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Crossing the Quality Chasm: A New Health System for the 21st Century

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

Medicare: A Strategy for Quality Assurance: Volume 1

Health care for the elderly American is among our nation's more pressing social issues. Our society wishes to ensure quality health care for all older people, but there is growing concern about our ability to maintain and improve quality in the face of efforts to contain health care costs. Medicare: A Strategy for Quality Assurance answers the U.S. Congress' call for the Institute of Medicine to design a strategic plan for assessing and assuring the quality of medical care for the elderly. This book presents a proposed strategic plan for improving quality assurance in the Medicare program, along with steps and timetables for implementing the plan by the year 2000 and the 10 recommendations for action by Congress. The book explores quality of care--how it is defined, measured, and improved--and reviews different types of quality problems. Major issues that affect approaches to assessing and assuring quality are examined. Medicare: A Strategy for Quality Assurance will be immediately useful to a wide audience, including policymakers, health administrators, individual providers, specialists in issues of the older American, researchers, educators, and students.

Política Nacional de Atenção Integral à Saúde da Criança (PNAISC): orientações …

Esta publicação tem a finalidade de ofertar aos gestores, aos trabalhadores e à sociedade civil subsídios teórico-práticos para a efetivação de mudanças no modelo de gestão e atenção à saúde da criança no Brasil, tendo como referência a Política Nacional de Atenção Integral à Saúde da Criança (Pnaisc).

Recomendaciones sobre prácticas seleccionadas para el uso de anticonceptivos

Organización Mundial de la Salud, Departamento de Salud Reproductiva e Investigaciones Conexas. Recomendaciones sobre prácticas seleccionadas para el uso de anticonceptivos -Tercera edición, 2018. Este documento es parte del proceso para mejorar la calidad de la atención en la planificación familiar. En términos específicos, se trata de uno de dos pilares basados en la evidencia (documentos orientativos) que forman parte de la iniciativa de la Organización Mundial de la Salud (OMS) para elaborar e implementar guías de planificación familiar destinadas a programas de alcance nacional. El primer pilar, los Criterios médicos de elegibilidad para el uso de anticonceptivos (CME, ya en su quinta edición), ofrece información y orientación exhaustivas sobre la seguridad de diversos métodos anticonceptivos para el uso en el contexto de condiciones médicas y características específicas. El presente documento, (RPS, 3.ª edición), constituye el segundo pilar. Proporciona orientación sobre cómo usar los métodos anticonceptivos de manera segura y eficaz una vez que se los considera adecuados desde el punto de vista médico. En el caso de las recomendaciones emitidas en las RPS, las consideraciones de seguridad incluyen las barreras frecuentes que impiden el uso seguro, correcto y consistente de los métodos anticonceptivos y las ventajas de evitar embarazos no deseados o no planeados.

Manual de Anticoncepção

Finotti, Marta. Manual de anticoncepção. -- São Paulo: Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO), 2015. Anticoncepção corresponde ao uso de métodos e técnicas com a finalidade de impedir que o relacionamento sexual resulte em gravidez. É recurso de Planejamento Familiar, para a constituição de prole desejada e programada de forma consciente. Os métodos anticoncepcionais podem ser classificados de várias maneiras. Reconhecem-se dois grupos principais: I - Reversíveis.II - Definitivos.Os métodos reversíveis são:1 - Comportamentais.2 - De barreira.3 - Dispositivos intrauterinos.4 - Hormonais.5 - De emergência.Os métodos definitivos são os cirúrgicos:1 - Esterilização cirúrgica feminina.2 - Esterilização cirúrgica masculina.

