A EQUIPE MULTIPROFISSIONAL E O DEBATE ACERCA DO ATENDIMENTO HUMANIZADO

The provision of health services permeates the interaction between professionals from different areas, highlighting the importance of the multidisciplinary team. Humanized care emerges as a crucial element in this context, aiming to provide a patient-centered approach, respecting their individuality and promoting comprehensive care. This study seeks to analyze the relationship between the performance of the multidisciplinary team and the implementation of humanized care, exploring the available literature to understand the practices, challenges and benefits associated with this approach in the healthcare setting. The methodology adopted consists of an integrative literature review, allowing a comprehensive analysis of relevant studies on the intersection between the multidisciplinary team and humanized care. The search and selection of articles were carried out systematically in scientific databases. The results reveal that the integrated action of the multidisciplinary team is essential to promote humanization in health care. The exchange of knowledge and collaboration between different professionals contribute to a more holistic and effective approach, meeting the physical, emotional and social needs of patients. Discussions address challenges faced by the multidisciplinary team, such as interdisciplinary communication and overcoming hierarchical barriers. Furthermore, the benefits of humanized care stand out, including greater patient satisfaction, improved adherence to treatment and strengthening of the therapeutic bond. This study highlights the importance of the multidisciplinary team in the context of humanized care, highlighting the need for policies and practices that encourage interdisciplinary collaboration. Promoting an organizational culture that values ​​humanization in care contributes to the quality and effectiveness of health services.A prestação de serviços de saúde permeia a interação entre profissionais de diversas áreas, destacando a importância da equipe multiprofissional. O atendimento humanizado emerge como um elemento crucial nesse contexto, visando proporcionar uma abordagem centrada no paciente, respeitando sua individualidade e promovendo a integralidade do cuidado. Este estudo busca analisar a relação entre a atuação da equipe multiprofissional e a implementação do atendimento humanizado, explorando a literatura disponível para compreender as práticas, desafios e benefícios associados a essa abordagem no cenário da saúde. A metodologia adotada consiste em uma revisão integrativa da literatura, permitindo a análise abrangente de estudos relevantes sobre a interseção entre a equipe multiprofissional e o atendimento humanizado. A busca e seleção dos artigos foram realizadas de forma sistemática em bases de dados científicas. Os resultados revelam que a atuação integrada da equipe multiprofissional é fundamental para promover a humanização no atendimento em saúde. A troca de conhecimentos e a colaboração entre diferentes profissionais contribuem para uma abordagem mais holística e eficaz, atendendo às necessidades físicas, emocionais e sociais dos pacientes. Discussões abordam desafios enfrentados pela equipe multiprofissional, como a comunicação interdisciplinar e a superação de barreiras hierárquicas. Além disso, destacam-se os benefícios do atendimento humanizado, incluindo maior satisfação do paciente, melhoria na adesão ao tratamento e fortalecimento do vínculo terapêutico. Este estudo ressalta a importância da equipe multiprofissional no contexto do atendimento humanizado, evidenciando a necessidade de políticas e práticas que incentivem a colaboração interdisciplinar. A promoção de uma cultura organizacional que valorize a humanização no cuidado contribui para a qualidade e efetividade dos serviços de saúde

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030