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Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-03-30T11:36:52Z No. of bitstreams: 2 Dissertação - Eldeci Cardoso da Silva - 2014.pdf: 4717681 bytes, checksum: 891e8f812b0baea3c679106aed6d5481 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-03-31T11:20:55Z (GMT) No. of bitstreams: 2 Dissertação - Eldeci Cardoso da Silva - 2014.pdf: 4717681 bytes, checksum: 891e8f812b0baea3c679106aed6d5481 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-03-31T11:20:55Z (GMT). No. of bitstreams: 2 Dissertação - Eldeci Cardoso da Silva - 2014.pdf: 4717681 bytes, checksum: 891e8f812b0baea3c679106aed6d5481 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-02-10 / Virtual Clinical cases are effective interactive tools for assessing clinical skills, simulating various aspects of doctor patient interaction. The aims of this study were to develop and psychometrically validate a virtual tool to assess knowledge about the diagnosis and rational treatment of diabetes mellitus, based on its pathophysiology, in a computer graphical user interface, and to propose a model of support for teaching, in order to promote Telecare and Tele-education. This was a methodological development study with a quantitative approach. The virtual clinical cases were applied to a group of 14 doctors from a universe of 60 Endocrinologists (experts) and to another group of 72 third-year medical school students. The process followed the guidelines for the evaluation of psychometric properties with descriptive and inferential analyses. For reliability analysis, Cronbach's alpha was applied to expert, student and all-group questionnaires (,890: ,606: ,770). The difference in scores between experts and students was highly significant by Friedman (p > 0.01) and Wilcoxon (p > 0.001) tests. From the analysis of the scores, a manual for regulation of VCC and a graphical interface in virtual clinical case format (simulation) were created, linked to a database hosted on the Telehealth system – Goiás Federal University of Goias platform. The instrument is easy to understand and to use by subjects. When applied to students and medical professionals, the instrument also fulfills a function of process evaluation parallel to the formative process and can also be useful in continuing education in the FHS. In summary, the VCC resulted in an instrument with proven psychometric properties and features, and can therefore be considered a valid and reliable instrument to measure knowledge about the diagnosis and rational treatment of DM based on its pathophysiology. The project has pioneered, since there was not an online tool, developed and previously validated for reviewing of clinical cases. We intend to continue this project expanding its use for formative assessment and continuing education in other specialties of internal medicine. / Casos clínicos virtuais são ferramentas interativas eficazes para avaliação de competências clínicas, simulando vários aspectos da interação médico paciente. O objetivo desse trabalho foi desenvolver e validar psicometricamente uma ferramenta virtual para avaliar conhecimentos sobre o diagnóstico e tratamento racional do diabetes mellitus, baseado em sua fisiopatologia, em uma interface gráfica computacional, além de propor um modelo de suporte para o ensino, promovendo assim a Teleassistência e a Teleducação. Foi realizado um estudo de desenvolvimento metodológico, de abordagem quantitativa, no qual os casos clínicos virtuais foram aplicados a um grupo de médicos endocrinologistas (experts) e a um grupo de discentes do terceiro ano de um curso de medicina. O processo seguiu as normas de avaliação das propriedades psicométricas com análises descritivas e inferenciais. Para análise da confiabilidade foi utilizado o alpha de Crombach para os questionários dos experts, discentes e todos os grupos (0,890: 0,606: 0,770). A diferença de escore entre experts e discentes foi altamente significativa pelos testes de Friedman (p>0,01) e Wilcoxon (p>0,001). A partir das análises dos escores, foram criados um manual de normatização dos casos clínicos virtuais e uma interface gráfica virtual em formato de casos clínicos, vinculados a um banco de dados hospedado na plataforma do sistema de Telessaúde-GO da Universidade Federal de Goiás. O instrumento demonstrou ser de fácil compreensão e utilização pelos sujeitos do estudo. Quando aplicado aos discentes e aos médicos o instrumento cumpriu, também, uma função de avaliação processual paralela ao processo formativo e poderá ser útil também na educação permanente na ESF. Os CCV resultaram em um instrumento com características e propriedades psicométricas comprovadas, e que pode, assim, ser considerado válido e confiável para medir o conhecimento sobre diagnóstico e tratamento racional do DM baseado em sua fisiopatologia. Pretende-se dar continuidade a esse projeto ampliando sua utilização para avaliação formativa e educação permanente em outras especialidades da clínica médica.