Relaxation techniques for pain management in labour

Smith CA, Levett KM, Collins CT, Armour M, Dahlen HG, Suganuma M. Relaxation techniques for pain management in labour. Cochrane Database Syst Rev. 2018 Mar 28;3:CD009514. doi: 10.1002/14651858.CD009514.pub2. Review. PubMed PMID: 29589650.Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute to the popularity of complementary methods of pain management. This review examined currently available evidence on the use of relaxation therapies for pain management in labour. This is an update of a review first published in 2011.To examine the effects of mind-body relaxation techniques for pain management in labour on maternal and neonatal well-being during and after labour.Relaxation, yoga and music may have a role with reducing pain, and increasing satisfaction with pain relief, although the quality of evidence varies between very low to low. There was insufficient evidence for the role of mindfulness and audio-analgesia. The majority of trials did not report on the safety of the interventions. Further randomised controlled trials of relaxation modalities for pain management in labour are needed. Trials should be adequately powered and include clinically relevant outcomes such as those described in this review.

Update on Nonpharmacologic Approaches to Relieve Labor Pain…

Simkin P, Bolding A. Update on nonpharmacologic approaches to relieve labor pain and prevent suffering. J Midwifery Womens Health. 2004 Nov-Dec;49(6):489-504. Review. PubMed PMID: 15544978. The control of labor pain and prevention of suffering are major concerns of clinicians and their clients. Nonpharmacologic approaches toward these goals are consistent with midwifery management and the choices of many women. We undertook a literature search of scientific articles cataloged in CINAHL, PUBMED, the Cochrane Library, and AMED databases relating to the effectiveness of 13 non-pharmacologic methods used to relieve pain and reduce suffering in labor. Suffering, which is different from pain, is not an outcome that is usually measured after childbirth. We assumed that suffering is unlikely if indicators of satisfaction were positive after childbirth. Adequate evidence of benefit in reducing pain exists for continuous labor support, baths, intradermal water blocks, and maternal movement and positioning. Acupuncture, massage, transcutaneous electrical nerve stimulation, and hypnosis are promising, but they require further study. The effectiveness of childbirth education, relaxation and breathing, heat and cold, acupressure, hypnosis, aromatherapy, music, and audioanalgesia are either inadequately studied or findings are too variable to draw conclusions on effectiveness. All the methods studied had evidence of widespread satisfaction among a majority of users.

The Pain and Discomfort of Labor and Birth

Lowe NK. The pain and discomfort of labor and birth. J Obstet Gynecol Neonatal Nurs. 1996 Jan;25(1):82-92. Review. PubMed PMID: 8627407. One unique aspect of childbirth is the association of this physiologic process with pain and discomfort. However, the experience of pain during labor is not a simple reflection of the physiologic processes of parturition. Instead, labor pain is the result of a complex and subjective interaction of multiple physiologic and psychological factors on a woman's individual interpretation of labor stimuli. An understanding of labor pain in a multidimensional framework provides the basis for a woman-centered approach to labor pain management that includes a broad range of pharmacologic and nonpharmacologic intervention strategies.

A Cientificação do Amor

Odent, Michel. A Cientificação do amor, 2ªedição, Florianópolis: Saint Germain, 2002. Michel Odent é um pesquisador da história do nascimento e das necessidades básicas da mãe e do bebê. Em 'A Cientificação do Amor', Odent questiona tudo o que se faz atualmente na sociedade moderna em relação aos cuidados na gestação e parto. As questões da dor e do apego entre mãe e filho são comparadas com o comportamento dos animais. Discute as intervenções médicas provocando o efeito 'nocebo', neologismo para designar os prejuízos de algumas condutas médicas. Neste livro, comenta o uso de drogas durante o parto; enumera os hormônios que participam do nascimento trazendo resultados recentes de pesquisas, para supor, de forma surpreendente, novas atribuições à ocitocina. O livro contém teses a respeito da fisiologia do amor valorizando os primeiros momentos da vida como sendo capazes de interferir permanentemente na nossa capacidade de amar. Ele afirma que o protótipo de todos os relacionamentos está nesta relação que se tem com a mãe desde o nascimento.

