Dependency is defined as authentic or pathological and is seen as a component important to the treatment of patients with chronic illness. It is hypothesized that a significant portion of ecology patients will meet the criteria for pathological dependence and differ on psychological and physiological parameters from those who do not. This study strongly supports the first two hypotheses but does not find that the two groups differ physiologically. One hundred eleven variables are surveyed. Fifty-two show significant differences between the groups and 29 are significant at greater than the .0001 level. A discriminant analysis was used to determine the least number of orthogonal variables that best discriminate between the groups. These are MMPI Scales 8, 3, subscale Ma2, employment status, and early childhood illness.

This study briefly reviews both historical and recent conceptualizations of dependency. In particular, it focuses on this concept's applicability to patients with chronic illnesses, especially those with allergies. Type and degree of dependency were seen as an important factor in the approach to the medical and psychological treatment of clinical ecology patients. The purpose of the study was to develop an objective measure of dependency which could quickly identify patients whose dependency conflicts interfere with the treatment process. The study was divided into three phases. In the first phase test responses by 84 inpatients to the CAQ, MMPI, and the HAT as well as historical and demographic data were analyzed by a series of stepwise discriminant analysis. The 53 resulting items were examined for those which most concisely discriminated between the two identified groups (pathologically dependent and nonpathologically dependent). These 15 items were used to test 120 additional patients in phase II. Fourteen items were retained and the coefficients obtained classified the patients in phase I and II with a 98.81 percent and 94.17 percent degree of accuracy respectively. These classification coefficients were used to classify another 30 patients in phase III with a 96.67 percent rate of accuracy. These results provide exceptionally strong support for the hypothesis that group classification can be obtained through the use of an objective screening instrument. The pathologically dependent patients tend to focus on disease, frequently are unemployed, have histories of childhood illnesses, have limited emotional controls, are depressed, ambivalent, and distrustful. Additionally, they experience difficulty establishing goals or accepting personal responsibility. Those patients identified as nonpathologically dependent exemplify the more positive aspects of these traits. The pathologically dependent patients appear to be caught in a dilemma between wellness and satisfaction of dependency needs. While all patients need an organized approach to treatment, the pathologically dependent require an extremely structured repititious approach and may require long term psychological intervention in order to make positive steps toward wellness.

Made available in DSpace on 2016-03-15T19:40:26Z (GMT). No. of bitstreams: 1 Paulo Roberto Ferreira.pdf: 529852 bytes, checksum: ecce2ffc57c1f52236add8a313c0702c (MD5) Previous issue date: 2007-08-06 / Fundo Mackenzie de Pesquisa / This work sought to understand how the family of chronically ill patients deals with them and how this care affects family structure. The main objective was to study changes in family relations due to caring for chronically disabled people 5 families responsible for severely mentally handicapped children, recruited in a specialized institution in Espírito Santo State. Data were obtained via adapted Crichton Geriatric Scale (DLA) that assesses the functional capacity of the patient and has the advantage of knowing the evolution of capacities and limitations of the patient through frequent registration; Smilkstein s Family APGAR was adapted to assess the level of the patient s family integration. Results showed an evolution in some of the severely mentally handicapped patients. Concerning the degree of dependence, in the beginning all the five patients were totally dependant and nowadays two are still totally dependant and three are partially dependant. It also could be observed that from the starting of illness to the moment, families are integrated in the helping relation, in their members participation in decision making situations, in freedom of family members concerning financial matters, in affective relations and in time that family members dedicate to the patient. It was observed that family interactions have not suffered damage due to the chronically illness of their members, and that they succeeded in different stages of adaptation to the illness. This study could show the family carers viewpoint, as they add to a reality that enriches the comprehension of family relation of severely handicapped patients and their family universe. / Este trabalho buscou compreender como a família de pacientes crônicos lida com o cuidado a estes pacientes e como este cuidado afeta a estrutura familiar. O objetivo principal, portanto, foi estudar as modificações nas relações familiares decorrentes do cuidado a pessoas com transtornos crônicos. Participaram desta pesquisa 5 famílias, responsáveis pelo cuidado de crianças com deficiência mental severa, recrutadas em uma instituição de atendimento a pessoas deficientes numa cidade do interior do Espírito Santo. Os dados foram obtidos através de respostas a questionário da escala geriátrica de Crichton (AVD), adaptada, que avalia a capacidade funcional do paciente e tem a vantagem de permitir conhecer a evolução das capacidades e limitações do paciente através do registro periódico; para avaliação do grau de integração do paciente utilizou-se a adaptação do APGAR Familiar de Smilkstein. Os resultados mostraram uma evolução em alguns dos deficientes mentais severos. Em relação ao grau de dependência, inicialmente todos os cinco pesquisados eram totalmente dependentes e atualmente, dois continuam totalmente dependentes e três encontram-se parcialmente dependentes. Observa-se também que desde início do surgimento da doença até o momento, as famílias encontram-se integradas na relação de ajuda, na participação de seus membros na tomada de decisões, na liberdade dos membros da família nas questões financeiras, na relação afetiva e no tempo que os membros da família dão ao paciente crônico. Observa-se que as interações familiares não sofreram prejuízo devido à doença crônica de seus membros e que elas foram bem sucedidas nas diferentes fases de adaptação a doença. Este estudo pode proporcionar uma visão dos familiares cuidadores, uma vez que eles agregam uma realidade que enriquece a compreensão da relação familiar das pessoas com deficiência mental severa e seu universo familiar.

