Class of 2005 Abstract / Objectives: To compare the interest in and the utility of a clinical intervention documentation tool for Pharm.D. students and preceptors on the basis of gender, age, and years and type of practice. Methods: A web-based survey (pre and post) was administered to all willing subjects. The survey web page was accessed through email. Results: Pre-surveys were completed by 14 students and 4 preceptors. Post-surveys were completed by 3 students (only one of which used the tool) and one preceptor. Due to the poor response rate results on the post-survey and the preceptors pre-survey were not analyzed. For the students pre-survey there were no statistical differences between the men and women in regards to their age. No statistically significant differences were found for students thoughts on utility and usefulness of the documentation tool on the basis of gender. Also there was no statistical difference between the men and women about the likely hood of them using a documentation tool if it was available to them. Implications: This study found that students regardless of gender thought that a documentation tool may prove useful for preceptors and themselves. If a documentation tool was implemented it could provide important information of student activity to the preceptors as well as the College of Pharmacy.

Magister Curationis - MCur / Background: Postpartum haemorrhage (PPH) is one of the most preventable causes of maternal death, yet it still ranks as one of the main conditions responsible for maternal mortality. PPH occurs at a stage when a mother is the least likely to receive care, and mothers often do not survive to be referred to a more specialised level of care. This is compounded by the patient not being able to warn healthcare providers timeously about their condition and healthcare providers lacking training resulting in a lack of accuracy in diagnosis, lack of resources, and differing methods of treatment. Due to the lack of consensus in available treatment options, and the paucity of research aimed at clinical interventions for midwives at the primary care level, this research report aimed to investigate the evidence in order to establish the best practices and evidence for clinical interventions to manage postpartum haemorrhage for midwives at the primary care level. This is to ensure that the continuing education for midwives in practice is based on evidence to keep their skill set current and expose practitioners to the latest evidence based care. Aim: To systematically review all available published evidence for the acute non-pharmaceutical, non-surgical, management of PPH for use by midwives at a primary maternity care setting.

Purpose: To examine the effectiveness of a community-based intensive multifactorial clinical intervention for patients with Type 2 diabetes, to evaluate the feasibility of achieving clinical targets for glycemic control in a community setting, and to identify factors that are predictive of glycemic control in this cohort (age, gender, disease duration, continuity of care, pharmacologic treatment, diabetes self-care and smoking status). Methods: Participants with Type 2 diabetes referred to the Diabetes Clinic following dissemination of the 2003 Clinical Practice Guidelines of Canadian Diabetes Association and who attended a minimum of two physician visits within a twelve month period were deemed eligible for participation. 70 patients were included in this retrospective study. Baseline and twelve month values for the following biomedical outcomes were collected via chart audit: BMI, hemoglobin A1c, blood pressure (systolic, diastolic) and lipid profile (HDL, LDL, triglycerides, total cholesterol, TC:HDL ratio). Data for identification of predictive factors for glycemic control were also retrieved by chart audit. Results: The results of the paired t-test yielded a significant improvement in hemoglobin A1c (p<0.05), systolic blood pressure (p<0.01), HDL-cholesterol (p<0.05), LDL-cholesterol (p<0.01), total cholesterol (p<0.05) and total cholesterol:HDL ratio (p<0.05) over twelve months. No significant difference in BMI, diastolic blood pressure or triglycerides was reported over twelve months. Over half the sample (52.9%) achieved clinical targets for glycemic control (hemoglobin A1c <7.0%) at twelve months. Logistic regression analysis identified disease duration (O.R. = 0.90, 95% CI Exp(B) = 0.079 - 0.773, p = 0.01) and continuity of care (O.R. = 0.25, 95% CI Exp(B) = 0.831 - 0.969, p = 0.02) as significant predictors of glycemic control at twelve months. Conclusions: These findings demonstrate the effectiveness of this community-based intensive multifactorial clinical intervention for patients with Type 2 diabetes and show that the implementation of CPGs related to glycemic control is feasible in a community-based setting. Additionally, patients in this cohort with increased disease duration and increased continuity of care were less likely to achieve clinical targets for glycemic control following a twelve month intensive multifactorial clinical intervention for Type 2 diabetes. In summary, health professionals should strive to implement similar intensive multifactorial interventions in community practice in order to decrease the likelihood of diabetes-related complications and improve the patients quality of life.