The purpose of this study was to explore and describe the use of Gestalt therapy as an alternative assessment technique with two primary school girls who have been sexually abused. The empirical study of limited extent, was qualitative in nature and conducted from the interpretivist paradigm. I used two in-depth clinical case studies situated within the context of psychotherapy outcome research as research design. I developed and implemented alternative assessment based on Gestalt therapy and employed observation, interviews, informal discussions, analysis of documentation, a reflective diary, field notes and visual data (photographs and original media) as data collection and documentation methods. I purposefully selected two primary school girls who have been sexually abused as participants in the study. The findings of the study were, firstly, that Gestalt therapy could be used as an effective alternative assessment technique with the target participants as it seemingly provided a safe setting to express emotions, fears and needs related to the trauma of sexual abuse. In this regard, a finding was that the primary participants had to deal with challenging emotions including anxiety, fear, aggression, anger, hatred, rage, sadness and depression. A related finding was that they experienced a need for love, unconditional acceptance, support and protection. Similarly, the study found that they also displayed negative behaviour such as inadequate social behaviour, restlessness and withdrawal from challenging social situations. Most importantly, utilising this mode of assessment rendered insight into the defence mechanisms they employed such as denial, avoidance, suppression and escapism. Secondly, alternative assessments based on Gestalt therapy seemed to have a positive effect on both participants, as indicated by change during and after the process of assessment in terms of emotions, behaviour and the use of defence mechanisms. / Dissertation (MEd (Educational Psychology))--University of Pretoria, 2007. / Educational Psychology / MEd / unrestricted

The purpose of this study was to explore and describe the use of Gestalt therapy as an alternative assessment technique with two primary school girls who have been sexually abused. The empirical study of limited extent, was qualitative in nature and conducted from the interpretivist paradigm. I used two indepth clinical case studies situated within the context of psychotherapy outcome research as research design. I developed and implemented alternative assessment based on Gestalt therapy and employed observation, interviews, informal discussions, analysis of documentation, a reflective diary, field notes and visual data (photographs and original media) as data collection and documentation methods. I purposefully selected two primary school girls who have been sexually abused as participants in the study. The findings of the study were, firstly, that Gestalt therapy could be used as an effective alternative assessment technique with the target participants as it seemingly provided a safe setting to express emotions, fears and needs related to the trauma of sexual abuse. In this regard, a finding was that the primary participants had to deal with challenging emotions including anxiety, fear, aggression, anger, hatred, rage, sadness and depression. A related finding was that they experienced a need for love, unconditional acceptance, support and protection. Similarly, the study found that they also displayed negative behaviour such as inadequate social behaviour, restlessness and withdrawal from challenging social situations. Most importantly, utilising this mode of assessment rendered insight into the defence mechanisms they employed such as denial, avoidance, suppression and escapism. Secondly, alternative assessments based on Gestalt therapy seemed to have a positive effect on both participants, as indicated by change during and after the process of assessment in terms of emotions, behaviour and the use of defence mechanisms. / Dissertation (MEd (Educational Psychology))--University of Pretoria, 2008. / Curriculum Studies / unrestricted

Masters of Art / This project suggested that HIV people in Region A (Nelson Mandela Metropole, formerly Port Elizabeth) health district of the Eastern Cape, seek HIV testing when they are already in stages three (late disease) and four (AIDS) of HIV infection. Data had been obtained from the AIDS Training Information and Counselling Centre in the Nelson Mandela Metropole in 2000. The consequences of diagnoses only in the advanced stages of HIV infection will have a devastating impact on case management. Therefore, this paper yielded important data for South African policy makers to write health and welfare policies that might improve the quality of life of those terminally infected with HIV. / South Africa

