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Postpartum Inpatient Management

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101. Safe midwifery staffing for maternity settings

complications (e.g. managing fetal distress, complicated birth) Managing Managing complications complications (e.g. postpartum haemorrhage, difficulty establishing infant feeding) Additional time for the following: Additional time for the following: Consider Consideration of preferred ation of preferred place of birth place of birth (e.g. home birth) Pro Providing care for women viding care for women needing specialist input needing specialist input ( (e.g.female genital mutilation) Managing specific (...) and free-standing). It aims to improve maternity care by giving advice on monitoring staffing levels and actions to take if there are not enough midwives to meet the needs of women and babies in the service. Who is it for? Midwives and other healthcare professionals Hospital managers and service managers Heads and directors of nursing and midwifery Commissioners, trust boards and policy decision-makers Women and babies who use maternity services Other national documents There are other national

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

103. Intrapartum care for healthy women and babies

1.16 Care of the woman after birth 74 Putting this guideline into practice 80 Context 82 More information 83 Recommendations for research 84 1 Models of midwifery-led care 84 2 Effect of information giving on place of birth 84 3 Long-term consequences of planning birth in different settings 85 4 Education about the latent first stage of labour 85 5 Postpartum haemorrhage 86 Appendix A: Adverse outcomes 87 Intrapartum care for healthy women and babies (CG190) © NICE 2019. All rights reserved (...) %) 585 (13.3%) Meconium staining 432 (12.2%) 301 (12.2%) 538 (12.2%) Retained placenta 250 (7.0%) 179 (7.3%) 203 (4.6%) Repair of perineal trauma 386 (10.9%) 184 (7.5%) 369 (8.4%) Neonatal concerns (postpartum) 180 (5.1%) 63 (2.6%) 5 (0.0%) Other 711 (20.1%) 396 (16.2%) 676 (16.3%) * Main reason for transfer to an obstetric unit for each woman (there may be more than 1 reason). 1.1.8 If further discussion is wanted by either the midwife or the woman about the choice of planned place of birth, arrange

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

104. The Association of Coloproctology of Great Britain and Ireland Consensus Guidelines in Surgery for Inflammatory Bowel Disease

friends and colleagues. Copy URL Share a link - there are areas of practice that are not covered in detail. The British Society of Gastroenterology (BSG) have taken the view that there should be an expanded and updated version of the guidelines for medical management that is particularly relevant to a UK audience. These BSG guidelines will have some input from the surgical community but there was an opportunity to expand the surgical component. The Inflammatory Bowel Disease (IBD) Clinical Advisory (...) Group of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) have therefore commissioned a set of guidelines focusing specifically on surgery for adults and adolescents with IBD. The guidelines are procedure‐based and are intended to dovetail with the BSG's comprehensive medically focused guidelines. The primary objective here is to provide detailed evidence‐based guidelines on the surgical management of IBD for the target audience of colorectal surgeons practising in Great

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2018 Association of Coloproctology of Great Britain and Ireland

105. Better Mental Health for All: A Public Health Approach to Mental Health Improvement

and the three shortlisted award entries from Torbay, Motherwell and Somerset who agreed to be interviewed on film about their work. Liz Skinner project managed the delivery of this report. Professor Simon Capewell (FPH’s Vice President for Policy), Professor Chris Packham (Chair of FPH’s Health Services Committee) and members of the FPH’s Health Policy and Advocacy Committee acted as reviewers and suggested additional content. Suggested Citation Better Mental Health for All: A Public Health Approach (...) and less therapeutic and more custodial institutions. It was against this background that the therapeutic optimism of the post Second World War, twenty first century phase began, following the discovery of antidepressants and major tranquillisers which revolutionised the management of the major psychoses. However, this was oversold and the resources for proper community care were never forthcoming. We have witnessed a mental health service in increasing disarray, unable to deliver for children

