Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / In despite of the great advantages of adopting computer systems for storing patient's information in hospitals and clinics, such systems are adopted with restrictions in these institutions. Some studies indicate that the rejection of such systems by the clinicians is greats due to computing not consider the particularities of the activities performed by the user in the clinical field. Considering this background, the project ClinicSpace aims to build a prototype tool to help health professionals in performing of their activities, using concepts and technologies of ubiquitous computing, which suggests that the computation must be fully integrated into the environment, disappearing from the user's consciousness and assisting him in their daily activities. This paper proposes an architecture called pEHS - Pervasive Electronic Healthcare System - a electronic health system inserted in the ClinicSpace's proposal, where the computing is oriented to clinical activities and the applications do interact with the ubiquitous environment through context information. The contribution of this paper is the proposal of a new software architecture in which pEHS modular applications follows the medical activities, making the system to adapt to the clinician's activities. In the architecture there are two points in evidence: the possibility of access to any information from the patient's health history and the adaptation of pEHS applications to the context information at runtime. The prototyped architecture will be used in the ClinicSpace project to build the applications needed for the clinicians helping them to carry out their activities. / Apesar das grandes vantagens existentes na adoção de sistemas computacionais para armazenamento das informações do paciente em ambientes hospitalares, tais sistemas são adotados com restrições em hospitais. Estudos indicam que a rejeição destes pelos clínicos é grande devido à computação não levar em consideração as características das atividades desempenhadas pelo usuário e sua forma particular de o fazê-lo. Tendo em vista essa necessidade, o projeto ClinicSpace tem por objetivo prototipar uma ferramenta para auxílio ao profissional de saúde na realização de suas atividades, utilizando conceitos e tecnologias da Computação Ubíqua, a qual propõe que a computação deve ser totalmente integrada ao ambiente de forma a desaparecer da consciência do usuário e auxiliá-lo na realização de suas atividades diárias. Este trabalho propõe uma arquitetura chamada pEHS Pervasive Electronic Healthcare System sistema eletrônicos de saúde inserido na proposta do ClinicSpace, onde a computação é orientada a atividades clínicas e as aplicações interagem com o ambiente ubíquo através das informações de contexto. A contribuição deste trabalho é uma proposta nova de arquitetura de software na qual as aplicações modulares do pEHS acompanham as atividades médicas, fazendo com que o sistema adapte-se às atividades do profissional. Destacam-se dois pontos da arquitetura:a possibilidade de acesso a qualquer informação do histórico de saúde do paciente e a adaptação das aplicações pEHS às informações de contexto em tempo de execução. A arquitetura prototipada será utilizada no andamento do projeto ClinicSpace para a construção das aplicações necessárias aos profissionais de saúde para a realização de suas atividades de forma personalizada.

Une attention de plus en plus importante est accordée à la santé mentale au travail en raison, entre autres de la perte de bien-être chez les personnes atteintes d’un trouble mental courant (ex. trouble anxieux, trouble dépressif), ainsi que des coûts associés à l’absentéisme. Quand il est question d’invalidité au travail, plusieurs acteurs sont normalement impliqués dont le médecin de famille et le psychiatre lorsque nécessaire. Dans le cadre de ce mémoire conçu sous le format d’articles, deux articles sont présentés. Le premier article aborde plusieurs dilemmes auxquels les médecins traitants sont confrontés lors de la gestion de la reprise professionnelle d’un patient avec un trouble mental courant. Ces dilemmes sont illustrés par trois vignettes cliniques et appuyés par la littérature scientifique. Les trois vignettes portent sur les dilemmes relatifs aux thèmes suivants: 1) l’évaluation du potentiel thérapeutique des arrêts de travail; 2) le rôle d’expert octroyé aux médecins traitants et au processus d’évaluation de la capacité à travailler; 3) les aspects administratifs liés à cette évaluation; 4) la relation thérapeutique médecin-patient. La littérature nous indique que ce sont des dilemmes récurrents chez les médecins traitants dans le contexte de la gestion de la reprise professionnelle à la suite d’un trouble mental courant. Dans une suite logique, le deuxième article présente une étude qualitative effectuée auprès de médecins de famille et de psychiatres. Les objectifs de cette étude sont de documenter les tâches de ces cliniciens liées à la gestion d’une invalidité en raison d’un trouble mental courant, d’identifier les éléments facilitants et entravants qu’ils perçoivent dans le processus d’arrêt de travail et de retour au travail. Il est par ailleurs question de dégager les besoins de formation et d’outils qui pourront éventuellement être mis en place pour les aider dans l’accomplissement de leurs tâches. La collecte de données a été faite via des groupes de discussion (focus groups) totalisant trois groupes de médecins de famille et deux groupes de psychiatres (N=28). Tous les enregistrements ont été retranscrits en verbatim et par la suite codifiés. Les réponses générées par les groupes de discussion ont fait émerger 180 unités thématiques réparties sur 4 grands thèmes, lesquels sont récurrents pour chaque objectif de recherche : 1) évaluer/documenter, 2) prescrire/traiter, 3) communiquer/collaborer/réseauter avec les autres acteurs et 4) arbitrer/défendre. Les unités thématiques démontrent l’importance de la collaboration entre les acteurs et d’une communication efficace entre ces derniers. Il ressort également que ces cliniciens aimeraient être mieux formés pour arrimer connaissances et pratiques. La santé mentale au travail est une thématique qui prend de plus en plus d’ampleur et de préoccupation au sein de notre société. La mise en place d’outils et de formation adaptés pour aider les médecins de famille et psychiatres à mieux exécuter leurs tâches ne pourrait qu’avoir un impact