Les progrès des technologies de l'information et de la communication, des MEMS, des capteurs, actionneurs, etc. ont permis l’émergence de différents dispositifs biomédicaux. Ces nouveaux dispositifs, souvent embarqués, contribuent considérablement à l'amélioration du diagnostic et du traitement de certaines maladies, comme le diabète par exemple. Des dispositifs embarqués encore plus complexes sont en cours d’élaboration, leur mise en œuvre nécessite des années de recherche et beaucoup d’expérimentation. Le cœur artificiel, encore en phase de réalisation, est un exemple concret de ces systèmes complexes. La question de la fiabilité, du test de fonctionnement et de sureté de ces dispositifs reste problématique et difficile à résoudre. Plusieurs paramètres (patient, évolution de la maladie, alimentation, activité, traitement, etc.) sont en effet à prendre en compte et la conséquence d’une erreur de fonctionnement peut être catastrophique pour le patient. L'objectif de cette thèse est de développer des outils et des approches méthodologiques permettant la validation et le test au niveau système de ce type de dispositifs. Il s’agit précisément d’étudier la possibilité de modéliser et simuler d’une manière conjointe un dispositif médical ainsi que son interaction avec le corps humain, du moins la partie du corps humain concernée par le dispositif médical, afin de mesurer les performances et la qualité de services (QoS) du dispositif considéré. Pour atteindre cet objectif notre étude a porté sur plusieurs points. Nous avons d’abord mis en évidence une architecture simplifiée d’un modèle de corps humain permettant de représenter et de mieux comprendre les différents mécanismes du corps humain. Nous avons ensuite exploré un ensemble de métriques et une approche méthodologique générique permettant de qualifier la qualité de service d’un dispositif médical donné en interaction avec le corps humain. Afin de valider notre approche, nous l’avons appliquée à un dispositif destiné à la régulation du taux de sucre pour des patients atteints du diabète. La partie du corps humain concernée par cette pathologie à savoir le pancréas a été simulé par un modèle simplifié que nous avons implémenté sur un microcontrôleur. Le dispositif de régulation de l’insuline quant à lui a été simulé par un modèle informatique écrit en C. Afin de rendre les mesures de performances observées indépendantes d’un patient donné, nous avons étudiés différentes stratégies de tests sur différentes catégories de patients. Nous avons pour cette partie mis en œuvre un générateur de modèles capable de reproduire différents états physiologiques de patients diabétiques. L’analyse et l’exploitation des résultats observés peut aider les médecins à considérablement limités les essais cliniques sur des vrai patients et les focaliser uniquement sur les cas les plus pertinent. / A Biomedical research seeks good reasoning for solving medical problems, based on intensive work and great debate. It often deals with beliefs or theories that can be proven, disproven or often refined after observations or experiments. The problem is how to make tests without risks for patients, including variability and uncertainty on a number of parameters (patients, evolution of disease, treatments …). Nowadays, medical treatment uses more and more embedded devices such as sensors, actuators, and controllers. Treatment depends on the availability and well-functioning of complex electronic systems, comprising thousands of lines of codes. A mathematical representation of patient or device is presented by a number of variables which are defined to represent the inputs, the outputs and a set of equations describing the interaction of these variables. The objective of this research is to develop tools and methodologies for the development of embedded systems for medical fields. The goal is to be able to model and jointly simulate the medical device as well the human body, at least the part of the body involved in the medical device, to analyze the performance and quality of service (QoS) of the interaction of the device with the human body. To achieve this goal our study focused on several points described below. After starting by defining a prototype of a new global and flexible architecture of mathematical model of human body, which is able to contain required data, we begin by proposing a new global methodology for modeling and simulation human body and medical systems, in order to better understand the best way to model and simulate these systems and for detecting performance and the quality of services of all system components. We use two techniques that help to evaluate the calculated QoS value. The first one calculates an index of severity which indicates the severity of the case studied. The second one using a normalization function that represents the simulation as a point in order to construct a new error grid and use it to evaluate the accuracy of value measured by patients. Using Keil development tools designed for ARM processors, we have declared a new framework in the objective to create a new tester model for the glucose-insulin system, and to define the basic rules for the tester which has the ability to satisfy well-established medical decision criteria. The framework begins by simulating a mathematical model of the human body, and this model was developed to operate in the closed loop of the glucose insulin. Then, the model of artificial pancreas has been implemented to control the mathematical model of human body. Finally a new tester model was created in order to analyze the performance of all the components of the glucose-insulin system.. We have used the suitability of partially observable Markov decision processes to formalize the planning of clinical management.