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1.
Syst Rev ; 11(1): 121, 2022 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-35698213

RESUMO

BACKGROUND: Systematic reviews of outcome measurement instruments are important tools in the evidence-based selection of these instruments. COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) has developed a comprehensive and widespread guideline to conduct systematic reviews of outcome measurement instruments, but key information is often missing in published reviews. This hinders the appraisal of the quality of outcome measurement instruments, impacts the decisions of knowledge users regarding their appropriateness, and compromises reproducibility and interpretability of the reviews' findings. To facilitate sufficient, transparent, and consistent reporting of systematic reviews of outcome measurement instruments, an extension of the PRISMA (Preferred Reporting of Items for Systematic reviews and Meta-Analyses) 2020 guideline will be developed: the PRISMA-COSMIN guideline. METHODS: The PRISMA-COSMIN guideline will be developed in accordance with recommendations for reporting guideline development from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. First, a candidate reporting item list will be created through an environmental literature scan and expert consultations. Second, an international Delphi study will be conducted with systematic review authors, biostatisticians, epidemiologists, psychometricians/clinimetricians, reporting guideline developers, journal editors as well as patients, caregivers, and members of the public. Delphi panelists will rate candidate items for inclusion on a 5-point scale, suggest additional candidate items, and give feedback on item wording and comprehensibility. Third, the draft PRISMA-COSMIN guideline and user manual will be iteratively piloted by applying it to systematic reviews in several disease areas to assess its relevance, comprehensiveness, and comprehensibility, along with usability and user satisfaction. Fourth, a consensus meeting will be held to finalize the PRISMA-COSMIN guideline through roundtable discussions and voting. Last, a user manual will be developed and the final PRISMA-COSMIN guideline will be disseminated through publications, conferences, newsletters, and relevant websites. Additionally, relevant journals and organizations will be invited to endorse and implement PRISMA-COSMIN. Throughout the project, evaluations will take place to identify barriers and facilitators of involving patient/public partners and employing a virtual process. DISCUSSION: The PRISMA-COSMIN guideline will ensure that the reports of systematic reviews of outcome measurement instruments are complete and informative, enhancing their reproducibility, ease of use, and uptake.


Assuntos
Guias como Assunto , Pesquisadores , Revisões Sistemáticas como Assunto , Consenso , Humanos , Reprodutibilidade dos Testes
2.
Transpl Int ; 35: 10289, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35664428

RESUMO

Organ transplantation is performed worldwide, but policies regarding donor imaging are not uniform. An overview of the policies in different regions is missing. This study aims to investigate the various protocols worldwide on imaging in deceased organ donation. An online survey was created to determine the current policies. Competent authorities were approached to fill out the survey based on their current protocols. In total 32 of the 48 countries approached filled out the questionnaire (response rate 67%). In 16% of the countries no abdominal imaging is required prior to procurement. In 50%, abdominal ultrasound (US) is performed to screen the abdomen and in 19% an enhanced abdominal Computed Tomography (CT). In 15% of the countries both an unenhanced abdominal CT scan and abdominal US are performed. In 38% of the countries a chest radiographic (CXR) is performed to screen the thorax, in 28% only a chest CT, and in 34% both are performed. Policies regarding radiologic screening in deceased organ donors show a great variation between different countries. Consensus on which imaging method should be applied is missing. A uniform approach will contribute to quality and safety, justifying (inter)national exchange of organs.


