Introduction Oral Non-steroidal anti-inflammatory drugs (NSAID) is an analgesia and is commonly used by people with osteoarthritis (OA). Oral NSAID is currently recommended as the second level of treatment for OA, and could be considered if physical activity, topical NSAID or paracetamol do not supply sufficient pain relief.   Aim To investigate how frequently oral NSAID is used in a sample of New Zealanders with OA and also to investigate the exposure to heightened risk of adverse events while using oral NSAID.   Method A cross-sectional survey was conducted to collect information about the use of oral NSAID by people with self-reported OA. The survey included 75 participants who were over the age of 45 with an average age of 70.6 years.   Results While having OA, 57,3% of the sample reported oral NSAID use. The results also show that 52% of the participants with cardiovascular (CV), gastrointestinal (GI) or renal comorbidities used oral NSAID, and 17,3% of them also combined that NSAID with medication for their comorbidity. Concerning the heightened risks of adverse events, 21% of the participants did acquire the analgesia over the counter (OTC), and 76,6% stated that they were over the age of 65.    Conclusion A majority of the participants in the study with self-reported OA take NSAID as an analgesia. Also, the study shows that NSAID is commonly used among participants with co-morbidity, which is similar to figures presented in previous studies in the area. However, the small sample size limits its generalizability to a larger population. / Introduktion Orala icke-steroida antiinflammatoriska läkemedel (NSAID) är en grupp smärtstillande mediciner som är vanligt använt av personer mer artros. Orala NSAID-preparat rekommenderas idag som en andrahandsbehandling och kan övervägas om fysisk aktivitet, topikala NSAID-preparat eller paracetamol inte ger tillräcklig smärtlindrande effekt.   Syfte Att undersöka hur vanligt användandet av orala NSAID-preparat är i ett stickprov av personer med artros i Nya Zeeland samt att undersöka exponering av orala NSAID-preparat i subgrupper med ökad risk för biverkningar vid användande av orala NSAID-preparat.   Metod En tvärsnittsstudie genomfördes för att samla in information kring användning av orala NSAID-preparat av personer med självrapporterad artros. Studiepopulationen bestod av 75 personer över 45 års ålder med en medelålder på 70,6 år.   Resultat 57,3% av deltagarna använder orala NSAID-preparat som behandling för sin självrapporterad artros. Gällande subgrupper med ökad risk för biverkning av NSAID användning visar studien att 52% av deltagare med kardiovaskulära, gastrointestinala eller njurpåverkade sjukdomar använder orala NSAID-preparat och av dessa kombinerar 17,3% NSAID-preparaten med medicin för sin samsjuklighet. Av deltagarna som uppgav att de använder orala NSAID-preparat erhåller 21% av dessa NSAID-preparaten receptfritt över disk. Av deltagare som var 65 år eller äldre uppgav 76,6% att de använder orala NSAID-preparat för behandling av artros.   Slutsats En majoritet av deltagarna med självrapporterad artros tar orala NSAID-preparat i smärtstillande syfte för sin artros. Studien visar också att NSAID ofta används bland deltagare med samsjuklighet, vilket motsvarar presenterade siffror från tidigare studier inom området. Den lilla stickprovsstorleken begränsar emellertid studiens generaliserbahet gentemot en större population.

The increasing use of health information technology (HIT) is due to a rising interest in improving the quality of health care. HIT has the potential to reduce cost and transform services. Proper clinical support systems will contribute to the meaningful use of HIT systems by providing a wide array of data to clinicians for the diagnosis and treatments. Clinical guidelines, created by a consensus of experts, can be put in place to assist physicians in making clinical decisions. Delphi methods are commonly used to create consensus from surveys completed by a team of experts. Image-based studies could create guidelines that standardize severity, deformity or other clinical classifications. As these studies were traditionally conducted using paper-based media, the cost and time requirement often make the process impractical. Using state of the art Web 2.0 technologies, a web-based system can aid medical researchers in conducting image-based Delphi studies for improved clinical guidelines and decision support.

