes after covariate adjustment. RESULTS: Enrollment in the care plan was associated with a reduced odds of 30-day all-cause readmission (OR 0.84, 95% CI 0.71-0.99), 30-day mortality (OR 0.63, 95% CI 0.44-0.88), and the composite endpoint of 30-day, all-cause readmissions and mortality (OR 0.78, 95% CI 0.67-0.92). The plan also reduced AECOPD-specific readmissions at 90 days (OR 0.78, 95% CI 0.63-0.96). CONCLUSION: A comprehensive care plan for patients hospitalized for AECOPD reduced the odds of all-cause readmission, mortality, and AECOPD specific readmission risk. This exploratory study reinforces the use of the AECOPD Care Plan at WFBMC. Future research should focus on a randomized, pragmatic clinical trial to further evaluate the impact of this plan on clinical outcomes.