The present research examines the effect of music therapy on the affect of hospitalised children. It took place on a paediatric ward of a New Zealand public hospital. This study aimed to investigate the role of music therapy in addressing patients’ psychosocial needs. Literature on the impact of hospitalisation, and on the use of music therapy in hospitals and paediatrics was reviewed. The research involved an audit of the therapist’s clinical notes from music therapy sessions over the course of seven months. The clinical notes included measurements of children’s mood from the beginning and end of sessions, using McGrath’s (1990) Affective Facial Scale. It was hypothesised that mood measures following music therapy would be higher than pre-music therapy scores. Statistical analysis of the facial scale data did not show a significant difference between ‘before’ and ‘after’ measures. These results were discussed with regard to a ceiling effect (this is, the measurements indicated patients were at the happy end of the scale before the music therapy session, so there was little room on the scale for mood to improve following music therapy). The measurement of emotion did not prove to be straightforward. The hospital environment may have influenced the patients’ responses in a number of ways. These environmental influences are discussed with reference to examples from the clinical notes. The usefulness of facial scales in this context is discussed, as well as other limitations of the research. Suggestions for future research include the use of other mood measures, and the inclusion of measurements of parental mood and how this affects the child.

This thesis addresses questions of how to incorporate quality of care, represented by disutility-bearing effects such as mortality, morbidity and re-admission, in measuring relative performance of public hospitals. Currently, case-mix funding and performance, measured with costs per case-mix adjusted separation, hold hospitals accountable for costs, but not effects, of care, creating economic incentives for quality of care minimising cost per admission. To allow an appropriate trade-off between the value and cost of quality of care a correspondence is demonstrated between maximising net benefit and minimising costs plus decision makers??? value of disutility events, where effects of care can be represented by disutility events and hospitals face a common comparator. Applying this correspondence to performance measurement, frontier methods specifying disutility events as inputs are illustrated to have distinct advantages over output specifications, allowing estimation of: 1. economic efficiency conditional on the value of avoiding disutility events. 2. technical, scale and congestion sources of net benefit efficiency; 3. best practice peers over potential decision makers??? value of quality; and 4. industry shadow price of avoiding disutility events. The accountability this performance measurement framework provides for effects and cost of quality of care are also illustrated as the basis for moving from case-mix funding towards a funding mechanism based on maximising net benefit. Links to evidence-based medicine in health technology assessment are emphasised in illustrating application of the correspondence to comparison of multiple strategies in the cost-disutility plane, where radial properties as shown to provide distinct advantages over comparison in the cost-effectiveness plane. The identified performance measurement and funding framework allows policy makers to create economic incentives consistent with evidence-based medicine in practice, while avoiding incentives for cream-skimming and cost-shifting. The linear nature of the net benefit correspondence theorem allows simple inclusion of multiple effects of quality, whether expressed as not meeting a standard, functional limitation or disutility directly. In applying the net benefit correspondence theorem to hospitals a clinical activity level is suggested, to allow correspondence conditions to be robustly satisfied in identification of effects with decision analytic methods, adjustment for within DRG risk factors and data linkage to effects beyond separation.

The present research examines the effect of music therapy on the affect of hospitalised children. It took place on a paediatric ward of a New Zealand public hospital. This study aimed to investigate the role of music therapy in addressing patients’ psychosocial needs. Literature on the impact of hospitalisation, and on the use of music therapy in hospitals and paediatrics was reviewed. The research involved an audit of the therapist’s clinical notes from music therapy sessions over the course of seven months. The clinical notes included measurements of children’s mood from the beginning and end of sessions, using McGrath’s (1990) Affective Facial Scale. It was hypothesised that mood measures following music therapy would be higher than pre-music therapy scores. Statistical analysis of the facial scale data did not show a significant difference between ‘before’ and ‘after’ measures. These results were discussed with regard to a ceiling effect (this is, the measurements indicated patients were at the happy end of the scale before the music therapy session, so there was little room on the scale for mood to improve following music therapy). The measurement of emotion did not prove to be straightforward. The hospital environment may have influenced the patients’ responses in a number of ways. These environmental influences are discussed with reference to examples from the clinical notes. The usefulness of facial scales in this context is discussed, as well as other limitations of the research. Suggestions for future research include the use of other mood measures, and the inclusion of measurements of parental mood and how this affects the child.

