O processo diagnóstico na medicina traduz-se por uma complexa interação entre conhecimentos, habilidades e procedimentos técnicos em condições de incerteza. As variáveis que o cercam são inúmeras e de difícil caracterização, dificultando o desenvolvimento de estudos mais aprofundados sobre o processo de elaboração do diagnóstico. O papel da necropsia na avaliação da performance do diagnóstico clínico já está bem demonstrado, sendo geralmente aceito que ela pode ser usada como uma ferramenta para analisar possíveis discrepâncias. A literatura médica vem apresentando com maior freqüência a questão dos erros no cuidado à saúde, e têm proposto que novos estudos são necessários para avaliar os erros diagnósticos e com isto propiciar condições para uma melhora desta questão. Nós propusemos um estudo para verificar a concordância diagnóstica em três fases deste processo, em pacientes do Hospital das Clínicas de Ribeirão Preto. Analisamos retrospectivamente todos os diagnósticos de trezentos pacientes que faleceram em nosso hospital, sendo cem pacientes para cada ano escolhido para este estudo (1980, 1990 e 2000). Classificamos os diagnósticos em: clínicos iniciais, considerados aqueles de entrada do paciente sem o apoio de exames complementares dentro do hospital; clínicos finais, todos os realizados durante a internação e após o óbito; necroscópicos, todos os diagnósticos elencados no relatório final deste procedimento. Utilizamos três grandes grupos para comparar estas fases: concordância, discordâncias maiores e discordâncias menores. Com estes achados realizamos uma avaliação do processo diagnóstico. As doenças do aparelho circulatório formaram o maior grupo de causas básicas de óbito seguido pelas neoplasias. O percentual de realização de necropsias foi ao redor de 75%. O número total de procedimentos diagnósticos pesquisados aumentou de 236 em 1980 para 366 em 2000, principalmente devido a exames não invasivos como as ultrassonografias e as tomografias. As discrepâncias maiores não apresentaram melhora percentual, mantendo-se estáveis ao redor de 21% no período do estudo.Houve um aumento das concordâncias diagnósticas (de 41 para 55%) confrontando o diagnóstico clínico final e o necroscópico, porém às custas de diminuição das discrepâncias menores. Das variáveis analisadas de idade, gênero, tempo de estadia hospitalar, admissões anteriores, vulnerabilidade, exames comuns, modernos e totais, apenas a de admissões apresentou diferença estatística na comparação de pacientes com discrepâncias maiores em relação aos demais, com p=0,006, tendo o grupo dos demais pacientes uma média maior (de 1,85 x 1,35).A avaliação do processo diagnóstico através da comparação entre o diagnóstico clínico inicial e o clínico final mostrou concordância entre os passos em cerca de 80%. Os casos com discrepâncias maiores à necropsia em relação ao diagnóstico clínico final, apresentaram 90% de concordância entre o diagnóstico clínico inicial e o final. Este achado reforça a tese de que o encerramento prematuro do diagnóstico parece ser o principal fator relacionado com a manutenção destas discrepâncias. O aumento de concordância diagnóstica deu-se, portanto, com a diminuição de discrepâncias menores, sem alteração nas maiores que são aquelas que poderiam ter influenciado no prognóstico do paciente. A disponibilidade de novos exames e tecnologias de ponta não foi suficiente para alterar este quadro. / The diagnostic process in medicine is a complex interaction of cognitive skills and technical procedures in conditions of uncertainty. The variables around of it are innumerable and with difficult characterization. Because of this, there is not a good development of studies concerning the elaboration of diagnoses. The role of autopsy in auditing clinical diagnosis performance it is well demonstrated and it is generally accepted that autopsy may be used as a tool for quality management to analyze diagnostic discrepancies. The medical literature presents more frequently the question of medical errors. It has been proposed that studies are needed to assess how and when diagnostic errors occur and this might improve diagnostic performance further. We propose a study to verify the agreement of medical diagnostics, based on detailed, ongoing comparison of three steps of the clinical diagnoses with autopsy diagnoses over 20 years, in patients of the Ribeirão Preto Clinics Hospital. We analyzed retrospectively diagnostic errors, with use of necropsy as the gold standard for diagnosis. We randomly selected 300 patients who died at a tertiary-care teaching hospital in Brazil—100 in each of 1980, 1990, and 2000. We classified discrepancies between admission diagnosis, clinical diagnosis and necropsy findings, into three categories, major and minor discrepancies and concordance. With these findings