RESUMEN
PURPOSE: The summary presented herein represents Part II of the two-part series dedicated to the Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. Part II outlines the appropriate management of the male in an infertile couple. Medical therapies, surgical techniques, as well as use of intrauterine insemination (IUI)/in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) are covered to allow for optimal patient management. Please refer to Part I for discussion on evaluation of the infertile male and discussion of relevant health conditions that are associated with male infertility. MATERIALS/METHODS: The Emergency Care Research Institute Evidence-based Practice Center team searched PubMed®, Embase®, and Medline from January 2000 through May 2019. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (table[Table: see text]). This summary is being simultaneously published in Fertility and Sterility and The Journal of Urology. RESULTS: This Guideline provides updated, evidence-based recommendations regarding management of male infertility. Such recommendations are summarized in the associated algorithm (figure[Figure: see text]). CONCLUSION: Male contributions to infertility are prevalent, and specific treatment as well as assisted reproductive techniques are effective at managing male infertility. This document will undergo additional literature reviews and updating as the knowledge regarding current treatments and future treatment options continues to expand.
Asunto(s)
Infertilidad Masculina/terapia , Medicina Reproductiva/normas , Urología/normas , Varicocele/terapia , Consejo/normas , Suplementos Dietéticos , Medicina Basada en la Evidencia/métodos , Medicina Basada en la Evidencia/normas , Fertilización In Vitro/métodos , Fertilización In Vitro/normas , Humanos , Infertilidad Masculina/diagnóstico , Infertilidad Masculina/etiología , Masculino , Medicina Reproductiva/métodos , Escroto/diagnóstico por imagen , Moduladores Selectivos de los Receptores de Estrógeno/uso terapéutico , Análisis de Semen , Sociedades Médicas/normas , Recuperación de la Esperma/normas , Resultado del Tratamiento , Estados Unidos , Urología/métodos , Varicocele/complicaciones , Varicocele/diagnósticoAsunto(s)
Andrología/normas , Suplementos Dietéticos , Enfermedades de los Genitales Masculinos/dietoterapia , Infertilidad Masculina/dietoterapia , Medicina Reproductiva/normas , Disfunciones Sexuales Fisiológicas/dietoterapia , Andrología/organización & administración , Suplementos Dietéticos/normas , Práctica Clínica Basada en la Evidencia/normas , Humanos , Italia , Masculino , Enfermedades de la Próstata/dietoterapia , Medicina Reproductiva/organización & administración , Conducta Sexual/fisiología , Sociedades Médicas/organización & administración , Sociedades Médicas/normas , Vitaminas/uso terapéuticoRESUMEN
OBJECTIVE: To estimate the prevalence of awareness and use of evidence-based reproductive health interventions and to describe the barriers associated with the use of evidence-based interventions among health providers in north-west Cameroon. METHODS: In February 2004, a population-based descriptive study of the awareness and use of 13 evidence-based interventions targeted health workers providing reproductive health care. Their awareness and use of a composite of four vital interventions was also evaluated. These were peripartum use of antiretrovirals to prevent transmission of HIV, antenatal corticosteroid administration, magnesium sulfate prophylaxis and active management of placental delivery with uterotonics. In-depth interviews with key informants were conducted as part of a qualitative substudy to discover the barriers to the use of evidence-based interventions. FINDINGS: Overall, 91.4% (328/359) of reproductive health workers were surveyed. Their awareness of evidence-based interventions varied from 29% for the use of antenatal corticosteroids to 97% for the use of iron and folic acid supplementation during pregnancy. Their use of these interventions ranged from 10.2% for antenatal corticosteroids to 94.8% for iron and folic acid supplementation. Only 50/322 (15.5%; 95% confidence interval (CI)=11.8-20.0) of health workers were aware of all four vital interventions, and only 12/312 (3.8%; 95% CI=2.0- 6.6) reported using all of them regularly. A total of 26 key informants participated in the qualitative substudy. A deficiency in the education and training of health workers, especially a lack of continuing education, was commonly identified as the most important barrier to their awareness of evidence-based practices. A lack of awareness and a lack of supplies and materials were the main barriers to practice. CONCLUSION: The awareness and practice of important evidence-based reproductive health interventions were less than optimal. To improve maternal and perinatal outcomes both remedial programmes to enhance awareness, including continuing education for health workers, and the provision of necessary supplies are needed.
Asunto(s)
Medicina Basada en la Evidencia , Pautas de la Práctica en Medicina , Complicaciones del Embarazo/prevención & control , Atención Prenatal/normas , Medicina Reproductiva/normas , Corticoesteroides/uso terapéutico , Camerún , Competencia Clínica , Suplementos Dietéticos/estadística & datos numéricos , Femenino , Ácido Fólico/uso terapéutico , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Humanos , Compuestos de Hierro/uso terapéutico , Población , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Encuestas y CuestionariosRESUMEN
We report community-based development of reproductive health indicators for China's rural areas. To generate these indicators, we sequenced two participatory techniques known as nominal group process and Delphi survey methodology. Nominal group process entailed grassroots reproductive health workers' generating indicators, followed by refinement and prioritization of these indicators through a consensus-building Delphi process among nationally and internationally known reproductive health experts. Major criteria for the indicators were practicality, feasibility, and measurability within China's rural areas. We explain the importance of establishing these indicators for application in rural China and other developing countries as a complement to the World Health Organization's reproductive health indicators for global monitoring; present the identified indicators; and describe lessons learned from field testing in low-, middle-, and high-income counties of China's countryside.