2016 Faculty of Public Health

106. 10 priorities for integrating physical and mental health

and five times more unplanned inpatient admissions than a matched control group drawn from the general population. Eighty per cent of these admissions were for physical rather than mental health problems. While this cannot be attributed to shortcomings in primary care exclusively, effective primary care will be critical in addressing these inequalities. What would a more integrated approach look like? Responsibility for monitoring and managing the physical health of people with severe mental illnesses (...) as a predictive factor for longer hospital stays and higher institutionalisation rates. Patients with dementia often experience delays in discharge, even when there is no substantive medical reason for delay. There is evidence linking untreated or under-treated mental health problems among general hospital inpatients to higher rates of re-attendance at A&E after discharge. Self-harm accounts for more than 150,000 A&E attendances per year in England and can require significant staff time to manage. What would

2016 The King's Fund

107. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

School of Medicine, Internal Medicine, Endocrinology, Pediatrics, Pediatric Endocrinology, New Haven, Connecticut; 7 Walter Reed National Military Medical Center, Diabetes Obesity & Metabolic Institute, Bethesda, Maryland; 8 Assistant Clinical Professor, Mount Sinai School of Medicine, NY, ProHealth Care Associates, Division of Endocrinology, Lake Success, New York; 9 Center for Weight Management, Division of Endocrinology, Diabetes and Metabolism, Scripps Clinic, San Diego, California. Address (...) citations used in this CPG, 524 (29.3%) were based on strong (evidence level [EL] 1), 605 (33.8%) were based on intermediate (EL 2), and 308 (17.2%) were based on weak (EL 3) scientific studies, with 353 (19.7%) based on reviews and opinions (EL 4). Conclusion: The final recommendations recognize that obesity is a complex, adiposity-based chronic disease, where management targets both weight-related complica- tions and adiposity to improve overall health and quality of life. The detailed evidence-based

2016 American Association of Clinical Endocrinologists

108. Expert Opinion on neuraminidase inhibitors for prevention and treatment of influenza (Feb 2016)

all ILI cases, including cases not confirmed in laboratory. Intention to treat - infected Analysis of only laboratory -confirmed, influenza-infected participants of influenza trials. Isolation The separation of infected persons to prevent transmission to susceptible ones. Isolation refers to separation of ill persons; quarantine refers to separation of potentially exposed but well persons. Long-term care facility Health care facility for inpatients that require a long term stay. Morbidity Disease

2016 European Centre for Disease Prevention and Control - Expert Opinion

109. Guideline supplement: Hypertensive disorders of pregnancy

practice management during pregnancy, labour and postpartum 2.3 Clinical questions The following clinical questions were generated to inform the guideline scope and purpose: • How is hypertension in pregnancy classified and described? • How is preeclampsia diagnosed? • What measures reduce risks of HDP or limit disease progression (if any)? • What is considered best practice management with regard to: o Initial investigations o Target BP o Antihypertensive therapy o Model of care o Antenatal (...) surveillance • What is best practice management with regard to planning birth and intrapartum and postpartum care? • What are the longer term consequences of HDP? 2.4 Exclusions The following exclusions were identified in the guideline scope: • Management of anaesthesia • Routine antenatal, intrapartum and postpartum care Queensland Clinical Guideline Supplement: Hypertensive disorders of pregnancy Refer to online version, destroy printed copies after use Page 5 of 13 2.5 Search strategy A search

2016 Queensland Health

110. Maternity shared care

into account individual circumstances, may be appropriate. This document does not address all elements of standard practice and accepts that individual clinicians are responsible for: • Providing care within the context of locally available resources, expertise, and scope of practice • Supporting consumer rights and informed decision making in partnership with healthcare practitioners, including the right to decline intervention or ongoing management • Advising consumers of their choices in an environment (...) /teleconference if necessary) • Document inpatient care provided during the antenatal, intrapartum and postnatal period Labour and birth • Care of the woman and baby during labour and birth • The PMC may or may not be involved Discharge summary • Provide a discharge summary to the PMC preferably within 5 days of birth to enable prompt and appropriate follow up (and to the GP if the GP is not the PMC) and where appropriate, the community child health service • Offer a copy of the PHR and the discharge summary