Assuntos
Abdome , Obtenção de Tecidos e Órgãos , Abdome/diagnóstico por imagem , Consenso , Guias como Assunto , Humanos , Doadores de Tecidos , Tomografia Computadorizada por Raios X
3.
Expert Opin Pharmacother ; 23(8): 917-927, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35575510

RESUMO

INTRODUCTION: As of today, there is still a need to determine which COPD patients may benefit from ICS therapy, whether ICSs are useful in COPD patients without chronic bronchitis, and whether long-acting bronchodilators can reduce the risk of exacerbations in frequent exacerbators even if ICSs are not used, and whether combination therapy including ICSs is helpful in infrequent exacerbators to optimize the use of ICSs in COPD. AREAS COVERED: Herein, the authors provide an overview of use of ICS in COPD, discuss their value to the current treatment armamentarium and focus on emerged aspects on which there is no consensus. EXPERT OPINION: There is growing agreement on why, in whom, and when ICS therapy can be used in COPD, although the consensus is still lacking because of the heterogeneity of COPD. The use of BECs is only helpful in T2 inflammation, while there is a lack of biomarkers indicating the presence of T1 and T17 immunity, which is poorly responsive to ICS. Identifying ICS-sensitive endotypes using specific biomarkers that have yet to be identified and validated is likely to demonstrate that ICSs can influence the natural course of COPD in at least a subset of patients.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Administração por Inalação , Corticosteroides , Biomarcadores , Broncodilatadores , Quimioterapia Combinada , Guias como Assunto , Humanos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
4.
Expert Rev Med Devices ; 19(4): 315-325, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35579009

RESUMO

INTRODUCTION: Early Feasibility Studies (EFS) are among the pre-market clinical investigations allowed by the International Standard for Clinical investigation of medical devices (MD) for human subjects. The Food and Drug Administration (FDA) introduced an EFS program in the US in 2013. The European Union (EU) MD Regulation, that entered into force in May 2021, opened the possibility of EFS in the EU. However, European countries at present have no standardized procedural framework for EFS. In this paper, we address the desirability of a European EFS program. AREAS COVERED: Characteristics of EFS conducted so far are reviewed, and perceptions of an expert, multidisciplinary panel of key stakeholders are explored regarding desirability and feasibility of a European EFS program and critical factors favoring or hampering its implementation. EXPERT OPINION: Implementing an EFS program in the EU would contribute to creating a favorable environment for early-stage clinical investigations, with positive effects on the quality and timeliness of clinical evidence for novel MDs, and attractiveness of the European system for pre- and post-market clinical research. Based on discussion with experts, also leveraging on the US experience, three dimensions should be considered for effective design and implementation: process, resources, and ethical issues.


Assuntos
União Europeia , Europa (Continente) , Estudos de Viabilidade , Guias como Assunto , Humanos , Estados Unidos , United States Food and Drug Administration
5.
Inquiry ; 59: 469580221100348, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35611718

RESUMO

Due to the Irretrievable impacts of the COVID-19 pandemic on society, this study aimed to analyze the barriers and reasons for the Iranian people's implementation of public health measures during the COVID-19 pandemic in 2021. The study explores the barriers and reasons for non-compliance by Iranian people in following and maintaining the health guidelines to combat the spread of the coronavirus in 2021. This research is qualitative and recorded participants' feedback from the Ardabil province of Iran. The study used a purposeful sampling method and lasted from April to May 2021 to collect the data through semi-structured interviews with 45 participants based on their gender, education, employment status, and marital status. The researchers analyzed the qualitative content until the required data-target through interviews implementation. This study incorporated MAXQDA version 10 to analyze the data and followed Goba and Lincoln's criteria to ensure quality research results. After analyzing the data, two main categories (internal and external barriers) and seven subcategories were obtained. The internal barriers exhibited further classified subcategories, such as mental, belief, and awareness barriers. The results indicated that external barriers included social, political, managerial, and economic barriers. The study results designated that a set of internal and external factors might cause individuals' non-compliance with health guidelines and standard SOPs in the advent of the pandemic COVID-19. Recognition of such factors, identified following the social, cultural, and political context and individuals' characteristics during the COVID-19 outbreak, can be used effectively to plan educational and management programs. As a result, elimination and eradication of obstacles and the relevant dimensions may facilitate disease control. Moreover, the high prevalence and spread of the disease can be managed by reducing the influence of factors preventing proper health behaviors.