positif sur la pratique de ces cliniciens et leurs patients. / An increasing amount of attention is being given to mental health in the workplace, due in part to the loss of well-being for individuals with common mental disorders (ex. anxiety disorder, depressive disorder), as well as the costs associated with absenteeism. In the context of this paper-based master, two articles will be presented. The first article will address three clinical vignettes and the dilemmas physicians may encounter in managing the vocational rehabilitation of a patient struggling with a common mental disorder. The vignettes will be supported by literature. Three clinical cases address dilemmas related to the following themes: 1) the assessment of the therapeutic potential of work absence, 2) the expert role given to clinicians and the process of assessing work disability, 3) the administrative aspects related to this assessment and 4) the impact of this assessment on therapeutic alliance between the clinician and his/her patient with common mental disorders. The literature tells us that these are recurring dilemmas for clinicians when managing the return to work of their patients with common mental disorders. The second article will present a qualitative study carried out among family physicians and psychiatrists. The objectives of this study are to document the clinical tasks related to the management of a disability due to a common mental disorder, identify the facilitators and barriers perceived in this process and identify training needs which could potentially help these clinicians perform their tasks, thereby enabling sustainable recovery of the worker. This is a qualitative study which collects data through focus groups, including three groups of family physicians and two groups of psychiatrists (N=28). All recordings were transcribed as stated and coded. The responses generated by the focus groups identified 180 thematic units distributed over 4 main themes, which are recurring for each research objective: 1) assess/document; 2) prescribe/treat; 3) communicate/collaborate/network with other stakeholders and 4) arbitrate/defend. The thematic units demonstrate the importance of collaboration between stakeholders and having effective communication among them. It also emerges that these clinicians would like to be better trained to align knowledge and practice. Mental health in the workplace is a topic which is becoming increasingly important and of concern within our society. The implementation of adapted tools and training to help family physicians and psychiatrists to better perform their tasks can only have a positive impact on the practice of these clinicians and their patients.

The project ClinicSpace aims to fill gaps in current clinical systems, regarding to the characteristics of pervasive computing tasks and clinical activities support to the user (physician). The architecture of the model ClinicSpace, built from the perspective given by the activity theory, it is composed of several modules that interconnected offer the features needed in a system geared to clinical pervasive end-user. One of these modules is the treatment of the clinical tasks. This work holds a discussion on the present requirements for the treatment of the clinical tasks, defining an architecture to link them to the tasks of the user, allowing context customization and automatic entry of data. The customization is achieved through the use of Programmable Elements of Context, which are represented by actuators, physical or logical, responsible for providing the system capacity of automatic executions, based on the parameters specified by the user. Yet the automatic data comes from the implicit way of obtaining these, the information used by applications that the user performs in the course of their duties. For this, an architecture was set up to support the customization and the semantic specification of data used. Building such features extended the pervasive middleware EXEHDA, modifying the already existing services and adding new ones. The main contribution of this work is the interconnection between the components that make up the architecture, building a unique view of the context of a task from the perspective of the necessary data for it and the ability to be customized by the user. Thus, it reduces the need for explicit data entry, and it contributes to the reducing rejections of its adoption of clinical systems in highly dynamic environments such as hospitals. / O projeto ClinicSpace tem por objetivo preencher as lacunas existentes nos sistemas clínicos atuais, no que tange às características de pervasividade e apoio de tarefas computacionais às atividades clínicas que o usuário (médico) realiza. A arquitetura do modelo ClinicSpace, construída a partir da perspectiva dada pela teoria da atividade, é composta por vários módulos que interligados oferecem as características necessárias a um sistema clínico pervasivo orientado ao usuário-final. Um desses módulos é o tratamento de contexto das tarefas clínicas. Esse trabalho realiza uma discussão sobre os requisitos presentes para o tratamento de contexto das tarefas clínicas, definindo uma arquitetura para associá-los às tarefas do usuário, permitindo personalização de contexto e entrada automática de dados. A personalização é obtida através da utilização de Elementos Programáveis de Contexto, que são representados por atuadores, físicos ou lógicos, responsáveis por dotar o sistema de capacidade de execuções automáticas, baseadas em parâmetros de contexto especificados pelo usuário. Já a entrada automática de dados trata da obtenção destes de maneira implícita, obtendo as informações utilizadas pelas aplicações que o usuário executa, no decorrer de suas tarefas. Para isso, definiu-se uma arquitetura com suporte à personalização e especificação semântica dos dados nela utilizados. Para construir tais funcionalidades, estendeu-se o middleware pervasivo EXEHDA, modificando serviços existentes e agregando novos serviços. A principal contribuição do trabalho está na interligação existente entre os componentes que integram a arquitetura, construindo uma visão única do contexto de uma tarefa sob a perspectiva dos dados necessários a ela e da capacidade de personalização pelo usuário. Dessa forma, reduz-se a necessidade da entrada explícita de dados, e contribui-se para a redução da rejeição da adoção dos sistemas clínicos em ambientes altamente dinâmicos, como os hospitalares.