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PhD thesis assessing the role of non-randomized studies with randomized in evidence syntheses of health interventions. / Randomized studies (RS) are considered the best source of evidence for knowledge syntheses (e.g., systematic reviews, health technology assessments, health guidelines, among others) about healthcare interventions. Historically, non-randomized studies (NRS) have been usually discarded from knowledge syntheses of interventions due to their intrinsic risk of bias and confounding, and they are used only when RS are considered unfeasible or unethical to conduct. With better research methods in observational studies and new tools for the evaluation of risk of bias, NRS are more likely to be a helpful source of information when used as replacement, sequential, or complementary evidence. This, together with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, provide an opportunity for guiding decisions about using RS and NRS in knowledge synthesis and increasing our certainty in a body of evidence. This work aims to improve research synthesis methods by assessing the role and use of RS and NRS in knowledge syntheses using GRADE. This can help health professionals, researchers, guideline developers, and policy-makers build better and more complete healthcare recommendations. / Thesis / Doctor of Philosophy (PhD) / All recommendations about healthcare interventions (from common medicines to strategies to prevent diseases) should ideally come from an adequate synthesis (e.g., systematic reviews) of the least biased studies. Many researchers and authors of health syntheses consider randomized studies (RS), the ‘gold standard’ to demonstrate if an intervention is truly effective. Unfortunately, they are not always available, feasible, or ethical to conduct. Non-randomized studies (NRS), also called observational studies, can potentially provide complementary evidence for a research question. Unfortunately, they are usually considered of poorer quality because of their intrinsic nature of being prone to bias and confounding. In most circumstances, authors of syntheses discard these types of studies from the outset, without considering their potential for providing evidence that could complement or even replace that from randomized studies. This work aims to improve this situation by offering methods for evaluating the appropriateness of integrating both RS and NRS, guiding authors and researchers in cases where this is possible, hence increasing the certainty in a body of evidence and help all stakeholders reach decisions.

Formål: Bestemme omfangen, typen, udløsende årsager, bagvedliggende faktorer og konsekvenser af vold og trusler om vold mod behandlere i Københavns Amts Behandlingscenter for Stofbrugere samt at udvikle kliniske retningslinier for håndtering og minimering af vold og trusler om vold. Metode: Omfanget af voldsepisoder blev vurderet ved to metoder: 1) Retrospektiv anonym tværsnitsspørgeskemaundersøgelse af samtlige 84 fastansatte medarbejder 2) Kohorte undersøgelse med prospektiv registrering af alle psykiske og fysiske voldsepisoder i en tre måneders periode i 2001-2002. Årsager, faktorer og konsekvenser blev undersøgt i semi-strukturerede interviews med den voldsramte medarbejder og den voldelige klient. Håndteringen af voldsepisoderne blev vurderet i en audit procedure og kliniske retningslinier i relation til håndtering af arbejdsrelateret vold og trusler om vold blev udviklet . Resultat: I tværsnitsundersøgelsen svarede 73 (87%), 45% (n=33) af medarbejderne havde været udsat for vold af psykisk eller fysisk karakter indenfor det sidste år, 48% (n=35) indenfor de sidste fem år. Hyppigheden var uafhængig af medarbejderens alder, køn og arbejdserfaring. Kohorteundersøgelsen afslørede, med en svar procent på 57%, 16 tilfælde af ren psykisk vold medførende en incidens på 0.77 pr. arbejdsår pr. medarbejder eller 0.24 psykisk voldsepisode pr. dag, 11 tilfælde af kombineret psykisk/fysisk vold medførende en incidens 0.53 pr. arbejdsår pr. medarbejder eller 0.17 psykisk/fysisk voldsepisode pr. dag (ca. een ugentligt). Politi blev tilkaldt 5(19%) gange. Bagvedliggende faktorer inkluderede dybe frustrationer mod behandlersystemet, lavt selvværd og dårlig kommunikationsevne hos klienterne. Hovedparten af medarbejderne oplevede efterfølgende angstreaktioner. Sygemelding og psykologisk krisehjælp forekom kun i få tilfælde. På basis af audit-panelets rekommandationer blev der udviklet kliniske retningslinier for håndtering af vold og trusler om vold. Konklusion: Prævalenses og incidensen af vold og trusler om vold i arbejdet med stofbrugere er højere end i andre fagområder både i og uden for sundhedsvæsenet med væsentlige konsekvenser for både medarbejderen og specielt for den voldelige klient. Resultaterne i dette studie kvantificerer arbejdsrelateret vold som ikke fremgår af officielle registre (”mørketal”) / Purpose: To determine the extent, type, precipitating factors, causality and consequences of work related threats and violence at the Copenhagen County Substance Abuse Treatment Centre and to develop clinical guidelines in order to minimise threats and violence. Methods: The extent of violent episodes was estimated using two methods: 1) Retrospective anonymous questionnaire issued to all (n=84) full-time employed staff-members. 2) In a tree months period 2001-2002 prospective registration of all physical and psychological violent episodes at the Copenhagen County Substance Abuse Treatment Centre was performed. Precipitating factors, causality and consequences were investigated in semi-structured interviews including all abused staff-members and violent clients. The management of violent episodes was audited in an audit panel and clinical guidelines regarding work related threats and violence were developed. Results: 73 (87%) staff-members completed the questionnaire. 33(45%) staff-members had experienced work related violence in the last year, 35(48%) in the last 5 years. There were no sub-group differences. The prospective registration identified 16 episodes of psychological violence, constituting an incidence of 0.77 pr. work-year pr. staff-member or 0.24 psychological violent episodes pr. day at the centre. 11 combined physical and psychological violent episodes were identified ending up with an incidence of 0.53 violent episode pr. work-year pr. staff-member or 0.17 violent episodes at the centre pr. day. Police was called in 5(19%) of the cases. The clients were characterized by harboring deep frustrations towards the system, low self-esteem and poor communication skills. The majority of the abused staff-members experienced anxiety reactions. Only a few required sick-leave and psychological crises counseling. On the basis of the audit-panel’s recommendations clinical guidelines regarding threats and violence were developed. Conclusions: The prevalence and incidence of work related threats and violence is higher among staff-members treating substance users than in other fields both in- and outside the Health Service. There are consequences of significance for both the abused staff-member and the violent client. The results of this study quantify the extent of violence not registered in official registers. / <p>ISBN 91-7997-109-1</p>