Assuntos
COVID-19 , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Fidelidade a Diretrizes , Guias como Assunto , Humanos , Irã (Geográfico) , Pandemias , Pesquisa Qualitativa , SARS-CoV-2
6.
J Korean Med Sci ; 37(20): e166, 2022 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-35607744

RESUMO

The appropriate plot effectively conveys the author's conclusions to the readers. Journal of Korean Medical Science (JKMS) will provide a series of special articles to show you how to make consistent and excellent plots more easily. In this article, we will cover pyramid charts. A pyramid chart is a simple yet popular tool for looking at the structure of a population by age and gender. Other variables can also be applied. This article helps researchers use these charts more easily by introducing effective tools and explaining how to use them.


Assuntos
Guias como Assunto , Manuscritos como Assunto , Humanos , Pesquisadores
7.
Prensa méd. argent ; 108(3): 136-145, 20220000. fig
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1373083

RESUMO

Introducción: la Pandemia por SARS CoV ­ 2 (COVID ­ 19) tuvo un impacto significativo en el desarrollo de los servicios quirúrgicos en general y obligo a establecer protocolos de actuación para las distintas patologías a fin de cuidar al máximo los recursos humanos y la capacidad instalada de los hospitales para hacer frente a esta contingencia mundial. Objetivos: presentar una casuística de 7 pacientes con reconstrucción microquirúrgica de patología de cabeza y cuello en estadios avanzados y patología de miembros inferiores durante la pandemia por COVID - 19. Materiales y Métodos: trabajo retrospectivo, se revisaron las historias clínicas físicas y digitales. Se incluyeron 5 pacientes con patología avanzada de cabeza y cuello y 2 pacientes con patología de miembros inferiores. Resultados: cinco pacientes fueron operados por patología avanzada de cabeza y cuello: 3 pacientes con carcinomas escamosos de cavidad oral estadio IVa, 1 paciente con carcinoma escamoso de piel avanzado estadio IV y 1 paciente con fractura compleja de maxilar inferior por herida de arma de fuego con fistula oro-cutánea crónica, con exposición del material de osteosíntesis, mala oclusión y pérdida de peso importante por dificultad para alimentación. Dos pacientes fueron operados por patología de miembros inferiores en tercio inferior de pierna, uno por fractura expuesta grave con defecto de tejidos blandos y el otro por una ulcera arterial. Conclusión: la cirugía reconstructiva microquirúrgica puede realizarse con buenos niveles de seguridad para el personal de salud y para los pacientes afectados por patologías avanzadas de cabeza y cuello y otras patologías que requieran colgajos libres. Es fundamental respetar estrictamente los protocolos para evitar los contagios en el medio intrahospitalario, entendiendo que debe considerarse todo paciente que ingrese al hospital como COVID (+) hasta que se demuestre lo contrario


Introduction: the SARS CoV ­ 2 (COVID ­ 19) Pandemic had a significant impact on the development of surgical services in general and forced the establishment of action protocols for the different pathologies in order to take maximum care of human resources and capacity. installed in hospitals to deal with this global contingency. Objectives: to present a casuistry of 7 patients with microsurgical reconstruction of head and neck pathology in advanced stages and lower limb pathology during the COVID - 19 pandemic. Materials and Methods: retrospective work, physical and digital medical records were reviewed. Five patients with advanced head and neck disease and 2 patients with lower limb disease were included. Results: five patients underwent surgery for advanced head and neck disease: 3 patients with stage IVa squamous cell carcinoma of the oral cavity, 1 patient with stage IV advanced squamous cell carcinoma of the skin, and 1 patient with a complex fracture of the lower jaw due to a gunshot wound. with chronic oro-cutaneous fistula, with exposure of the osteosynthesis material, poor occlusion and significant weight loss due to difficulty feeding. Two patients underwent surgery for pathology of the lower limbs in the lower third of the leg, one for a severe open fracture with a soft tissue defect and the other for an arterial ulcer. Conclusion: microsurgical reconstructive surgery can be performed with good levels of safety for health personnel and for patients affected by advanced pathologies of the head and neck and other pathologies that require free flaps. It is essential to strictly respect the protocols to avoid contagion in the hospital environment, understanding that every patient who enters the hospital must be considered as COVID (+) until proven otherwise.