The effects of acupuncture on mental wellbeing in chronically ill patients Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague Student: Anna Šteflová Tutor: PharmDr. Jitka Pokladníková, Ph.D. Introduction: Demand of patients for the Traditional Chinese medicine (TCM) in Czech Republic is raising and therefore it is necessary to critically evaluate its benefit for specific diagnoses, so that it would be possible to draw conclusions about its use in clinical practice. Objective: To evaluate influence of acupuncture with other methods of TCM on wellbeing and subjective level of pain in patients with musculoskeletal disorders. Methods: Wellbeing of patients before and after TCM therapy was assessed using validated questionnaire WEMWBS (Warwick-Edinburgh Mental Well-being Scale) and subjective level of pain before and after TCM therapy was determined using VAS (Visual Analogue Scale). The changes of wellbeing and subjective level of pain were evaluated first for the whole set of patients with musculoskeletal disorders and subsequently for the subsets of patients divided by the type of musculoskeletal disorder (according to International Classification of Diseases and Related Health Problems) and by the intensity of pain at the beginning of the...

The effects of acupuncture on mental wellbeing in chronically ill patients II Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague Student: Ivana Chuová Tutor: PharmDr. JitkaPokladníková, Ph.D Introduction: Traditional Chinese Medicine (TCM), including acupuncture, is widely used in the treatment of chronically ill patients, whose numbers are increasing. This treatment is widely used either alone or as a supplementary method. Though, more attention should be given to the research of TCM effectiveness in studies. Objective: To assess the effect of selected sociodemographic and clinical variables such as age, gender, size of residence, type of musculoskeletal disorders and concomitant use of Chinese phytotherapy on the alteration in personal well-being and pain in patients with musculoskeletal disorders, who underwent the acupuncture therapy at the Czech-Chinese Centre of TCM University Hospital Hradec Králové (FNHK). Methods: The Evaluation of patients' personal well-being from the data obtained by using WEMWBS and Visual Analogue Scale (VAS) questionnaires. The patients were undergoing therapy at the Czech-Chinese TCM FNHK Centre. The process of the Data collection from questionnaires took place in the period from 7 April 2017 to 12...

Caring for the chronically ill is a growing phenomenon that deserves careful attention and research, since the quality of life of the palliative caregiver is threatened by the continuous exposure to psychological, physiological, as well as relational burdens. A hermeneutic phenomenological study was used to explore palliative caregivers‟ experiences of compassion fatigue when caring for chronically ill patients in a hospice setting. Semi-structured interviews were conducted with Bophelong Community Care Centre‟s palliative caregivers between the ages of 20 and 60 years who were employed in a hospice for a minimum of at least two years, thus well-placed to describe their experiences of compassion fatigue when caring for chronically ill patients in a hospice setting. Data was collected through individual interviews, recorded and transcribed. Using thematic analysis, meaningful patterns and themes of data were discovered to better understand compassion fatigue as a phenomenon of interest. The findings pointed to four categories, i.e. the effects of compassion fatigue on palliative caregivers‟ emotional wellbeing, personal and work relationships, physical discomfort, and spiritual awareness, that describe the experiences of palliative caregivers of compassion fatigue in a hospice setting, thus providing a holistic understanding of the complexity of compassion fatigue in a palliative care hospice setting. / Psychology / M. A. (Psychology)

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Les systèmes de santé accordent une attention croissante au point de vue des usagers dans l’organisation de l’offre de soins. L’instauration d’une offre de soins sensible aux besoins et préférences des patients constitue un enjeu majeur de qualité et d’efficacité des soins. Ce travail analyse le point de vue des patients pour l’offre de soins de médecine générale en utilisant différentes méthodes permettant d’obtenir des informations complémentaires en termes d’expérience de soins, de satisfaction, d’importance ou encore de préférences. Il s’agit des méthodes Delphi, de classement du meilleur au pire et de révélation des préférences par les choix discrets. Ces méthodes sont appliquées sur deux échantillons : en population générale pour la première et chez des patients poly-pathologiques pour les 2 autres afin d’identifier les principaux enjeux actuels et à venir de la réorganisation de l’offre de soins de médecine générale du point de vue des patients. Les résultats montrent le rôle central de la relation médecin-patient et plus particulièrement de l’échange d‘informations entre le médecin et le patient. Cependant une relation médecin-patient de qualité ne doit pas pour autant être réalisée au détriment de la qualité technique du soin et de la coordination de la prise en charge du patient. Ce travail montre également l’importance de prendre en compte l’expérience de soins des patients lors de l’analyse de leur point de vue, et plus particulièrement de leur disposition au changement. L’évaluation systématique et régulière des préférences des patients en pratique quotidienne peut permettre d’améliorer la communication médecin-patient ainsi que le contenu de l’offre de soins du point de vue des patients. / The healthcare systems are paying a great interest to the patients’ perspective for the organization of health care provision. Healthcare system which is accountable and responsive of patients’ needs and preferences is a major issue for the quality and efficiency of care. In this thesis, we analyze the views of patients for the supply of GP care in using different complementary methods about patients’ experience, satisfaction, importance or preferences. These methods are applied to a sample of patients in GP and to a sample of chronically ill patients in order to identify current and future major issues for the reorganization of GP care from the patients’ perspective. The results show the main role of the doctor-patient relationship and especially of the information exchange between doctor and patient and between patient and doctor. However the quality of the doctor-patient relationship is not enough. The technical quality of care (i.e. thoroughness) and the coordination are of high importance for patients. This work highlights that it is necessary to take into account the patients’ experiences in the analysis of their perspective (e.g. preferences) to fully and appropriately understand the results, especially in terms of willingness to change. The systematic and regular screening of patient preferences in daily GP practice can improve the doctor-patient communication and the content of the provision of care from the perspective of patients.