Magister Pharmaceuticae - MPharm / Tuberculosis (TB) is a major contributor to the disease burden in developing countries resulting in deaths of approximately 2 million people a year. South Africa (SA) has one of the highest annual TB incidences with an estimate of 558 per 100 000 population (2003) and the situation shows no sign of abating. TB remains the most common opportunistic infection and cause of death amongst HIV- infected patients. Both TB and HIV treatment depend exclusively on multi-drug regimens that require close monitoring among health care professionals. With increasing workload due to staff shortage and high patient load, the quality of care in nurse-led primary care clinics maybe compromised. Existing clinic staff may overlook drug-drug interactions, side effects and may not be aware of the consequences when a formulation is modified during multi-drug therapy administration. As the custodian of medicines, pharmacists are ideally placed to monitor therapy. Clinicbased training programmes which are offered to nurses provide an opportunity to work alongside clinic staff and engage in patient-centered care where the pharmacotherapeutic outcome of TB and HIV drug regimens could be closely monitored. / South Africa

This study was undertaken in the Kingsway informal settlement, which is situated in Ekhurhuleni on the East Rand. This is a poor community as many residents are unemployed and unable to obtain adequate healthcare especially for HIV/AIDS. The perceived high rate of HIV infection, as well as, the apparent high death rate due to AIDS was my major concern. Intervention and help were my main intention. I was motivated to embark on this study to be empowered and informed about treatment processes of HIV/AIDS. The study was intended to use living theory action research to investigate the need for establishing a Voluntary Counselling and Testing (VCT) centre. For action in the real environment a research team was formed from volunteers. The relevant influential persons in the community were consulted and the required permission obtained to embark on the study. This was also to ensure that there was co-operation from community leaders. Proper documents, giving permission, were obtained after formal requests were made. Ethical guidelines were followed in this research. I started by stating my values before the research. During the process I showed how my values were transformed by various activities that were intended to educate me. These changes were indications of my development. At the end of the study I indicated how my initial values were improved or transformed, and what new values I gained. / Dissertation (MA)--University of Pretoria, 2010. / Psychology / unrestricted

En Algérie, le champ de la santé s’est modifié avec l’émergence et l’extension du secteur privé des soins à but lucratif dans ses deux composantes : cliniques privées et médecine de ville, mettant ainsi fin à l’hégémonie durant trois décennies du secteur public. Un système de soins hybride en a résulté où un secteur public caractérisé par de multiples dysfonctionnements semble nourrir un secteur privé en pleine croissance. Cette dynamique s’opère dans un contexte de transition plurielle : une transition économique mal assumée, une transition sociologique avec une forte urbanisation, une rapide transition démographique, une transition épidémiologique en cours et une transition politique toujours en suspens. Les interactions entre les stratégies individuelles des professionnels de santé et les éléments contextuels ont déterminé les évolutions du système de santé algérien. Les cliniques privées comme nouvelle figure dans le paysage sanitaire sont des structures innovantes dans le sens où de nouvelles méthodes d’organisation et de travail, des modalités de coopération inhabituelles et des modes de coordination inédits ont émergé en rupture avec les modes de fonctionnement anciens créant ainsi une dynamique collective entre médecins et patients. Elles attirent aussi bien les médecins, en quête de compléments de revenus, que les patients à la recherche d’une rapide prise en charge, évitant les longues attentes dans le secteur public. Au fonctionnement cloisonné du système de soins se substitue un fonctionnement en réseau dans les rapports entre les différents acteurs au gré des affinités, des sensibilités et des intérêts financiers. / In Algeria, the health field has changed with the emergence and expansion of the private healthcare sector profit in its two components: private clinics and physicians in liberal, thus ending the hegemony over three decades the public sector. A hybrid system where care has resulted in a public sector characterized by multiple failures seems to feed a growing private sector. This dynamic occurs in the context of a plural transition: an unplanned economic transition, a sociological transition with a strong urbanization, rapid demographic transition, an epidemiological transition and ongoing political transition still pending. Interactions between individual strategies of health professionals and the contextual elements have determined the evolution of the Algerian health system. The private clinics as new figure in the healthcare landscape reveals innovative structures in the sense that, new methods of organization and working with unusual interaction and coordination modes that emerged out leading to a drift from the old operating mode systems creating a collective dynamics between doctors and patients. They attract both doctors, looking for additional income, patients in search of an immediate and better care, try to avoid long waiting list in the public sector. The enclosed operating care system is replaced by an operation network in relation between the various actors in the healthcare system according to affinities, sensitivities and financial interests.