Assuntos
Humanos , Medidas de Segurança/normas , Procedimentos Cirúrgicos Operatórios , Protocolos Clínicos , Guias como Assunto/prevenção & controle , Extremidade Inferior/cirurgia , Equipamento de Proteção Individual , COVID-19 , Cabeça/cirurgia , Pescoço/cirurgia
9.
World J Gastroenterol ; 28(16): 1608-1624, 2022 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-35581966

RESUMO

Supralevator, suprasphincteric, extrasphincteric, and high intrarectal fistulas (high fistulas in muscle layers of the rectal wall) are well-known high anal fistulas which are considered the most complex and extremely challenging fistulas to manage. Magnetic resonance imaging has brought more clarity to the pathophysiology of these fistulas. Along with these fistulas, a new type of complex fistula in high outersphincteric space, a fistula at the roof of ischiorectal fossa inside the levator ani muscle (RIFIL), has been described. The diagnosis, management, and prognosis of RIFIL fistulas is reported to be even worse than supralevator and suprasphincteric fistulas. There is a lot of confusion regarding the anatomy, diagnosis, and management of these five types of fistulas. The main reason for this is the paucity of literature about these fistulas. The common feature of all these fistulas is their complete involvement of the external anal sphincter. Therefore, fistulotomy, the simplest and most commonly performed procedure, is practically ruled out in these fistulas and a sphincter-saving procedure needs to be performed. Recent advances have provided new insights into the anatomy, radiological modalities, diagnosis, and management of these five types of high fistulas. These have been discussed and guidelines formulated for the diagnosis and treatment of these fistulas for the first time in this paper.


Assuntos
Fístula Retal , Canal Anal/diagnóstico por imagem , Canal Anal/patologia , Canal Anal/cirurgia , Guias como Assunto , Humanos , Diafragma da Pelve , Prognóstico , Fístula Retal/diagnóstico por imagem , Fístula Retal/etiologia , Reto/diagnóstico por imagem , Reto/patologia , Reto/cirurgia
10.
BMC Psychiatry ; 22(1): 228, 2022 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-35361184

RESUMO

BACKGROUND: People with substance use disorders may be at a greater risk of contracting COVID-19 infection and developing medical complications. Several institutional and governmental health agencies across the world developed ad hoc guidance for substance use disorder services and care of individuals misusing substances. We aimed to synthesise the best available recommendations on management and care of people with or at risk of substance use disorders during the COVID-19 pandemic from existing guidelines published in UK, USA, Australia, Canada, New Zealand, and Singapore. METHODS: We systematically searched existing guidelines and websites from 28 international institutions and governmental bodies in the context of the COVID-19 pandemic (May 4th 2021). We summarized the extracted data as answers to specific clinical questions. RESULTS: We organised the available recommendations from 19 sources in three sections. First, we focused on general advice and recommendations for people who misuse alcohol or drugs during the COVID-19 pandemic, the design of contingency plans, safeguarding issues for children and families of service users and advice to the public, patients, and carers. Then, we summarised specific guidelines for people who use illicit drugs and related services, such as opioid substitution treatment and needle and syringe programmes. Finally, we provided a synthesis on specific recommendations for services supporting people who misuse alcohol and key topics in the field, such as management of alcohol detoxification and safe transition between supervised and unsupervised consumption. CONCLUSIONS: Available guidance reflected different approaches, ranging from being extremely cautious in providing recommendations other than generic statements to proposing adaptation of previously available guidelines to confront the challenges of the COVID-19 pandemic. After the early phase, guidance focused on reduction of infection transmission and service delivery. Guidance did not provide advice on infection prevention via vaccination programmes and service access strategies tailored to individuals with substance use disorders.