Purpose: To examine the effectiveness of a community-based intensive multifactorial clinical intervention for patients with Type 2 diabetes, to evaluate the feasibility of achieving clinical targets for glycemic control in a community setting, and to identify factors that are predictive of glycemic control in this cohort (age, gender, disease duration, continuity of care, pharmacologic treatment, diabetes self-care and smoking status). Methods: Participants with Type 2 diabetes referred to the Diabetes Clinic following dissemination of the 2003 Clinical Practice Guidelines of Canadian Diabetes Association and who attended a minimum of two physician visits within a twelve month period were deemed eligible for participation. 70 patients were included in this retrospective study. Baseline and twelve month values for the following biomedical outcomes were collected via chart audit: BMI, hemoglobin A1c, blood pressure (systolic, diastolic) and lipid profile (HDL, LDL, triglycerides, total cholesterol, TC:HDL ratio). Data for identification of predictive factors for glycemic control were also retrieved by chart audit. Results: The results of the paired t-test yielded a significant improvement in hemoglobin A1c (p<0.05), systolic blood pressure (p<0.01), HDL-cholesterol (p<0.05), LDL-cholesterol (p<0.01), total cholesterol (p<0.05) and total cholesterol:HDL ratio (p<0.05) over twelve months. No significant difference in BMI, diastolic blood pressure or triglycerides was reported over twelve months. Over half the sample (52.9%) achieved clinical targets for glycemic control (hemoglobin A1c <7.0%) at twelve months. Logistic regression analysis identified disease duration (O.R. = 0.90, 95% CI Exp(B) = 0.079 - 0.773, p = 0.01) and continuity of care (O.R. = 0.25, 95% CI Exp(B) = 0.831 - 0.969, p = 0.02) as significant predictors of glycemic control at twelve months. Conclusions: These findings demonstrate the effectiveness of this community-based intensive multifactorial clinical intervention for patients with Type 2 diabetes and show that the implementation of CPGs related to glycemic control is feasible in a community-based setting. Additionally, patients in this cohort with increased disease duration and increased continuity of care were less likely to achieve clinical targets for glycemic control following a twelve month intensive multifactorial clinical intervention for Type 2 diabetes. In summary, health professionals should strive to implement similar intensive multifactorial interventions in community practice in order to decrease the likelihood of diabetes-related complications and improve the patients quality of life.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-07-24T14:50:01Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Tese_Luciana_Holmes_FOLHA_APROVA ÇÃO_Ficha_Catalográfica_25_01.pdf: 3698873 bytes, checksum: f3ad9bfbfbdb382b59bf0c7b2216b2b2 (MD5) / Made available in DSpace on 2017-07-24T14:50:01Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Tese_Luciana_Holmes_FOLHA_APROVA ÇÃO_Ficha_Catalográfica_25_01.pdf: 3698873 bytes, checksum: f3ad9bfbfbdb382b59bf0c7b2216b2b2 (MD5) Previous issue date: 2016-02-29 / A nova classificação da dengue (dengue sem sinais de alarme, dengue com sinais de alarme e dengue grave) da Organização Mundial de Saúde e adotada pelo Ministério da Saúde do Brasil objetiva identificar os pacientes que apresentam um maior risco de complicações. Entre março de 2009 e maio de 2011 formou-se uma coorte prospectiva com suspeitos de dengue em dois hospitais da capital da Paraíba no nordeste do Brasil. De 770 pacientes, 554 preencheram os critérios de inclusão, representados por crianças e adultos, com confirmação laboratorial do diagnóstico de dengue, sendo coletadas informações clínicas, laboratoriais e exame ultrassonográfico. O estudo realizado foi para validar a classificação revisada da Organização Mundial da Saúde, na identificação de casos graves, baseado nos níveis de intervenção clínica (Categoria I, II e III) e nos achados ultrassonográficos. Foram testadas a sensibilidade, especificidade, valores preditivos positivo e negativo da nova classificação com os níveis de intervenção. A sensibilidade e a especificidade da dengue grave para os casos da Categoria III foram de 100% e 91%, respectivamente, com valor preditivo positivo de 15,5% e valor preditivo negativo de 100%. Esses dados demonstram uma maior sensibilidade da classificação revisada na detecção de pacientes com risco de evoluírem para formas graves da doença. A ultrassonografia mostrou ser uma ferramenta útil na identificação de casos suspeitos de dengue e na detecção precoce de sinais de extravasamento plasmático. Os achados ecográficos mais relevantes foram espessamento difuso da parede da vesícula biliar, líquido livre na cavidade abdominal e pélvica, derrame pleural, esplenomegalia e hepatomegalia. O espessamento da parede da vesícula biliar e os derrames cavitários mostraram significância estatística com a nova classificação. / The new classification of Dengue (Dengue without Warning Signs, Dengue with Warning Signs and Severe Dengue) from the World Health Organization and adopted by the Department of Health of Brazil aims to identify patients with a higher risk of complications. From March 2009 to May 2011 formed