we made an evaluation of the diagnostic process. The cardiovascular diseases were the major group of basic causes of death, and the neoplasias were the second. The percentage of necropsy was around 75%. The total number of diagnostics procedures increase from 236 in 1980 to 366 in 2000, mainly because of non invasive exams such ultrassonography and tomography. The major discrepancies maintained 21% over the studied period. There was an increase of the diagnostic concordance over the studied period (from 41 to 55%), when we compare the final clinical diagnostics and the necropsy, however only with the reduction of minor discrepancies. We analyzed variables like age, sex, days of stay on hospital, previous admissions, vulnerability, common exams, modern exams and total exams. Only previous admissions presented significant statistically difference, when comparing patients with major discrepancies with the others, p=0,006. The others group presented a higher media (1,85 x 1,35) of previous admissions. The assessment of the diagnostic process with the comparison of admission and the final clinical diagnoses revealed 80% of concordance. The cases of major discrepancies presented 90% of concordance between the admission and the final clinical diagnoses. This reinforces the thesis that the premature closure of the diagnostic is the principal factor related with the maintenance of these discrepancies. The increase of diagnostics concordances was due to the decrease of minor discrepancies, without alterations of majors. These ones are that with some influence in the prognostic of the patients. The availability of new exams and technologies were not sufficient to change the rate of discrepancies.

O processo diagnóstico na medicina traduz-se por uma complexa interação entre conhecimentos, habilidades e procedimentos técnicos em condições de incerteza. As variáveis que o cercam são inúmeras e de difícil caracterização, dificultando o desenvolvimento de estudos mais aprofundados sobre o processo de elaboração do diagnóstico. O papel da necropsia na avaliação da performance do diagnóstico clínico já está bem demonstrado, sendo geralmente aceito que ela pode ser usada como uma ferramenta para analisar possíveis discrepâncias. A literatura médica vem apresentando com maior freqüência a questão dos erros no cuidado à saúde, e têm proposto que novos estudos são necessários para avaliar os erros diagnósticos e com isto propiciar condições para uma melhora desta questão. Nós propusemos um estudo para verificar a concordância diagnóstica em três fases deste processo, em pacientes do Hospital das Clínicas de Ribeirão Preto. Analisamos retrospectivamente todos os diagnósticos de trezentos pacientes que faleceram em nosso hospital, sendo cem pacientes para cada ano escolhido para este estudo (1980, 1990 e 2000). Classificamos os diagnósticos em: clínicos iniciais, considerados aqueles de entrada do paciente sem o apoio de exames complementares dentro do hospital; clínicos finais, todos os realizados durante a internação e após o óbito; necroscópicos, todos os diagnósticos elencados no relatório final deste procedimento. Utilizamos três grandes grupos para comparar estas fases: concordância, discordâncias maiores e discordâncias menores. Com estes achados realizamos uma avaliação do processo diagnóstico. As doenças do aparelho circulatório formaram o maior grupo de causas básicas de óbito seguido pelas neoplasias. O percentual de realização de necropsias foi ao redor de 75%. O número total de procedimentos diagnósticos pesquisados aumentou de 236 em 1980 para 366 em 2000, principalmente devido a exames não invasivos como as ultrassonografias e as tomografias. As discrepâncias maiores não apresentaram melhora percentual, mantendo-se estáveis ao redor de 21% no período do estudo.Houve um aumento das concordâncias diagnósticas (de 41 para 55%) confrontando o diagnóstico clínico final e o necroscópico, porém às custas de diminuição das discrepâncias menores. Das variáveis analisadas de idade, gênero, tempo de estadia hospitalar, admissões anteriores, vulnerabilidade, exames comuns, modernos e totais, apenas a de admissões apresentou diferença estatística na comparação de pacientes com discrepâncias maiores em relação aos demais, com p=0,006, tendo o grupo dos demais pacientes uma média maior (de 1,85 x 1,35).A avaliação do processo diagnóstico através da comparação entre o diagnóstico clínico inicial e o clínico final mostrou concordância entre os passos em cerca de 80%. Os casos com discrepâncias maiores à necropsia em relação ao diagnóstico clínico final, apresentaram 90% de concordância entre o diagnóstico clínico inicial e o final. Este achado reforça a tese de que o encerramento prematuro do diagnóstico parece ser o principal fator relacionado com a manutenção destas