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Indicadores de Salud , Bienestar Materno/clasificación , Medicina Reproductiva/normas , Salud Rural , Salud de la Mujer , Adulto , Tasa de Natalidad , China/epidemiología , Técnica Delphi , Países en Desarrollo , Femenino , Fertilidad , Salud Holística , Humanos , Mortalidad Infantil , Recién Nacido , Mortalidad Materna , Bienestar Materno/estadística & datos numéricos , Embarazo , Derechos de la Mujer , Organización Mundial de la SaludRESUMEN
Qualitative research was carried out in central Mali to inform the development of curricula for an intervention to improve young people's reproductive health. Both the young people and 'societal gatekeepers' (including religious leaders and traditional healers) perceived reproductive health to comprise the social dynamics in which reproductive health decision-making is embedded and not just the biological aspects of sexual relations and fertility. Their definitions of reproductive health reflected social taboos about pre-marital sex, infidelity and illegitimate children, and comprised holistic notions of bodily and spiritual cleanliness. It is argued that the 'Cairo' definition sees many of the social factors identified by respondents as comprising the context or background of reproductive health. The findings presented here indicate that local populations may see them as integral to the concept itself. It is discussed how the 'Cairo' definition of reproductive health needs to be made culturally specific in order to facilitate programme design and implementation.
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Servicios de Salud Comunitaria/organización & administración , Servicios de Planificación Familiar/normas , Necesidades y Demandas de Servicios de Salud , Medicina Reproductiva/normas , Educación Sexual/organización & administración , Adolescente , Adulto , Características Culturales , Países en Desarrollo , Servicios de Planificación Familiar/tendencias , Femenino , Educación en Salud/organización & administración , Humanos , Masculino , Malí , Investigación Cualitativa , Medicina Reproductiva/educación , Medicina Reproductiva/tendencias , Características de la Residencia , Sexo Seguro , Conducta SexualAsunto(s)
Derechos Humanos , Medicina Reproductiva/normas , Salud de la Mujer , Ética Médica , Femenino , Salud Global , Humanos , Partería/normas , Embarazo , Factores SexualesRESUMEN
OBJECTIVE: To describe the work of the Scottish Programme for Clinical Effectiveness in Reproductive Health (SPCERH) in order to draw lessons applicable to other clinical effectiveness programmes. DESIGN: Overview of an integrated clinical effectiveness programme relating to reproductive health. SETTING: Scotland. SUBJECTS: The programme is designed to reach all professionals who share responsibility for reproductive healthcare--including obstetrician/gynaecologists, midwives, general practitioners, family planning doctors, commissioners of services and NHS managers. RESULTS: During its first three-year Workplan, SPCERH has conducted an integrated programme of audit, guideline and educational activities. Findings have been disseminated using multi-faceted approaches including publications, presentations and interactive meetings. Evidence from surveys undertaken within the Programme indicates that clinicians have changed or reconsidered their practice in several key areas in response to audit and guideline recommendations made by the Programme. CONCLUSIONS: As a way of funding and organising clinical effectiveness activities, the integrated Programme has many advantages over the stand-alone Project. These advantages include: enabling the linkage of national audits to national guidelines and other forms of NHS guidance; enabling the re-audit of topics after a time interval sufficient to allow for the implementation of change; the building of expertise within a dedicated team and the use of that expertise across a range of linked projects; the availability of an experienced team which can respond to new priority issues at short notice.
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Obstetricia/normas , Guías de Práctica Clínica como Asunto , Desarrollo de Programa , Medicina Reproductiva/normas , Medicina Estatal/organización & administración , Servicios de Planificación Familiar/normas , Medicina Familiar y Comunitaria/normas , Femenino , Guías como Asunto , Investigación sobre Servicios de Salud , Humanos , Masculino , Auditoría Médica , Partería/normas , Obstetricia/educación , Grupo de Atención al Paciente , Medicina Reproductiva/educación , Escocia , Medicina Estatal/normasAsunto(s)
Prestación Integrada de Atención de Salud/normas , Guías como Asunto , Hospitales/normas , Planificación en Desastres/normas , Suministros de Energía Eléctrica/normas , Joint Commission on Accreditation of Healthcare Organizations , Rehabilitación/normas , Medicina Reproductiva/normas , Estados Unidos , Revisión de Utilización de Recursos/normasRESUMEN
The role the midwives play in women's healthcare in Chile demonstrates appropriate utilization of human resources according to their capacity to provide services. Historically, the Chilean midwife came into being more than 160 years ago, exclusively as a birth attendant. The midwives' functions have evolved, particularly during the last few decades, following the demographic and epidemiological evolution of the Chilean population and the new paradigm of healthcare addressed to woman throughout her life cycle, not only during pregnancy and childbirth. At the present time, the midwife is the professional that provides the great majority of gynecological and obstetrics care at the primary healthcare level, while also attending most of the deliveries in the public health services. The close link with physicians working as a team, and the emotional ties of the midwife as a provider with the woman as a client, is emphasized as an additional advantage of the presence of the midwife as a key person in women's healthcare.