The present research examines the effect of music therapy on the affect of hospitalised children. It took place on a paediatric ward of a New Zealand public hospital. This study aimed to investigate the role of music therapy in addressing patients’ psychosocial needs. Literature on the impact of hospitalisation, and on the use of music therapy in hospitals and paediatrics was reviewed. The research involved an audit of the therapist’s clinical notes from music therapy sessions over the course of seven months. The clinical notes included measurements of children’s mood from the beginning and end of sessions, using McGrath’s (1990) Affective Facial Scale. It was hypothesised that mood measures following music therapy would be higher than pre-music therapy scores. Statistical analysis of the facial scale data did not show a significant difference between ‘before’ and ‘after’ measures. These results were discussed with regard to a ceiling effect (this is, the measurements indicated patients were at the happy end of the scale before the music therapy session, so there was little room on the scale for mood to improve following music therapy). The measurement of emotion did not prove to be straightforward. The hospital environment may have influenced the patients’ responses in a number of ways. These environmental influences are discussed with reference to examples from the clinical notes. The usefulness of facial scales in this context is discussed, as well as other limitations of the research. Suggestions for future research include the use of other mood measures, and the inclusion of measurements of parental mood and how this affects the child.

Thesis (MSc. (Physiology)--Faculty of Health Sciences) - University of Pretoria, 2005. / Includes bibliographical references.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2006. / INTRODUCTION: The primary objective was to determine whether acidified formulae (pH 3.5 and 4.5) decreased gastric and tracheal colonisation, as well as microbial contamination of the enteral feeding delivery system, compared with a non-acidified control formula (pH 6.8) in critically ill patients. Secondary objectives included tolerance of the trial formulae and mortality in relation to the administration of acidified formulas. DESIGN: The trial was a controlled, double-blinded, randomised clinical trial of three parallel groups at a single centre. METHOD: Sixty-seven mechanically ventilated, medical and surgical critically ill patients were randomised according to their APACHE II scores and included in the trial. Patients received either an acidified (pH 3.5 or 4.5) or control polymeric enteral formula via an 8-Fr nasogastric tube at a continuous rate. Daily samples were taken for microbiologic analyses of the enteral formulae at various stages of reconstitution and at 6-hour and 24-hour intervals during administration thereof (feeding bottle and delivery set). Daily patient samples included nasogastric and tracheal aspirates, haematological evaluation and gastro-intestinal tolerance. The trial period terminated when patients were extubated, transferred from the ICU, enteral nutrition became contraindicated, a patient died, or for a maximum of 21 days. RESULTS: Gastric pH showed no significant difference (p = 0.86) between the 3 feeding groups [pH 3.5 (n = 23), pH 4.5 (n = 23) and pH 6.8 (n = 21)] at baseline prior to the administration of enteral formulae. After initiation of feeds, the gastric pH decreased significantly (p< 0.0001) in the acidified formulae as compared to the control formula during the trial period. Patients who received acidified enteral formulae (pH 3.5 and 4.5) had significantly less (p < 0.0001) contamination from the feeding bottles and delivery systems in respect of Enterobacteriacea, and Enterococcus., The more acidified group (pH 3.5) showed significantly less gastric contamination (p = 0.029) with Enterobacteriacea, , but not for fungi. The 3.5 acidified group also had the lowest gastric growth in terms of colony counts (≤104) of these organisms, but not for fungi, when compared to the control group (≤105). Vomiting episodes were 22% and abdominal distension 12%, with a higher incidence in the control group. Adverse events occurred equally between the groups with a higher, but not significantly different incidence of 37% in the control group and 32% for the acidified groups. There was no evidence of gastro-intestinal bleeding in any patient. Overall, the mortality rate in this trial was 6%, with 6.5% for the acidified groups (n=46) and 4.8% for the control group (n=21), a statistically insignificant difference. CONCLUSION: Acidified enteral formulae significantly decrease gastric colonisation by preserving gastric acidity that decreases the growth of Enterobacteriaceaes organisms. Acidified formulae significantly decrease bacterial contamination of the enteral feeding system (bottle and delivery set) of Enterobacteriaceae and Enterococcus organisms. Acidified formulae are tolerated well in critically ill patients.