2016 Queensland Health

111. Perinatal substance use: maternal

assessment • Consider anaesthetic review in third trimester to discuss: o Optimum modes of analgesia for labour, birth and postpartum o Venous access • Potential crisis situations 34 Late presentations 34 • Women presenting for the first time in third trimester or labour are at increased risk of pregnancy complications due to inadequate antenatal care • Preferred management: o Admit to hospital (regardless of drugs used) o Undertake comprehensive assessment including history of drug and alcohol use o (...) from the guideline, taking into account individual circumstances may be appropriate. This guideline does not address all elements of standard practice and accepts that individual clinicians are responsible for: • Providing care within the context of locally available resources, expertise, and scope of practice • Supporting consumer rights and informed decision making in partnership with healthcare practitioners including the right to decline intervention or ongoing management • Advising consumers

2016 Queensland Health

112. Hypertensive disorders of pregnancy

risk factor for venous thromboembolism (VTE) occurring in pregnancy or the puerperium 1 • Refer to the Queensland Clinical Guideline VTE prophylaxis in pregnancy and the puerperium 27 Fluid management • Administration of large volumes of intravenous fluids before or after birth may cause pulmonary oedema or worsen peripheral oedema 1 • In the immediate postpartum period, oliguria is common and physiological and does not require fluid therapy unless the serum plasma creatinine is rising • Strict (...) be appropriate. This guideline does not address all elements of standard practice and accepts that individual clinicians are responsible for: • Providing care within the context of locally available resources, expertise, and scope of practice • Supporting consumer rights and informed decision making in partnership with healthcare practitioners including the right to decline intervention or ongoing management • Advising consumers of their choices in an environment that is culturally appropriate and which

2016 Queensland Health

113. Diagnosis of Right Lower Quadrant Pain and Suspected Acute Appendicitis

must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their role as end-users, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any conflicts of interest. The list of Key Informants who provided input to this report follows: Anthony Chow, M.D. Division of Infectious Diseases University of British Columbia Vancouver Hospital Vancouver, BC (...) business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. The list of Technical Experts who provided input to this report follows: Anthony Chow, M.D. Division of Infectious Diseases University of British Columbia Vancouver Hospital Vancouver, BC, Canada Tyler Hughes, M.D. McPherson Hospital McPherson

2016 Effective Health Care Program (AHRQ)

114. Collaboration in Practice: Implementing Team-Based Care

Medicare beneficiary visits two primary care providers and five specialists per year, as well as health care providers of diagnostic, pharmacy, and other services. This figure is several times larger for x Introduction people with multiple chronic conditions (4). In order to manage large amounts of information and multiple handoffs, seamless communication and transitions among health care providers (within a team or among teams) are required to support wellness and care for patients with complex health (...) to function to the full extent of their education, certification, and experience. In order to manage large amounts of information and multiple handoffs, seamless communication and transitions among health care providers (within a team or among teams) are required to support wellness and to care for patients with complex health conditions. These transitions require a shift to interprofessional collaboration that entail a necessary evolution away from single-provider care to a team-based approach, which

2016 American College of Obstetricians and Gynecologists

115. Clinical Challenges of Long-Acting Reversible Contraceptive Methods

gynecologic care provider, postpartum insertion, breastfeeding, and extreme anteflexion or retroflexion of the uterus ( ). A perforated IUD may be free floating in the abdomen or pelvis, encased in adhesions, or adherent to bowel or omentum. The most common management strategy for uterine perforation, recommended by the World Health Organization, is surgical removal preceded by ruling out pregnancy and initiating emergency oral contraception and alternative contraception. Laparoscopic surgery is preferred (...) fails to improve clinically after 48–72 hours, antibiotics should be continued and IUD removal considered (28). Tuboovarian Abscess The CDC does not make recommendations about the management of tuboovarian abscess in a woman with an IUD. There is little evidence on this topic. Current management protocols include inpatient treatment with intravenous antibiotics for tuboovarian abscess with consideration of IUD removal if no clinical improvement. Vaginosis The relationship between bacterial vaginosis