Purpose of Study: Workplace-based assessment is an opportunity for a learner to be assessed in their community of practice by an expert rater. The challenges and biases brought into this assessment relationship are complex. A shift towards Competency Based Medical Education in post-graduate residency education has triggered consideration of how to implement feasible assessment tools for the operating room, the in-patient ward, and the outpatient clinic. Competent performance in outpatient clinic is vital to surgical practice, yet no assessment tool currently exists to assess daily performance of technical and nontechnical skills of surgery residents. This project describes the development of a competency-based assessment tool, the Ottawa Clinic Assessment Tool (OCAT). Research Question: How does the OCAT demonstrate validity for measurement of surgical resident performance in clinic? Method: A consensus group of experts was gathered to generate ideas reflective of a competent ‘generalist’ surgeon in clinic. An entrustability anchor scale was developed. A six-month pilot study of the OCAT was conducted in orthopedics, general surgery and obstetrics and gynecology with quantitative and qualitative evidence of validity collected. Two subsequent feedback sessions, and a survey for staff and residents evaluated the OCAT for clarity and utility. Results: The OCAT was developed as a 13-item tool, with a global assessment item and 2 short answers questions. 44 staff surgeons completed 132 OCAT assessments of 79 residents. Psychometric data was collected as evidence of internal structure validity and relations with other variables. Analysis of feedback indicated the rating scale was practical and useful for surgeons and residents. Conclusions & Contribution to the Research Field: Surgical programs will require a daily clinic assessment tool to help define resident competency progression. Multiple sources of validity evidence collected in this pilot project demonstrate that the OCAT can measure resident clinic competency in a valid and feasible manner.

Este trabalho objetivou conhecer o processo de busca e a clientela atendida em terapia de casal e família. Para tanto, realizaram-se dois estudos. Inicialmente, através de uma revisão sistemática da literatura, foram identificados seis fatores associados à busca pelas terapias de casal e família: fatores pessoais, relacionais, culturais, de gênero, estratégias anteriores de ajuda e tipo de problema. Posteriormente, através de um estudo empírico, a clientela atendida em terapia familiar em uma clínica-escola de Porto Alegre (RS) foi caracterizada. Foram realizadas entrevistas estruturadas com 41 adultos encaminhados para terapia familiar, nas quais foram investigadas variáveis sociodemográficas e familiares, o processo de busca de ajuda, o problema apresentado, tentativas anteriores de ajuda utilizadas e expectativas sobre o tratamento. Os resultados permitem reflexões sobre a prática clínica com famílias em clínicas-escola, especialmente a respeito do envolvimento dos clientes no processo terapêutico e à transição da queixa para a demanda desde o período de avaliação inicial. / This research aimed to investigate the help seeking process and the clients attended in couples and family therapy. To achieve this objective, two studies were realized. First, a systematic literature review identified six factors associated with the search for couples and family therapy: personal factors, relationship factors, gender, cultural aspects, prior sources of help and type of problem. After that, a second study characterized the clients attended in family therapy in a school clinic located in Porto Alegre (RS). Structured interviews with 41 adults referred for family therapy were realized. Sociodemographic and familial variables, the search for help process, the main problem, the prior sources of help and the expectations about the treatment were investigated. These results allows reflections about family therapy practice in school clinics, especially about the involvement of the clients on therapeutic process and the transition from the first complaint to the real demand since evaluation period.

The administration of the public service of health, historically organized for the state, passes for transformations that search the improvement of the service offered to its public, the using citizen. The state of São Paulo implemented from 1998 a management system that uses recognized entities socially (SOH - Social Organization of Health) to execute the planned and controlled actions of health for the government. In agreement to this trend of opening and development of the public politics, the federal government search to improve the quality of relationship in its sectors of attendance. The presented research evaluated questions organizations of a clinic of specialties of the city of São Paulo that functions operated for a SOH. Using the perspective of the user, it searched to verify with are the administrative questions that are perceived and valued for the citizen. The results had evidenced low the capacity of perception and evaluation of the users of the clinic. The analysis perceived in the data of the research with superficial characteristics and without criteria technician, can be related with the low educational level of the layers poor of main the Brazilian population that are user public system of health. (National system of health). The research proved the development of the public management in the health area, as well as the viability of application of research correlated to the applied model. / A administração do serviço público de saúde, historicamente organizada pelo Estado, passa por transformações que buscam a melhoria do serviço oferecido ao seu público alvo, o cidadão usuário. O estado de São Paulo implementou a partir de 1998 um sistema de gestão que utiliza entidades reconhecidas socialmente (OSS Organização Social de Saúde) para executar as ações de saúde planejadas e controladas pelo governo. Em concordância à essa tendência de abertura e remodelamento das políticas públicas, o Governo Federal busca melhorar a qualidade de relacionamento em seus setores de atendimento. A pesquisa avaliou questões organizacionais de um ambulatório de especialidades da cidade de São Paulo que funciona operacionalizado por uma OSS. Usando a perspectiva do usuário, buscou verificar quais são os quesitos administrativos que são percebidos e valorizados pelo cidadão. Os resultados evidenciaram a baixa capacidade de percepção e avaliação dos usuários do ambulatório. A análise percebida nos dados da pesquisa, com características superficiais, emotivas e sem critérios técnicos, pode estar relacionada com o baixo nível educacional das camadas mais pobres da população brasileira que são os principais usuários do sistema público de saúde (SUS Sistema Único de Saúde). A pesquisa provou o desenvolvimento do gerenciamento público na área de saúde, assim como a viabilidade de aplicação de pesquisas correlacionadas ao modelo aplicado.