Made available in DSpace on 2014-12-17T14:47:04Z (GMT). No. of bitstreams: 1 HilderjaneCS_DISSERT.pdf: 2963070 bytes, checksum: bff0803d876ff74c7299b7dc49baf353 (MD5) Previous issue date: 2013-12-12 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / O The aim of this study was to characterize the occurrence of trauma in the elderly population served by the mobile pre-hospital service, in Natal, Rio Grande do Norte. This is a descriptive, transversal and quantitative approach and whose population consisted of 2,080 trauma victims. The sample, of systematic random type, consisted of 400 elderly people, aged from 60 years old, assisted by the Office of Mobile Emergency in Natal / RN, between January 2011 and December 2012. Data collection began after consent and assent of the institution of a Research Ethics Committee under No. 309 505. It was proceeded to documentary retrospective analysis of records of this service through a form of self-development, validated by expert judges considered reliable (&#945;> 0.75) and valid (CVI = 0.97) in their clarity and relevance. Data were tabulated by the Statistical Package for Social Sciences, version 20.0. The results show that older victims have an average age of 74.19 years old, with a prevalence of female involvement by chronic diseases, especially hypertension, average usage of 2.2 routine medications with vital signs within normal limits. The trauma prevailed during the daytime, in the residence of the victims, north of the city and on weekends. Among the mechanisms of trauma were falls, traffic accidents and physical aggression, whose most common type was brain-cerebral trauma and the main consequences were suture wounds and closed fractures. Basic Support Units were as more driven to pre-hospital care (87.8%) and the main destination place consisted of a referral hospital for emergency of the state (57.5%). Among the most commonly performed procedures by nursing staff immobilization with rigid board and neck collar and the peripheral venipuncture, and the main component used for volume replacement to saline were highlighted. There was a significant relationship between the deaths and the mechanism of injury, mechanism of injury and procedures, except medication administration procedures carried out, except immobilization and unit for service. It is highlighted the prevalence of trauma in the elderly, poor follow-up Pre-Hospital Trauma Life Support protocol and the paucity of records and nursing procedures performed. There is need for a protocol of care specific to elderly trauma victims and education strategies for the prevention of such events / O objetivo deste estudo foi caracterizar a ocorr?ncia de traumas na popula??o idosa atendida pelo servi?o pr?-hospitalar m?vel, no munic?pio de Natal, Rio Grande do Norte. Trata-se de um estudo descritivo, de delineamento transversal e abordagem quantitativa, cuja popula??o foi constitu?da por 2.080 v?timas de trauma. A amostra, do tipo aleat?ria sistem?tica, consistiu em 400 pessoas idosas, com idade a partir de 60 anos, assistidas pelo Servi?o de Atendimento M?vel de Urg?ncia de Natal/RN, entre janeiro de 2011 a dezembro de 2012. A coleta de dados teve in?cio ap?s consentimento da institui??o e parecer favor?vel de um Comit? de ?tica em Pesquisa sob o n? 309.505. Procedeu-se ? an?lise documental retrospectiva das fichas de atendimento do servi?o atrav?s de um formul?rio de elabora??o pr?pria, validado por ju?zes especialistas, considerado como confi?vel (&#945;>0,75) e v?lido (IVC=0,97) em sua clareza e relev?ncia. Os dados foram tabulados pelo software Statistical Package for Social Science, vers?o 20.0. Os resultados obtidos evidenciam que as v?timas idosas possuem idade m?dia de 74,19 anos, com preval?ncia do sexo feminino, acometimento por doen?as cr?nicas, especialmente a hipertens?o arterial, uso m?dio de 2,2 medicamentos rotineiros, com sinais vitais dentro dos padr?es de normalidade. Os traumas prevaleceram no per?odo diurno, na resid?ncia das v?timas, zona norte da cidade e nos fins de semana. Entre os mecanismos de trauma destacaram-se as quedas, os acidentes de tr?nsito e as agress?es f?sicas, cujo tipo de trauma mais comum foi o cranioencef?lico e principais consequ?ncias os ferimentos passivos de sutura e as fraturas fechadas. As Unidades de Suporte B?sico estiveram como as mais acionadas para o atendimento pr?-hospitalar (87,8%) e o principal local de destino consistiu no hospital de refer?ncia em urg?ncia do Estado (57,5%). Entre os procedimentos mais realizados pela equipe de enfermagem destacaram-se a imobiliza??o com prancha r?gida e colar cervical, bem como a pun??o venosa perif?rica, e principal componente utilizado para reposi??o vol?mica a solu??o fisiol?gica. Houve rela??o significativa entre os ?bitos e o mecanismo de trauma; mecanismo de trauma e procedimentos realizados, exceto administra??o de medicamentos; procedimentos realizados, exceto de imobiliza??o, e unidade destinada ao atendimento. Ressalta-se a preval?ncia do trauma na popula??o idosa, o seguimento deficiente do protocolo Pre-Hospital Trauma Life Support e a incipi?ncia dos registros de procedimentos de enfermagem realizados. H? necessidade de um protocolo de atendimento ao trauma espec?fico ?s v?timas idosas e estrat?gias de educa??o para a preven??o de eventos desta natureza

Within the framework of ethnography, an inquiry was made into the many dimensions of psychological treatment and training in a psychiatric hospital, with particular reference to State Patients. Ethnography is the study of an intact cultural or social group based mainly on observations over a prolonged period of time in which the researcher is a participant. The multicultural aspects of the therapeutic community were also inquired into. Ethnographic data was collected and processed over a period of 16 years in three psychiatric hospitals, the main source of data gathered from Weskoppies Hospital in Pretoria. The ecosystemic psychotherapeutic perspective was used as a meta-model to describe eight therapeutic approaches in which intern-psychologists were trained. The hospital is described as a therapeutic community in which rehabilitation is a multi-professional responsibility. Each profession, or sub-culture, has its own framework and culture in which it works within the broader system of the psychiatric hospital. Ethical considerations and recommendations are levelled at the academic and practical aspects of clinical psychology, hospital management, and different levels of government. / Psychology / D.Litt. et Phil.