Assuntos
Alcoolismo , COVID-19 , Transtornos Relacionados ao Uso de Substâncias , Alcoolismo/psicologia , Alcoolismo/terapia , Criança , Guias como Assunto , Pessoal de Saúde , Humanos , Pandemias , Transtornos Relacionados ao Uso de Substâncias/psicologia
11.
BMC Med Res Methodol ; 22(1): 89, 2022 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-35369859

RESUMO

BACKGROUND: Rapid Advice Guidelines (RAG) provide decision makers with guidance to respond to public health emergencies by developing evidence-based recommendations in a short period of time with a scientific and standardized approach. However, the experience from the development process of a RAG has so far not been systematically summarized. Therefore, our working group will take the experience of the development of the RAG for children with COVID-19 as an example to systematically explore the methodology, advantages, and challenges in the development of the RAG. We shall propose suggestions and reflections for future research, in order to provide a more detailed reference for future development of RAGs. RESULT: The development of the RAG by a group of 67 researchers from 11 countries took 50 days from the official commencement of the work (January 28, 2020) to submission (March 17, 2020). A total of 21 meetings were held with a total duration of 48 h (average 2.3 h per meeting) and an average of 16.5 participants attending. Only two of the ten recommendations were fully supported by direct evidence for COVID-19, three recommendations were supported by indirect evidence only, and the proportion of COVID-19 studies among the body of evidence in the remaining five recommendations ranged between 10 and 83%. Six of the ten recommendations used COVID-19 preprints as evidence support, and up to 50% of the studies with direct evidence on COVID-19 were preprints. CONCLUSIONS: In order to respond to public health emergencies, the development of RAG also requires a clear and transparent formulation process, usually using a large amount of indirect and non-peer-reviewed evidence to support the formation of recommendations. Strict following of the WHO RAG handbook does not only enhance the transparency and clarity of the guideline, but also can speed up the guideline development process, thereby saving time and labor costs.


Assuntos
COVID-19 , COVID-19/epidemiologia , Criança , Surtos de Doenças , Guias como Assunto , Humanos , Saúde Pública
13.
Can Fam Physician ; 68(3): 179-190, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35292455

RESUMO

OBJECTIVE: To develop a clinical practice guideline to support the management of chronic pain, including low back, osteoarthritic, and neuropathic pain in primary care. METHODS: The guideline was developed with an emphasis on best available evidence and shared decision-making principles. Ten health professionals (4 generalist family physicians, 1 pain management-focused family physician, 1 anesthesiologist, 1 physical therapist, 1 pharmacist, 1 nurse practitioner, and 1 psychologist), a patient representative, and a nonvoting pharmacist and guideline methodologist comprised the Guideline Committee. Member selection was based on profession, practice setting, and lack of financial conflicts of interest. The guideline process was iterative in identification of key questions, evidence review, and development of guideline recommendations. Three systematic reviews, including a total of 285 randomized controlled trials, were completed. Randomized controlled trials were included only if they reported a responder analysis (eg, how many patients achieved a 30% or greater reduction in pain). The committee directed an Evidence Team (composed of evidence experts) to address an additional 11 complementary questions. Key recommendations were derived through committee consensus. The guideline and shared decision-making tools underwent extensive review by clinicians and patients before publication. RECOMMENDATIONS: Physical activity is recommended as the foundation for managing osteoarthritis and chronic low back pain; evidence of benefit is unclear for neuropathic pain. Cognitive-behavioural therapy or mindfulness-based stress reduction are also suggested as options for managing chronic pain. Treatments for which there is clear, unclear, or no benefit are outlined for each condition. Treatments for which harms likely outweigh benefits for all or most conditions studied include opioids and cannabinoids. CONCLUSION: This guideline for the management of chronic pain, including osteoarthritis, low back pain, and neuropathic pain, highlights best available evidence including both benefits and harms for a number of treatment interventions. A strong recommendation for exercise as the primary treatment for chronic osteoarthritic and low back pain is made based on demonstrated long-term evidence of benefit. This information is intended to assist with, not dictate, shared decision making with patients.