discrepâncias. O aumento de concordância diagnóstica deu-se, portanto, com a diminuição de discrepâncias menores, sem alteração nas maiores que são aquelas que poderiam ter influenciado no prognóstico do paciente. A disponibilidade de novos exames e tecnologias de ponta não foi suficiente para alterar este quadro. / The diagnostic process in medicine is a complex interaction of cognitive skills and technical procedures in conditions of uncertainty. The variables around of it are innumerable and with difficult characterization. Because of this, there is not a good development of studies concerning the elaboration of diagnoses. The role of autopsy in auditing clinical diagnosis performance it is well demonstrated and it is generally accepted that autopsy may be used as a tool for quality management to analyze diagnostic discrepancies. The medical literature presents more frequently the question of medical errors. It has been proposed that studies are needed to assess how and when diagnostic errors occur and this might improve diagnostic performance further. We propose a study to verify the agreement of medical diagnostics, based on detailed, ongoing comparison of three steps of the clinical diagnoses with autopsy diagnoses over 20 years, in patients of the Ribeirão Preto Clinics Hospital. We analyzed retrospectively diagnostic errors, with use of necropsy as the gold standard for diagnosis. We randomly selected 300 patients who died at a tertiary-care teaching hospital in Brazil—100 in each of 1980, 1990, and 2000. We classified discrepancies between admission diagnosis, clinical diagnosis and necropsy findings, into three categories, major and minor discrepancies and concordance. With these findings we made an evaluation of the diagnostic process. The cardiovascular diseases were the major group of basic causes of death, and the neoplasias were the second. The percentage of necropsy was around 75%. The total number of diagnostics procedures increase from 236 in 1980 to 366 in 2000, mainly because of non invasive exams such ultrassonography and tomography. The major discrepancies maintained 21% over the studied period. There was an increase of the diagnostic concordance over the studied period (from 41 to 55%), when we compare the final clinical diagnostics and the necropsy, however only with the reduction of minor discrepancies. We analyzed variables like age, sex, days of stay on hospital, previous admissions, vulnerability, common exams, modern exams and total exams. Only previous admissions presented significant statistically difference, when comparing patients with major discrepancies with the others, p=0,006. The others group presented a higher media (1,85 x 1,35) of previous admissions. The assessment of the diagnostic process with the comparison of admission and the final clinical diagnoses revealed 80% of concordance. The cases of major discrepancies presented 90% of concordance between the admission and the final clinical diagnoses. This reinforces the thesis that the premature closure of the diagnostic is the principal factor related with the maintenance of these discrepancies. The increase of diagnostics concordances was due to the decrease of minor discrepancies, without alterations of majors. These ones are that with some influence in the prognostic of the patients. The availability of new exams and technologies were not sufficient to change the rate of discrepancies.

The present study reflects upon the identification process for gifted or highly able children through a systematic study of the literature, with the aim of providing them with an adequate and stimulating education beginning at an early age. The identification process requires an adequate diagnostic process of giftedness, and creativity is an important determining factor. Creativity, however, is a very complex construct due to differences in definition in the psychology field. This study aims to make a valuable contribution by discussing how to measure creativity in gifted or highly able children, as well as proving recommendations in the diagnostic process. / El presente estudio busca reflexionar acerca del proceso de identificación de los niños superdotados o talentosos, a partir de un estudio sistemático de la literatura especializada, con el fin de brindarles una educación adecuada y estimulante desde edades tempranas. El procesode identificación demanda un proceso diagnóstico adecuado de la superdotación, enel que la creatividad es un factor determinante. La creatividad como concepto psicológico,es una categoría especialmente compleja, debido a que existen diferentes aproximaciones y definiciones de la misma. Este estudio contribuye a dar respuesta a la mejor manera en que se puede medir la creatividad en niños superdotados o talentosos, proponiendo recomendaciones al respecto.