Submitted by Rafael Arruda Alves (alves.a.rafael@gmail.com) on 2018-09-02T19:03:08Z No. of bitstreams: 1 Tese Final de Rafael Arruda Alves.pdf: 2482600 bytes, checksum: 9403ffa0524bb4525d6449decfc63f9f (MD5) / Approved for entry into archive by Sulamita Selma C Colnago null (sulamita@btu.unesp.br) on 2018-09-03T16:22:03Z (GMT) No. of bitstreams: 1 alves_ap_me_bot.pdf: 2482600 bytes, checksum: 9403ffa0524bb4525d6449decfc63f9f (MD5) / Made available in DSpace on 2018-09-03T16:22:03Z (GMT). No. of bitstreams: 1 alves_ap_me_bot.pdf: 2482600 bytes, checksum: 9403ffa0524bb4525d6449decfc63f9f (MD5) Previous issue date: 2018-08-01 / A Urgência e Emergência se constitui em um importante componente da assistência à saúde, principalmente devido ao crescimento do número de acidentes e da violência urbana. O Serviço de Atendimento Móvel de Urgência (SAMU) foi criado pelo governo federal em 2003 com função tanto operacional, voltada para os atendimentos pré-hospitalares através das ambulâncias de suporte básico de vida (USB) e suporte avançado de vida (USA), quanto pela central de regulação das urgências, que atende aos chamados telefônicos do 192, com papel de organizar os fluxos de atenção integral às urgências. Essa organização permite proporcionar dados provenientes de seu funcionamento que devem servir como importante ferramenta para o planejamento de ações estratégicas para saúde regional. O SAMU de Bauru foi iniciado em 2004 com três ambulâncias, passando a um serviço regional em 2011, abrangendo dezessete munícipios, atualmente, dispõe de duas motos (URAM), sete ambulâncias de suporte básico e duas de suporte avançado, ligadas através da central reguladora com oito bases descentralizadas instaladas em munícipios da região, atendendo uma área de 5.312,399km² e 634.195 habitantes. Emerge deste contexto o problema da presente pesquisa, desenhado a partir do questionamento sobre os resultados nas condutas pré-hospitalares e do processo de trabalho da central de regulação das urgências do município de Bauru, visando mensurar a contribuição com a assistência da urgência ao longo dos anos, cooperando para as ações de planejamento futuras, através de dados norteadores que possibilitem a construção de diretrizes técnicas. Os atendimentos realizados pelo SAMU Bauru regional no período de 7 anos foram analisados quanto ao tipo de ocorrência, variabilidade sazonal e adequação da regulação, e nesse período houve uma média de 8985 chamadas telefônicas/mês, sendo 83% delas reguladas, resultando em 242.162 em atendimentos. Destes, 67% se referiam a causas clínicas, 23% a emergências traumáticas, 9% foram classificados como outros tipos de causa, e 3537 resultaram em óbitos, o que representa 1,5% de todas as ocorrências realizadas. Para esclarecimento do perfil dos usuários, foi organizada uma estratificação dos dados desta série histórica com foco no ano de 2016, que permite confirmar que o SAMU é um observatório valioso da saúde loco regional, pois não apenas se configura como um importante serviço de atendimento ao usuário em suas necessidades de saúde, como também se mostra uma peça gestora de importância para organização da rede de saúde, atuando como um termômetro destas atuações, uma vez que a maior parcela da população ao ligar para o 192 tem uma necessidade real, seja por dificuldade ou impedimento de acesso a uma unidade de saúde, por um problema real de seus agravos clínicos, ou por eventos agudos e súbitos. / Emergency and Urgent Care is an important component of health care, mainly due to the increase in the number of accidents and urban violence. The Emergency Mobile Care Service (SAMU) was created by the federal government in 2003 with both an operational function aiming prehospital care through ambulances of basic life support (USB) and advanced life support (USA), as well as by the emergency regulation center, which attends the calls to the 192 line, with the role of organizing the flows of integral attention to the to provide data from its functioning that should serve as important tools for the planning of strategic actions for regional health. The SAMU of Bauru started serving in 2004 with three ambulances, becoming a regional service in 2011, covering seventeen municipalities, and currently has two motorcycles (URAM), seven ambulances of basic support and two of advanced support, linked through the regulation central by eight decentralized bases installed in municipalities in the region, serving an area of 5,312,399km² and 634,195 inhabitants. It emerges from this