Older adults (65+) are one of the fastest growing segments of the population in the United States. Chronic pain is common among this population, and chronic low back pain (CLBP) in particular is the number one pain complaint among older adults. In addition to larger societal and fiscal costs, CLBP is associated with a host of personal negative consequences such as physical disability, poor psychosocial functioning, and decreased quality of life. Despite being a leading health problem in older adulthood, little is known about how older adults actually experience this type of pain. Thus, the purpose of this dissertation was to understand older adults’ lived experience of CLBP. To improve understanding of CLBP in this understudied population, a qualitative study using a phenomenological method was conducted. Phenomenology, rooted in existential philosophy, is the study of the nature and meanings of phenomena, in which experiences related to the phenomena are the main source of insight. van Manen’s Phenomenology of Practice method specifically guided the investigation with regard to study conception, data collection, and data analysis. Participants were 21 older pain clinic patients living with CLBP who engaged in one-on-one in-depth interviews. Findings suggest that CLBP is an all-encompassing presence in participants’ lives. Seven main themes include: (1) Living a life full of pain; (2) Pain affects everything; (3) With others but a lone in my pain; (4) With pain comes sorrow; (5) Aging painfully; (6) Managing the incurable; (7) You just have to keep going. Implications for social work practice, research, and policy are discussed. By building a deeper understanding of older adult’s experiences and personal meaning of CLBP, social workers may be more able to provide meaningful and effective psychosocial services in the context of interdisciplinary CLBP management.

[pt] Os atos de fala na clínica psicanalítica sintetizam a articulação empreendida no presente trabalho entre a vertente pragmática da filosofia da linguagem e a clínica psicanalítica, tendo como pano de fundo a obra freudiana. A teoria austiniana dos atos de fala se contrapõe a toda a filosofia da linguagem que a precedeu, ao afirmar que a linguagem não tem apenas uma função de representação do mundo ou do pensamento, tampouco de descrição ou relato de fatos. Falar é uma forma de agir no mundo e, como toda ação, produz efeitos, mudanças e transformações. Na clínica psicanalítica encontramos um reduto onde se pode perceber na prática e de forma clara esta característica da linguagem humana: nela a fala assume todo seu poder de ato, sendo o modo pelo qual as mudanças se produzem. / [en] With the speech acts in psychoanalytic clinic we summarize our link between the pragmatic point of view on language studies and psychoanalytic clinic, where we use Sigmund Freud s work as background. The Austin s theory of speech acts oppose the whole language philosophy which preceded him, saying that the language s function is not just to represent the world, the thoughts, or to describe facts. To speak is a way to act in the world, and as all acts it has effects, and starts transformations and changes. We can see clearly within psychoanalytic clinic this feature of human language, where the speech take all it s act power, being the way by which changes is made.

No description available.

Background Neuropathic pain (NP), defined as pain caused by a lesion or disease of the somatosensory system, affects 6.9 – 10 % of people worldwide. Pregabalin is currently recommended as a first line drug for NP in South Africa. Methods A cross-sectional retrospective descriptive medicines usage evaluation (MUE) of Pregabalin at Groote Schuur Chronic Pain clinic for the year 2017 was conducted. A MUE using a standardized data collection form was performed on 100 randomly selected folders. Data are summarized using descriptive statistics. Results The majority of cases were women (76) with a mean age of 55.9y (SD12.49). A diagnosis of NP was recorded in 58 folders and a “possible” diagnosis recorded in 7 folders. In 79 cases there was no mention of a tool/method used to diagnose NP. The most common condition diagnosed was chronic post-surgical pain with a neuropathic component (n=16), followed by NP (n=15). The most common initiating and current dose of Pregabalin was 75mg twice daily. In 56 patients, Pregabalin was prescribed in conjunction with a tricyclic antidepressant (TCA) or selective noradrenaline reuptake inhibitor (SNRI). Patient education was documented as having taken place in 76 of cases. Conclusions Based on this MUE we recommend the use of screening tools for the diagnosis of neuropathic pain, and a focus on the initiating dose of Pregabalin. The use of a standardized assessment document and the interdisciplinary team input at this clinic appears to optimize prescribing of Pregabalin in line with practice guidelines.