Assuntos
Dor Crônica , Dor Lombar , Neuralgia , Dor Crônica/terapia , Guias como Assunto , Humanos , Dor Lombar/terapia , Neuralgia/terapia , Manejo da Dor , Atenção Primária à Saúde
14.
BMJ Open ; 12(3): e059040, 2022 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-35296489

RESUMO

INTRODUCTION: The German Guideline Program in Oncology (GGPO) has published patient versions of clinical practice guidelines for more than 10 years. However, a systematic evaluation of these is lacking. The project aims to investigate the role and applicability of patient versions by considering the perspectives of experts, patients and healthcare providers to derive recommendations for the development, dissemination and implementation of patient versions in Germany. METHODS AND ANALYSIS: The project comprises two main modules. In module 1, we will first obtain information on methods and approaches for the development, dissemination and implementation of patient versions by conducting systematic searches in Medline and screening the websites of guideline organisations. We will include any articles, such as methodological or empirical reports, published in German or English since 2000, that address methodological aspects related to patient versions. Further, we will conduct 20 interviews with experts from international and German organisations who are involved in the development of patient versions. In module 2, we will first conduct interviews to explore patients and healthcare providers' perceptions of patient versions of the GGPO. For the group of patients and the group of healthcare providers, we aim to conduct 25 interviews each. Second, we will conduct focus groups, separately for breast, prostate and colon cancer. The recruitment of participants for the interviews and focus groups will primarily be done through a previous survey about patient versions in oncology. The results will be used to derive recommendations for enhancing the development, dissemination and implementation of patient versions by involving the relevant stakeholder groups. ETHICS AND DISSEMINATION: Ethical approval for the qualitative parts of the project was given by the Ethics Committee of Witten/Herdecke University (number 160/2021). Participants will be required to provide informed consent. The project findings will be published in peer-reviewed journals and presented at scientific conferences.


Assuntos
Oncologia , Alemanha , Guias como Assunto , Humanos , Masculino , Educação de Pacientes como Assunto , Revisões Sistemáticas como Assunto
15.
Actual. SIDA. infectol ; 30(108): 28-41, 20220000. tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1363367

RESUMO

El objetivo de este estudio fue indagar sobre experiencias y percepciones del personal de salud (PDS) de la Argentina en la implementación de protocolos para su protección durante la pandemia por COVID-19. Se realizó una encuesta al PDS a nivel nacional, relevando datos sociodemográficos, de protocolos, recursos y aspectos psicosociales. Se analizaron 2010 encuestas. El 76,4% fueron mujeres, 43 años de edad media, 35% médicos/as y 72,7% del subsistema público. El 37,2% aumentó su carga horaria y el 22,5% presentaba algún factor de riesgo, de quienes 20,4% tuvo licencia o reasignación de tareas. Se establecieron protocolos sobre uso de equipos de protección personal (EPP) en 91% de las instituciones y otras temáticas en menor medida. La claridad de los mismos fue bien valorada y hubo entrenamiento en el 60,8% de los casos. La conformidad con la disponibilidad y calidad del EPP fue variable, con mejor valoración en el subsector privado. El 60,4% tuvo necesidad de obtener EPP por medios propios. El 48,4% de los encuestados siguió los protocolos de uso de EPP, variando según grupos de riesgo. El indicador global de valoración institucional fue 6,45/10 (IC 95% 6,38-6,53). El 87,2% del PDS dijo haber sentido angustia y esto se relacionó con peor comunicación con superiores y peor valoración institucional. De este estudio surgen dificultades en la implementación de los nuevos cuidados, y la necesidad de intensificar esfuerzos en recursos y organización institucional para mejorar las condiciones de trabajo.