2016 American College of Obstetricians and Gynecologists

116. The Obstetric and Gynecologic Hospitalist

, to admitting and providing the full spectrum of labor and delivery and postpartum care for some or all obstetric patients. Depending on the hospital, ob-gyn hospitalists may directly supervise and teach residents and students; provide surgical and consultative support to certified nurse–midwives, certified midwives, and family physicians; or manage unassigned patients in the emergency department or medical floors. Other responsibilities may include assisting in cesarean or multiples’ deliveries, providing (...) coverage for precipitous births, managing obstetric emergencies such as postpartum hemorrhage, and providing coverage for obstetrician–gynecologists during scheduled clinic hours. The ob-gyn hospitalists also may provide assistance for scheduled operative cases and could support fatigued ob-gyn physicians. The ob-gyn hospitalists also may work with nursing leadership to ensure effective resource use and to monitor quality metrics, such as elective delivery before 39 weeks of gestation. It is estimated

2016 American College of Obstetricians and Gynecologists

117. Smoking: acute, maternity and mental health services

is the basis of QS82 and QS43. Ov Overview erview This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes smokefree policies and services and recommends effective ways to help people stop smoking or to abstain from smoking while using or working in secondary care settings. Who is it for? Health and social care professionals, including clinical leads in secondary care services and managers of clinical services Commissioners, leaders of the local (...) health and care system and Trust boards Estate managers and other managers People using secondary care services and their families and carers Smoking: acute, maternity and mental health services (PH48) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5 of 66Introduction: scope and purpose of this guidance Introduction: scope and purpose of this guidance What is this guidance about? The guidance supersedes

2013 National Institute for Health and Clinical Excellence - Clinical Guidelines

118. #UnderstandingPsychosis?

of interest’ then that’s clearly nonsense as they are both invested in promulgating psychiatry’s hegemony . Secondly, the entire review is carried on psychiatries terms, i.e. its entirely positivist. The belief that investigations into humans where they are both object and subject can be objective is naive at best and delusional at worst. Thirdly (and most damningly) they are failing to see the wood for the trees. The fact is psychiatry has failed in managing and curing mental illness long term (...) experience).” – Exposing dangerous dogma – 4.1 The UP&S document had no mention of an important condition called postpartum psychosis. The facts of this condition are as follows. It occurs in about 1 in 1000 pregnancies. Women with bipolar disorder have a very high risk of postpartum psychosis, with over 60% being affected if un-medicated. Postpartum psychosis can be very severe and escalates quickly. About 40-50% of mothers will have delusions regarding their baby. In about 4% of cases

2017 The Mental Elf

119. Evidence-based guidelines for treating bipolar disorder

after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use (...) alongside NICE 2014 Bipolar Disorder: Assessment and Management (NICE2014) (https:// www.nice.org.uk/guidance/cg185), the recommendations from which are in places compared with our own. The quality of the evidence base Evidence categories (I to IV) traditionally imply a hierarchy from the best evidence, based on high-quality randomized trials, to the weakest, based on opinion/clinical impression (Shekelle et al., 1999). This approach explicitly downgrades non-experimental descriptive studies

2016 British Association for Psychopharmacology

120. Birth after Previous Caesarean Birth

is 72–75%. What factors determine the individualised likelihood of VBAC success? Women with one or more previous vaginal births should be informed that previous vaginal delivery, particularly previous VBAC, is the single best predictor of successful VBAC and is associated with a planned VBAC success rate of 85–90%. Previous vaginal delivery is also independently associated with a reduced risk of uterine rupture. Intrapartum management of planned VBAC What delivery setting is appropriate (...) incision in women undergoing ERCS. [New 2015] All women undergoing ERCS should receive thromboprophylaxis according to existing RCOG guidelines. [New 2015] Early recognition of placenta praevia, adopting a multidisciplinary approach and informed consent are important considerations in the management of women with placenta praevia and previous caesarean delivery. [New 2015] How should women in special circumstances be cared for? Clinicians should be aware that there is uncertainty about the safety

2015 Royal College of Obstetricians and Gynaecologists

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