context the problem of the present research, designed by the questioning about the results in the prehospital conducts and the work process of the regulation center of urgencies in the city of Bauru, aiming to measure the contribution offered by the assistance of the urgency over the years, cooperating for the actions of future planning, through guiding data that enabled the construction of technical guidelines. SAMU Bauru regional consultations in the 7-year period were analyzed by type of occurrence, seasonal variability and adequacy of regulation. There was an average of 8985 telephone calls per month, which 83% were regulated, resulting in 242,162 consultations, 67% referred to clinical reasons, 23% were due to traumatic emergencies, 9% were classified as other causes, and 3537 were fatal victims, representing 1.5% of all occurrences. In order to clarify the profile of the users, a stratification of the data of this historical series was carried out focusing on the year 2016, confirming that SAMU is a valuable regional loco health observatory, and not only an important service of attending the user to its needs It is clear that the largest part of the population, when to call 192, has a real need, either due to difficulty or impediment of access to health services, a health unit, and a real problem of their clinical problems, or by sudden and acute events.

Orientador: Adriana Polachini do Valle / Resumo: A Urgência e Emergência se constitui em um importante componente da assistência à saúde, principalmente devido ao crescimento do número de acidentes e da violência urbana. O Serviço de Atendimento Móvel de Urgência (SAMU) foi criado pelo governo federal em 2003 com função tanto operacional, voltada para os atendimentos pré-hospitalares através das ambulâncias de suporte básico de vida (USB) e suporte avançado de vida (USA), quanto pela central de regulação das urgências, que atende aos chamados telefônicos do 192, com papel de organizar os fluxos de atenção integral às urgências. Essa organização permite proporcionar dados provenientes de seu funcionamento que devem servir como importante ferramenta para o planejamento de ações estratégicas para saúde regional. O SAMU de Bauru foi iniciado em 2004 com três ambulâncias, passando a um serviço regional em 2011, abrangendo dezessete munícipios, atualmente, dispõe de duas motos (URAM), sete ambulâncias de suporte básico e duas de suporte avançado, ligadas através da central reguladora com oito bases descentralizadas instaladas em munícipios da região, atendendo uma área de 5.312,399km² e 634.195 habitantes. Emerge deste contexto o problema da presente pesquisa, desenhado a partir do questionamento sobre os resultados nas condutas pré-hospitalares e do processo de trabalho da central de regulação das urgências do município de Bauru, visando mensurar a contribuição com a assistência da urgência ao longo dos anos, cooperando para as ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Emergency and Urgent Care is an important component of health care, mainly due to the increase in the number of accidents and urban violence. The Emergency Mobile Care Service (SAMU) was created by the federal government in 2003 with both an operational function aiming prehospital care through ambulances of basic life support (USB) and advanced life support (USA), as well as by the emergency regulation center, which attends the calls to the 192 line, with the role of organizing the flows of integral attention to the to provide data from its functioning that should serve as important tools for the planning of strategic actions for regional health. The SAMU of Bauru started serving in 2004 with three ambulances, becoming a regional service in 2011, covering seventeen municipalities, and currently has two motorcycles (URAM), seven ambulances of basic support and two of advanced support, linked through the regulation central by eight decentralized bases installed in municipalities in the region, serving an area of 5,312,399km² and 634,195 inhabitants. It emerges from this context the problem of the present research, designed by the questioning about the results in the prehospital conducts and the work process of the regulation center of urgencies in the city of Bauru, aiming to measure the contribution offered by the assistance of the urgency over the years, cooperating for the actions of future planning, through guiding data that enabled the construction of technical guidelines.... (Complete abstract click electronic access below) / Mestre