Este estudo analisou uma amostra de 40 gestantes HIV + , referenciadas e acompanhadas na rede de serviços do Sistema Único de Saúde (SUS) de Curitiba, 2005. Objetivou analisar, por intermédio dos registros em prontuários, a adesão dos profissionais ao protocolo de atenção a gestantes Programa Mãe Curitibana. Observouse que (a) os registros de dados administrativos (nome completo, data de nascimento, endereço e datas das vindas das gestantes ao ambulatório) foram preenchidos em todos os prontuários; (b) dados como da inibição da lactação e orientação para a não amamentação dos recémnatos, filhos de gestantes HIV + , não foram registrados nos prontuários em 22,5% e 27,5% respectivamente; (c) a definição do tipo de parto, levando em conta o resultado da carga viral, foi encontrada em 55% dos prontuários; (d) o percentual de parto por cesárea foi de 82,5%, sendo 2/3 programados. Concluise que há adesão parcial ao protocolo Assistencial do Programa Mãe Curitibana. Recomendase um processo de avaliação sistemática desses serviços, em conjunto com os profissionais da entidade, para que as falhas identificadas nos registros sejam corrigidas. / This study analyzed a 40 HIV + pregnants sample, that were referred and had been attended by the Brazilian's Public Health System in Curitiba, 2005. The objective was to evaluate the health professionals' adhesion to the "Programa Mãe Curitibana" protocol, by analyzing the medical record data. It was observed that: (a) the administrative data registers (full name, birth date, the prenatal consultations dates) had been registered in all medical records; (b) information about the lactation inhibition and the advice of not to breastfeed the newborn were not registered in 22,5% and 27,5% of medical records, respectively; (c) the delivery type, considering the viral load, were registered in 55% of the medical records; (d) cesarean sections represented 82,5% and 2/3 of these were programmed. The study conclusion is that there is compliance to the assistance protocol of the "Mãe Curitibana" program and it is recommended a systematic evaluation process, in cooperation with the health professionals, to improve data registration.