During the COVID-19 pandemic, health personnel (HP) faced changes in their working conditions due to exposure to the virus and increased demand for attention. This study inquires on the experiences and perceptions of HP in Argentina about the implementation of protocols for their protection. A survey including information on sociodemographic characteristics, protocols, resources and psychological aspects was performed for HP all over the country. Two thousand and ten surveys were analyzed: 76.4% female, mean age 43 years old, 35% physician, 72.7% public institutions. Hours of work increased for 37.2%, 22.5% had at least one risk factor, of which 20.4% had leave or re-assigned tasks. Protocols about use of personal protective equipment (PPE) were established by 91% of institutions and less frequently about other topics. Clarity of protocols was well evaluated, and in 60.8% of cases trainament was performed. Approval about access and quality of PPE was variable, with better performance on private institutions. 60.4% of the HP had to obtain PPE by their own means. 48.4% of the participants followed protocols on PPE, being this variable according to groups of risk. The global index for institutional valuation was 6.45/10 (CI 95%, 6.38-6.53). HCP expressed fear or anxiety in 87.2% of the cases, and this was related to worse communication with superiors and worse institutional valuation. This study raises difficulties on the implementation of new protocols and the need to reinforce efforts on resources and institutional organization, to improve working conditions for HP


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Condições de Trabalho , Atitude do Pessoal de Saúde , Inquéritos e Questionários , Guias como Assunto/prevenção & controle , Equipamento de Proteção Individual , COVID-19/prevenção & controle , Acontecimentos que Mudam a Vida
16.
Lima; Perú. Ministerio de Salud; Mar. 2022. 61 p. ilus.
Monografia em Espanhol | MINSAPERÚ, MINSAPERÚ | ID: biblio-1359735

RESUMO

El documento contiene las directrices para impulsar las intervenciones estratégicas sectoriales, por curso de vida, en el cuidado integral, prevención, diagnóstico, tratamiento y control del sobrepeso y obesidad en el contexto de la COVID-19


Assuntos
Guias como Assunto , Diagnóstico , Sobrepeso , COVID-19 , Obesidade
19.
South Med J ; 115(2): 115, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35118498
20.
BMC Pregnancy Childbirth ; 22(1): 99, 2022 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-35120470

RESUMO

BACKGROUND: Current guidelines for second stage management do not provide guidance for community birth providers about when best to transfer women to hospital care for prolonged second stage. Our goal was to increase the evidence base for these providers by: 1) describing the lengths of second stage labor in freestanding birth centers, and 2) determining whether proportions of postpartum women and newborns experiencing complications change as length of second stage labor increases. METHODS: This study is a retrospective analysis of de-identified client-level data collected in the American Association of Birth Centers Perinatal Data Registry, including women giving birth in freestanding birth centers January 1, 2007 to December 31, 2016. We plotted proportions of postpartum women and newborns transferred to hospital care against length of the second stage of labor, and assessed significance of these with the Cochran-Armitage test for trend or chi-square test. Secondary maternal and newborn outcomes were compared for dyads with normal and prolonged second stages of labor using Fisher's exact test. RESULTS: Second stage labor exceeded 3 hours for 2.3% of primiparous women and 2 hours for 6.6% of multiparous women. Newborn transfers increased as second stage increased from < 15 minutes to > 2 hours (0.6% to 6.33%, p for trend = 0.0008, for primiparous women, and 1.4% to 10.6%, p for trend < 0.0001, for multiparous women.) Postpartum transfers for multiparous women increased from 1.4% after second stage < 15 minutes to greater than 4% for women after second stage exceeding 2 hours (p for trend < 0.0001.) CONCLUSIONS: Complications requiring hospitalization of postpartum women and newborns become more common as the length of the second stage increases. Birth center guidelines should consider not just presence of progress but also absolute length of time as indications for transfer.


Assuntos
Centros de Assistência à Gravidez e ao Parto/normas , Guias como Assunto/normas , Segunda Fase do Trabalho de Parto , Transferência de Pacientes/normas , Adulto , Feminino , Humanos , Recém-Nascido , Complicações do Trabalho de Parto/terapia , Período Pós-Parto , Gravidez , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos
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