a prospective cohort with suspected dengue fever in two hospitals in the capital of Paraíba in northeastern Brazil. In 770, 554 patients met the inclusion criteria, represented by children and adults, presenting laboratory confirmation of the diagnosis of dengue, and collected clinical information, laboratory and ultrasound examination. The study was to validate the revised WHO classification to identification of severe cases, based on the clinical intervention (Category I, II e III) and ultrasound findings. Tested the sensitivity, specificity, positive predictive values and negative of new classification with the levels of intervention. The sensitivity and specificity of the Severe Dengue for the cases of category III were 100% and 91%, respectively, with positive predictive value of 15.5% and negative predictive value 100%. These data demonstrate a greater sensitivity of the revised classification in detecting patients with risk of evolve to serious disease. The ultrasonography was a useful tool in the confirmation of suspected cases of dengue fever and on early detection of signs of plasma leakage. Ultrasound findings more important were: thickened gall bladder wall, free fluid in the abdominal and pelvic cavities, pleural effusion, splenomegaly and hepatomegaly. The gallbladder wall thickening and effusions showed statistical significance with the new classification.

The objective of the current research was to test the initial feasibility and potential efficacy of a group-based Acceptance and Commitment Therapy (ACT) intervention for partner aggression, compared to a support and discussion control group, in a clinical sample of adults. Specifically, the study was intended to provide preliminary evidence of the impact of an ACT group on psychological and physical aggression, and to examine the processes responsible for any treatment effects. One hundred and one participants (mean age = 31; 68% female) were randomly assigned to receive ACT or the support and discussion control group. Both interventions consisted of 12 weekly 2-hour sessions and participants were assessed with self-report measures at pre-treatment, twice during treatment, at post-treatment, and at 3- and 6-month follow-up. Results of growth curve modeling analyses demonstrated that participants in the ACT group had significantly greater decreases in psychological and physical aggression at post-treatment and follow-up, and also showed improvements in depressive symptoms, interpersonal problems, and social functioning. Finally, the effect of the ACT group on psychological and physical aggression was mediated by experiential avoidance, suggesting that the intervention had its effects, at least in part, through increasing emotional acceptance. These results demonstrate that an ACT approach to aggression may be a viable alternative to traditional treatments.

This study investigates the concurrent and predictive validity of Power Management (PM), a newly developed online integrative therapeutic assessment. PM consists of a self-report personality inventory, the Relational Modality Evaluation Scale (RMES), a series of self-guided narrative prompts, and a detailed follow-up score-report. The study had three aims: (1) to evaluate the convergent validity of the RMES in relation to the Big Five Inventory-10 (BFI-10) and the Inventory of Interpersonal Problems Short-Circumplex (IIP-SC), (2) to investigate the test re-test reliability of the RMES, and (3) to investigate the therapeutic benefits of PM by comparing it with narrative and mindfulness self-guided interventions over time, on outcome measures evaluating affect, insight, psychopathology, well-being, self-esteem, ability to change, and personal relevance. Aim 3 was investigated using a short-term longitudinal design, in which outcome measures were administered at baseline (before interventions), immediately following interventions (post), and two weeks later (follow-up). The sample was recruited online through Mechanical Turk and at baseline included 82 men and 101 women, mean age = 35.82 years (SD = 9.61). Participants were randomly assigned to one of three interventions: PM (42 men, 56 women), narrative writing (26 men, 25 women), and mindfulness (14 men, 20 women). For Aim 1, partial correlations, controlling for demographics, identified statistically significant relationships between RMES, BFI-10, and IIP-SC subscales predicting personality constructs with high agency and high affiliation, high agency and low affiliation, low agency and high affiliation, low agency and low affiliation, as well as psychopathology. For Aim 2, The RMES showed strong test re-test reliability over a two-week period (r = .84, p < .000). For Aim 3, mixed-model repeated-measures ANOVAs indicated that the PM group had statistically significantly higher scores on outcome measures reflecting increased psychological well-being, insight, and motivation for change compared to the other groups. Scores improved between baseline and post for most psychotherapy outcome constructs across interventions. Gender mostly did not moderate results. Results suggest that PM is a promising therapeutic assessment worthy of further investigation. Mindfulness and narrative writing also showed evidence of effectiveness as delivered in an online format.