Este estudo analisou uma amostra de 40 gestantes HIV + , referenciadas e acompanhadas na rede de serviços do Sistema Único de Saúde (SUS) de Curitiba, 2005. Objetivou analisar, por intermédio dos registros em prontuários, a adesão dos profissionais ao protocolo de atenção a gestantes Programa Mãe Curitibana. Observouse que (a) os registros de dados administrativos (nome completo, data de nascimento, endereço e datas das vindas das gestantes ao ambulatório) foram preenchidos em todos os prontuários; (b) dados como da inibição da lactação e orientação para a não amamentação dos recémnatos, filhos de gestantes HIV + , não foram registrados nos prontuários em 22,5% e 27,5% respectivamente; (c) a definição do tipo de parto, levando em conta o resultado da carga viral, foi encontrada em 55% dos prontuários; (d) o percentual de parto por cesárea foi de 82,5%, sendo 2/3 programados. Concluise que há adesão parcial ao protocolo Assistencial do Programa Mãe Curitibana. Recomendase um processo de avaliação sistemática desses serviços, em conjunto com os profissionais da entidade, para que as falhas identificadas nos registros sejam corrigidas. / This study analyzed a 40 HIV + pregnants sample, that were referred and had been attended by the Brazilian's Public Health System in Curitiba, 2005. The objective was to evaluate the health professionals' adhesion to the "Programa Mãe Curitibana" protocol, by analyzing the medical record data. It was observed that: (a) the administrative data registers (full name, birth date, the prenatal consultations dates) had been registered in all medical records; (b) information about the lactation inhibition and the advice of not to breastfeed the newborn were not registered in 22,5% and 27,5% of medical records, respectively; (c) the delivery type, considering the viral load, were registered in 55% of the medical records; (d) cesarean sections represented 82,5% and 2/3 of these were programmed. The study conclusion is that there is compliance to the assistance protocol of the "Mãe Curitibana" program and it is recommended a systematic evaluation process, in cooperation with the health professionals, to improve data registration.

Este estudo analisou uma amostra de 40 gestantes HIV + , referenciadas e acompanhadas na rede de serviços do Sistema Único de Saúde (SUS) de Curitiba, 2005. Objetivou analisar, por intermédio dos registros em prontuários, a adesão dos profissionais ao protocolo de atenção a gestantes Programa Mãe Curitibana. Observouse que (a) os registros de dados administrativos (nome completo, data de nascimento, endereço e datas das vindas das gestantes ao ambulatório) foram preenchidos em todos os prontuários; (b) dados como da inibição da lactação e orientação para a não amamentação dos recémnatos, filhos de gestantes HIV + , não foram registrados nos prontuários em 22,5% e 27,5% respectivamente; (c) a definição do tipo de parto, levando em conta o resultado da carga viral, foi encontrada em 55% dos prontuários; (d) o percentual de parto por cesárea foi de 82,5%, sendo 2/3 programados. Concluise que há adesão parcial ao protocolo Assistencial do Programa Mãe Curitibana. Recomendase um processo de avaliação sistemática desses serviços, em conjunto com os profissionais da entidade, para que as falhas identificadas nos registros sejam corrigidas. / This study analyzed a 40 HIV + pregnants sample, that were referred and had been attended by the Brazilian's Public Health System in Curitiba, 2005. The objective was to evaluate the health professionals' adhesion to the "Programa Mãe Curitibana" protocol, by analyzing the medical record data. It was observed that: (a) the administrative data registers (full name, birth date, the prenatal consultations dates) had been registered in all medical records; (b) information about the lactation inhibition and the advice of not to breastfeed the newborn were not registered in 22,5% and 27,5% of medical records, respectively; (c) the delivery type, considering the viral load, were registered in 55% of the medical records; (d) cesarean sections represented 82,5% and 2/3 of these were programmed. The study conclusion is that there is compliance to the assistance protocol of the "Mãe Curitibana" program and it is recommended a systematic evaluation process, in cooperation with the health professionals, to improve data registration.

Bibliographic record: RYŠAVÁ, Markéta. Health professionals' beliefs concerning the non-specific back pain and their influence on following the recommended therapy procedures. Prague: Charles University, 2nd Faculty of Medicine, Department of Rehabilitation and Sports Medicine, 2021. 138 p., Appendixes, Supervisor of the work: Mgr. Tomáš Kavka Abstract: Nonspecific back pain (nonspecific LBP) is the most common reason for visiting a doctor and it is the leading cause of activity limitation and inability to work by patients. The theoretical part of this thesis describes the issue of LBP and related clinical guidelines. In addition, it summarizes current research results of the influence of health professionals' fear-avoidance beliefs (FA beliefs) on their clinical decision making for LBP patients. The practical part relates to the research of FA beliefs and non-adherence to clinical guidelines regarding care of individuals experiencing LBP among health professionals in the Czech Republic. The degree of FA beliefs was evaluated using a translated and cross-culturally adapted questionnaire "Fear- Avoidance Beliefs Tool", while the degree of non-adherence was evaluated using a self- reported questionnaire in connection to fictitious clinical vignette. A generalized linear model was used for data processing. The...