This study was an autoethnography authored in the form of layered accounts. It was based on my journey toward a correct diagnosis with the rare, orphan disease known as mastocytosis. The purpose of the study was to utilize my experiences to investigate mastocytosis from the perspective of an individual diagnosed with the disease. Furthermore, I investigated what ways and how much adult education philosophies and principles (e.g., humanistic, behaviorist, and adults’ involvement in learning) may have been salient in my being correctly diagnosed to examine not only the disparities, but also the similarities in the way each physician I encountered approached the diagnostic process. The layered accounts—written in three distinct layers—revealed my perception of my journey toward a correct diagnosis as blind, discouraging, and isolating (layers one). Also noted in layer one are detailed descriptions of my bouts with chorea (extreme, uncontrollable spasms affecting the limbs), which was rarely discussed in the literature. The responses of those around me (layer two) ranged from shock, genuine concern, uncertainty, judgement, dismissal, disbelief, humor, anger, hurt, and positivity. Pertinent literature on mastocytosis was juxtaposed with my experiences divulged in the first layer and highlighted similarities in the approach to the diagnostic process taken by the physicians who treated me and multiple disparities between what the literature states my experience as someone diagnosed with mastocytosis versus my actual experiences (layer three). In addition to identifying the most salient adult education philosophies and principles in my journey to a correct diagnosis, this research identified parallels between the facilitator-learner relationship in adult education and the physician-patient relationship. The results implicate three principles and three philosophies salient to my correct diagnosis, along with one philosophy and one principle which were the most salient. An overarching theme of self-directedness emerged along with a multiple disparities between what the literature states my experience should have been versus what took place as I sought medical care.

Ménière’s disease is the third most common inner ear disorder. The individual course of Ménière’s disease in different patients makes it difficult to diagnose on the basis of symptomatology alone. The impact of Ménière’s disease on quality of life has highlighted the importance of an additional tool to support the diagnosis of Ménière’s disease. Apart from the patient’s history, audiological data provide the most relevant information for confirming the diagnosis. The aim of this study was to analyse and describe the clinical and audiological features of a cohort of subjects diagnosed with Ménière’s disease, in order to develop understanding of the pathophysiology of the disease and to facilitate the diagnostic process. The research is based on a retrospective study of the medical records of 135 subjects with Ménière’s disease which were selected according to a non-probability sample. Descriptive statistics were used to organize, analyse and interpret the data. Sixty one percent of subjects presented with definite Ménière’s disease, 14 % with probable Ménière’s disease and 25 % with possible Ménière’s disease. The results showed a higher incidence of Ménière’s disease in females especially in the vestibular type. Three percent of subjects indicated a family history of Ménière’s disease. Bilateral Ménière’s disease presented in 39 % of subjects. The results confirmed that vertigo was the most debilitating symptom in Ménière’s disease. Correlating the clinical features of subjects with audiometric and vestibular tests highlighted the clinical value of an audiological test battery including the following tests: Pure tone audiometry, Speech discrimination, Oto-acoustic emissions, Electronystagmography and Electrocochleography. This confirms the role of the audiologist in the diagnostic and rehabilitation process in patients with Ménière’s disease. / Dissertation (Communication Pathology)--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / unrestricted

No description available.

Organisations are always confronted with the need to transform in order to adapt to environmental changes and have a competitive advantage. The concern is that when an organisation embarks on a transformation process, its individual employees are affected either positively or negatively. Employees can respond to transformation change by either being satisfied or dissatisfied in the organisation. The main aim of this research was to develop a diagnostic model for measuring employee satisfaction during organisational transformation. The first construct of organisational transformation was conceptualised using the open system paradigm, theoretical definitions and models of organisational change. In this study, organisational transformation is second order and drastic in the sense that it alters the way in which the organisation functions and relates to the external environment focusing on the vision, processes, systems, structure and culture. It is the fundamental and constant change at all levels of the organisation caused by external factors posing as risks for organisational survival. vi The second construct of employee satisfaction was conceptualised focusing on the humanistic paradigm, theoretical definitions and models. Employee satisfaction in this study is the individual’s positive emotional state of contentment stemming from the organisation’s ability to meet his or her needs and expectations based on his or her experience and evaluation of various organisational processes and practices. It influences employees’ performance and commitment to the organisation. A theoretical model was developed as a framework to enable organisations to diagnose or assess their employees’ satisfaction during organisational transformation. The model highlighted dimensions essential to diagnose employee satisfaction such as organisational strategy, policies and processes and outcomes, in order to determine employees’ contentment and fulfilment in the organisation. The main aim of the empirical research was to conduct a three year longitudinal study of employee satisfaction during organisational transformation; to operationalise the conceptually developed diagnostic model of employee satisfaction during transformation; and