Submitted by William Justo Figueiro (williamjf) on 2015-07-10T23:11:55Z No. of bitstreams: 1 46b.pdf: 606817 bytes, checksum: 2f58d08ceb4cd061f9bc2aeddb86dccd (MD5) / Made available in DSpace on 2015-07-10T23:11:55Z (GMT). No. of bitstreams: 1 46b.pdf: 606817 bytes, checksum: 2f58d08ceb4cd061f9bc2aeddb86dccd (MD5) Previous issue date: 2010-10 / Nenhuma / Esta Dissertação de Mestrado em Psicologia Clínica focalizou o estudo de caso de pacientes que manifestavam impotência sexual. Com base nas contribuições do referencial psicanalítico, mais especificamente, das teorizações de Bleichmar acerca da constituição do psiquismo e da constituição sexual masculina, foi desenvolvida uma pesquisa de delineamento qualitativo-exploratório. Dois estudos de casos de pacientes com disfunção erétil foram realizados, a partir dos relatos das sessões de psicoterapia. Os dados foram analisados por meio do Estudo de Caso em Psicanálise, identificando-se aspectos significativos da constelação familiar. Estes aspectos permitiram apontar a importância dos efeitos do processo de constituição do aparelho psíquico e constituição sexual masculina sobre as manifestações da sexualidade genital (adulta), bem como demonstrar a importância da escuta para reorganizar além da vida sexual, a potência diante da vida. / This Master's thesis in clinical psychology focused on the case study of patients who showed sexual impotence. Based on the contributions of psychoanalysis, more specifically, the theories of Bleichmar about the constitution of the psyche and of male sex, a study of exploratory qualitative research was designed. We investigated two case studies of patients with erectile dysfunction based on the reports of sessions of psychotherapy. Data were analyzed using the Case Study in Psychoanalysis. We identified significant aspects of family constellation that led to the conclusion about the importance of the effects of the constitution of the psychic apparatus and male sexual constitution on the manifestations of genital sexuality (adult). And also demonstrated the importance of listening to rearrange, beyond the sex life, the power to life.

Deux faits interpellent le psychologue intervenant auprès des hommes auteurs de violences dans le couple : la responsabilisation et la prévention de la récidive en tant qu’ils constituent le moyen et la visée des interventions. À partir d’une analyse liminaire du fonctionnement des centres de prise en charge en France, la dimension de la répétition en tant que grille d’interprétation de ces violences, et en particulier en tant qu’elle structure la clinique, est interrogée. Pour ce faire, je développe le concept de répétition à l’appui de la théorie psychanalytique et analyse 8 témoignages d’hommes en m’intéressant aux fantasmes sous-jacents. Cinq constats sont ainsi relevés : la récurrence d’imagos paternelles et maternelles fortes, de composantes cruelles chez l’objet, de traits sadiques et de libido homosexuelle. Le développement théorique qui s’ensuit s’articule autour de quatre thématiques : l’identification à l’agresseur, le fantasme de la mère cruelle, le sadisme et la jalousie. / Two aspects of clinical interventions for male perpetrators of intimate partner violence are of concern to psychologists: the perpetrators’ responsibility and the prevention of recidivism insofar as they constitute the means and the aim of these interventions. From the initial analysis of batterer programmes in France, repetition, as a dimension for interpretating male intimate partner violence, in particular within a clinical intervention context, is examined. To this end, I develop the concept of repetition based on psychoanalytic theory and analyse 8 interviews of male perpetrators, focussing on the underlying fantasies. This approach led to five findings: the recurrence of strong paternal and maternal imagos, cruelty components within the object, sadistic traits and homosexual libido. The ensuing theoretical development hinged on four concepts: identification with the aggressor, the fantasy of the cruel mother, sadism and jealousy.