O Cuidado em Enfermagem Materna

PIOTROWSKI, K. A. Cuidado de Enfermagem durante o parto e nascimento. In: LOWDERMILK, D.L.; PERRY, S. E.; BOBAK, I. M. O cuidado em enfermagem materna, 5. ed. Porto Alegre: Artmed Editora, 2002. O cuidado em enfermagem materna, 5ª edição, aborda o atendimento da mulher durante seus anos reprodutivos. Os temas e as preocupações com o nascimento dos filhos, incluindo o cuidado neonatal, são o enfoque principal, mas a promoção da saúde e o controle dos problemas comuns de saúde da mulher também são abordados. O profissional de enfermagem deve ser capaz de combinar a competência com o carinho e o pensamento crítico, abordando as necessidades fisiológicas e psicossociais das pacientes.O cuidado em enfermagem materna proporciona ao estudante o conhecimento e as habilidades necessários para que ele desenvolva essa competência, bem como sua capacidade de pensar criticamente e com isso atingir a sensibilidade exigida na enfermagem exercida com dedicação.

Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth

National Collaborating Centre for Women's and Children's Health (UK). Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth. London: RCOG Press; 2014 Dec. PubMed PMID: 25950072. This guideline covers the care of healthy women in labour at term (37–42 weeks of gestation). About 600 000 women give birth in England and Wales each year, of whom about 40% are having their first baby. Most of these women are healthy and have a straightforward pregnancy. Almost 90% of women will give birth to a single baby after 37 weeks of pregnancy with the baby presenting head first. Most women (about two-thirds) go into labour spontaneously. Thus the majority of women giving birth in the UK fall under the scope of this guideline.

Continuous support for women during childbirth

Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017 Jul 6;7:CD003766. doi: 10.1002/14651858.CD003766.pub6. Review. PubMed PMID: 28681500. Historically, women have generally been attended and supported by other women during labour. However, in hospitals worldwide, continuous support during labour has often become the exception rather than the routine.The primary objective was to assess the effects, on women and their babies, of continuous, one-to-one intrapartum support compared with usual care, in any setting. Secondary objectives were to determine whether the effects of continuous support are influenced by:1. Routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement and ability to cope with labour, including: policies about the presence of support people of the woman's own choosing; epidural analgesia; and continuous electronic fetal monitoring.2. The provider's relationship to the woman and to the facility: staff member of the facility (and thus has additional loyalties or responsibilities); not a staff member and not part of the woman's social network (present solely for the purpose of providing continuous support, e.g. a doula); or a person chosen by the woman from family members and friends;3. Timing of onset (early or later in labour);4. Model of support (support provided only around the time of childbirth or extended to include support during the antenatal and postpartum periods);5. Country income level (high-income compared to low- and middle-income).The primary objective was to assess the effects, on women and their babies, of continuous, one-to-one intrapartum support compared with usual care, in any setting. Secondary objectives were to determine whether the effects of continuous support are influenced by:1. Routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement and ability to cope with labour, including: policies about the presence of support people of the woman's own choosing; epidural analgesia; and continuous electronic fetal monitoring.2. The provider's relationship to the woman and to the facility: staff member of the facility (and thus has additional loyalties or responsibilities); not a staff member and not part of the woman's social network (present solely for the purpose of providing continuous support, e.g. a doula); or a person chosen by the woman from family members and friends;3. Timing of onset (early or later in labour);4. Model of support (support provided only around the time of childbirth or extended to include support during the antenatal and postpartum periods);5. Country income level (high-income compared to low- and middle-income).Continuous support during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labour, and decreased caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute Apgar score and negative feelings about childbirth experiences. We found no evidence of harms of continuous labour support. Subgroup analyses should be interpreted with caution, and considered as exploratory and hypothesis-generating, but evidence suggests continuous support with certain provider characteristics, in settings where epidural analgesia was not routinely available, in settings where women were not permitted to have companions of their choosing in labour, and in middle-income country settings, may have a favourable impact on outcomes such as caesarean birth. Future research on continuous support during labour could focus on longer-term outcomes (breastfeeding, mother-infant interactions, postpartum depression, self-esteem, difficulty mothering) and include more woman-centred outcomes in low-income settings.