develop a structural equation model (SEM) in order to test the theoretical model. The Employee Satisfaction Survey (ESS) was used in 2003, 2007 and 2008 to measure employee satisfaction. The initial year of the study (2003) comprised 1 140 participants who voluntarily completed the measuring instrument. The second year of the study (2007) involved 920 participants, while the final year of the study (2008) included 759 participants. In terms of the reliability and validity of the ESS, it was determined that in the three years of the study, most of the dimensions had acceptable internal consistency reliability based on the results of the Cronbach alpha test. The SEM investigated the impact of organisational strategy, policies and procedures and outcomes as the three domains of employee satisfaction during organisational transformation. The confirmatory factor analysis of the latent variables was conducted, and the path coefficients of the latent variables of organisational strategy, policies and processes and outcomes indicated a satisfactory fit for all these variables. The goodness-of-fit measure of the model indicated both absolute and incremental goodness-of-fit. The SEM confirmed the causal relationships between the latent and manifest variables, indicating that the latent variables, organisational vii strategy, policies and procedures and outcomes are the main indicators of employee satisfaction. This research adds to the field of organisational behaviour by proposing a model of employee satisfaction during organisational transformation. The domains of this model should enable organisations to identify developmental areas based on employees’ dissatisfaction or areas of strengths based on employees’ satisfaction. The diagnostic model will also enable organisations and practitioners to initiative interventions aimed at addressing areas of dissatisfaction as developmental areas and to leverage on its strengths as areas of satisfaction in the organisation. / Industrial & Organisational Psychology / D. Litt. et Phil. (Industrial and Organisational Psychology

Organisations are always confronted with the need to transform in order to adapt to environmental changes and have a competitive advantage. The concern is that when an organisation embarks on a transformation process, its individual employees are affected either positively or negatively. Employees can respond to transformation change by either being satisfied or dissatisfied in the organisation. The main aim of this research was to develop a diagnostic model for measuring employee satisfaction during organisational transformation. The first construct of organisational transformation was conceptualised using the open system paradigm, theoretical definitions and models of organisational change. In this study, organisational transformation is second order and drastic in the sense that it alters the way in which the organisation functions and relates to the external environment focusing on the vision, processes, systems, structure and culture. It is the fundamental and constant change at all levels of the organisation caused by external factors posing as risks for organisational survival. vi The second construct of employee satisfaction was conceptualised focusing on the humanistic paradigm, theoretical definitions and models. Employee satisfaction in this study is the individual’s positive emotional state of contentment stemming from the organisation’s ability to meet his or her needs and expectations based on his or her experience and evaluation of various organisational processes and practices. It influences employees’ performance and commitment to the organisation. A theoretical model was developed as a framework to enable organisations to diagnose or assess their employees’ satisfaction during organisational transformation. The model highlighted dimensions essential to diagnose employee satisfaction such as organisational strategy, policies and processes and outcomes, in order to determine employees’ contentment and fulfilment in the organisation. The main aim of the empirical research was to conduct a three year longitudinal study of employee satisfaction during organisational transformation; to operationalise the conceptually developed diagnostic model of employee satisfaction during transformation; and develop a structural equation model (SEM) in order to test the theoretical model. The Employee Satisfaction Survey (ESS) was used in 2003, 2007 and 2008 to measure employee satisfaction. The initial year of the study (2003) comprised 1 140 participants who voluntarily completed the measuring instrument. The second year of the study (2007) involved 920 participants, while the final year of the study (2008) included 759 participants. In terms of the reliability and validity of the ESS, it was determined that in the three years of the study, most of the dimensions had acceptable internal consistency reliability based on the results of the Cronbach alpha test. The SEM investigated the impact of organisational strategy, policies and procedures and outcomes as the three domains of employee satisfaction during organisational transformation. The confirmatory factor analysis of the latent variables was conducted, and the path coefficients of the latent variables of organisational strategy, policies and processes and outcomes indicated a satisfactory fit for all these variables. The goodness-of-fit measure of the model indicated both absolute and incremental goodness-of-fit. The SEM confirmed the causal relationships between the latent and manifest variables, indicating that the latent variables, organisational vii strategy, policies and procedures and outcomes are the main indicators of employee satisfaction. This research adds to the field of organisational behaviour by proposing a model of employee satisfaction during organisational transformation. The domains of this model should enable organisations to identify developmental areas based on employees’ dissatisfaction or areas of strengths based on employees’ satisfaction. The diagnostic model will also enable organisations and practitioners to initiative interventions aimed at addressing areas of dissatisfaction as developmental areas and to leverage on its strengths as areas of satisfaction in the organisation. / Industrial and Organisational Psychology / D. Litt. et Phil. (Industrial and Organisational Psychology