Made available in DSpace on 2016-04-28T20:40:11Z (GMT). No. of bitstreams: 1 Marcia Campos de Oliveira.pdf: 539358 bytes, checksum: f40ad60de73ac1d003173e93b01e757a (MD5) Previous issue date: 2009-10-19 / The hospital institution transplants the illness for itself, expropriating it of the body of the patient. On doing so, it creates a dynamics that favors the specialized treatment. Being thus, the patient is seen as a broken up form to Doctors, Nurses, Assistants, Nutritionists, among others. With the advanced technician the diagnosis has become next to the absolute and the therapeutical performance even more secure, characteristics sufficiently valued. Not rare, hospital advertisements of the following nature are propagated in the media: we have the best technology to take care of your children , more specifically in intensive care unit (ICU). But commonly the treatment is made of privation, illness and death. Being so, the technological apparatus and the medical precision can make the difference between the life and the death of the patient. Thus being, the ICU is organized to be a way of permanence of the patient on devices, asepsis, instability and, over all, urgency. However, only the technical care of the patient is not able to embrace the imponderable. The contradiction, the frustration and too many other proper aspects of the human being condition that are also part of the day of the one in the ICU, which, although exists, is not always able to emerge. To recognize the necessity of humanize the hospital attention became a public politics in Brazil since 2001. This stimulated other professionals to study the subject. This debate puts in question some attitudes and hospital procedures and, without a doubt, it provoked, ideological, epistemological and political confrontations. Ahead of this context, this research contributes to this quarrel; therefore it was worried about understanding a clinical way to intervene in this environment. For such, I made use of the phenomenological -hermetical method of research. Aiming to understand the experiences in IUC I mainly appealed to the thought and the clinic of Donald D. Winnicott and also of Gilberto Safra which had resonances in my clinical and procedural style. At first, the proceeding consisted of making me available to narrate fairy tales to hospitalized children. However, as the research evoluted, I realized, after some time in the ICU, that the potentiality of the meetings with the child, their parents accompanying and the medical staff, became something fundamental in the intervention. Hereupon, in a slow pace, the fairy tales were put aside, and I began to listen to the stories of the Institution s personnel. Thereon, the transition for the application of fairy tales to the potential space as a procedure, took place. Amongst the undergone experiences, I had examined four clinical situations involving hospitalized children, accompanying parents, health care team and my own transformation as a researcher sympathetic to the undergone suffering in the ICU / A instituição hospitalar transplanta a doença para si, expropriando-a do corpo do paciente. Ao fazê-lo, cria uma dinâmica que favorece o tratamento especializado. Sendo assim, o paciente é visto de forma fragmentada por Médicos, Enfermeiros, Auxiliares, Nutricionistas, dentre outros cuidadores. Com o avanço técnico o diagnóstico tem se tornado próximo ao absoluto e a terapêutica cada vez mais segura, características bastante valorizadas. Não raro, veiculam-se na mídia propagandas hospitalares da seguinte natureza: temos a melhor tecnologia para cuidar de seu filho. Mais especificamente em Unidade de Terapia Intensiva (UTI) o que comumente se vive é privação, adoecimento e morte. Nesse sentido, o aparato tecnológico e a precisão médica podem fazer a diferença entre a vida e a morte do paciente. Assim sendo, a UTI se organiza por meio da permanência de aparelhos ligados, assepsia, instabilidade e, sobretudo, urgência. No entanto, apenas o cuidado técnico não dá conta de acolher o imponderável, as contradições, as frustrações e demais aspectos próprios da condição humana que também estão presentes no cotidiano da UTI, os quais, apesar de existirem, nem sempre podem emergir. Reconhecer a necessidade de humanizar a atenção hospitalar tornou-se política pública no Brasil a partir de 2001. Isso incentivou a outros profissionais estudar o tema. Esse debate põe em questão várias atitudes e procedimentos hospitalares e, sem dúvida, provoca confrontos políticos, ideológicos e epistemológicos. Diante desse contexto, essa pesquisa contribui com essa discussão, pois se preocupou em compreender um modo clínico de intervir nesse ambiente. Para tal, utilizei-me do método fenomenológico-hermêutico de investigação. Visando compreender as vivências em UTI recorri principalmente ao pensamento e a clínica de Donald D. Winnicott e também de Gilberto Safra os quais produziram ressonâncias no meu estilo clínico. De início, o procedimento consistiu em disponibilizar-me para narrar contos de fadas escolhidos pela criança internada. Contudo, no decorrer da pesquisa percebi, na medida em que transitava pela UTI, que a potencialidade do encontro com a criança, com os pais acompanhantes e com a equipe se tornou algo fundamental na intervenção. Assim sendo, aos poucos os contos de fadas foram sendo deixados de lado e passei a ouvir histórias das pessoas na instituição. Desse modo, ocorreu a passagem do uso de história para o espaço potencial como procedimento. Dentre as vivências, discuti quatro situações clínicas envolvendo crianças hospitalizadas, mães e pais acompanhantes, equipe de saúde e a minha própria transformação como pesquisadora empática ao sofrimento experimentado em UTI