Thesis (M.S.)--University of Michigan, 1988.

Submitted by Kely Alves (kely.alves@unifenas.br) on 2018-07-31T18:14:09Z No. of bitstreams: 1 Dissertação Edson Dell Amore Filho.pdf: 708297 bytes, checksum: d624f6ac7e0eb9fcbdcd4058c5e05da6 (MD5) / Made available in DSpace on 2018-07-31T18:14:09Z (GMT). No. of bitstreams: 1 Dissertação Edson Dell Amore Filho.pdf: 708297 bytes, checksum: d624f6ac7e0eb9fcbdcd4058c5e05da6 (MD5) Previous issue date: 2018-03-12 / The medicine dehumanization has been largely attributed to the medicine schools, which privilege scientific aspects to the detriment of those theoreticians and focus on the humanism. The medicine schools were driven to review their curricula, emphasizing disciplines and organizing interventions for recovering of the humanism in medical practice. The general objective of the dissertation was to identify the actions proposed or developed in medicine courses for resumption of humanization in the medical practice. The specific objectives were to highlight the main attributes of the humanism and to describe the main educational interventions adopted for the humanism development in medical practice. A systematic revision of the literature was carried out for the attainment of the study objectives, by means of researching in the databases of the Latin American and Caribbean Health Sciences Literature and Pub Med, from 2010 to 2016, in Portuguese and English languages. The research resulted in the selection of 23 publications. The results showed that the humanism main attribute is the empathy, which the schools of medicine are developing as main actions the changes in the curriculum of the courses. The main educational implemented actions involve, besides the curricular changes, exchanges and extension programs, through the inclusion of new disciplines, the use of play activities and cultural contexts that are distinct from those of the students' origin. It was concluded that the range of the measures is still small, considering the universe of the medicine courses and its lack of results for more objective analysis. / A “desumanização” da medicina tem sido atribuída em grande parte às escolas de medicina, que privilegiam aspectos científicos, em detrimento daqueles teóricos e voltados ao humanismo. As escolas de medicina se viram impelidas a rever seus currículos, enfatizando disciplinas e organizando intervenções para retomada do humanismo na prática médica. O objetivo geral da dissertação foi identificar as ações propostas ou desenvolvidas nos cursos de medicina para a retomada da humanização na prática médica. Os objetivos específicos foram evidenciar os principais atributos do humanismo e descrever as principais intervenções educacionais adotadas para o desenvolvimento do humanismo na prática médica. Para a consecução dos objetivos do estudo, foi realizada uma revisão sistemática de literatura, mediante pesquisa nas bases de dados da Literatura Latino-Americana e do Caribe em Ciências da Saúde e PubMed, no período de 2010 a 2016, nos idiomas português e inglês. A pesquisa resultou na seleção de 23 publicações. Os resultados mostraram que o principal atributo do humanismo é a empatia e que as escolas de medicina estão desenvolvendo como principais ações alterações nos currículos dos cursos. As principais ações educacionais implementadas envolvem alterações curriculares, intercâmbios e programas de extensão, mediante a inclusão de novas disciplinas, uso de atividades lúdicas e atuação em contextos culturais distintos dos de origem dos estudantes. Concluiu-se que a abrangência das medidas ainda é pequena, considerando-se o universo dos cursos de medicina, e seus resultados carecem de análise mais objetiva.

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Patient-centred care is the gold standard of health care, yet in practice, problems prevail. The use of the ‘expert patient’ in health professional education is one form of learning patient-centred care. A gap in the literature regarding how the use of ‘expert patient’ in health professional education promotes patient-centred care was acknowledged in current research. With Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board approval, a sample of Queen’s University MScOT students participated in a qualitative study with the following research question: “How does the students’ experience of interacting with the ‘expert patient’ (‘XP’) relate to learning regarding client-centred practice (CCP)?” Three objectives were proposed: 1. Describe the OT students’ experience of interacting with the ‘expert patient’, 2. Describe the students’ learning regarding client-centered practice, 3. Identify the conditions particular to the ‘expert patient’ experience that led to learning regarding client-centered practice. In-depth interviews were conducted with the students subsequent to their ‘expert patient’ experience. Analysis revealed three conditions that together provided the foundation for student experiential learning regarding client-centred practice: interaction with particular persons with stable disability known as ‘expert patients’; students’ requirement to evaluate them and thus ‘experience power’; and explicit opportunities for ‘directed reflection and discussion’. Questions were raised for researchers, health care professional educators and health care professionals regarding the potentially transformative nature of engaging in unfamiliar contexts with openness to learning. The thesis allowed insight into the lived experience of OT students learning with ‘expert patients’; the admiration, discomfort, humility and gratefulness they experienced while gaining a sense of the meaning of collaboration, respect for autonomy and recognition of expertise. Implications of the research impact all stakeholders in health professional education. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-04-05 00:18:04.617

La Société Européenne de Cardiologie recommande pour les patients insuffisants cardiaques, en plus de la prise en charge médicamenteuse et interventionnelle, une prise en charge de type « éducation du patient » pour améliorer leur qualité de vie. En France, des programmes multidisciplinaires d’éducation du patient en hôpital ont mesuré leurs effets sur les ré-hospitalisations, la mortalité et le taux de participation des patients aux programmes. Certaines études internationales ont mesuré l’effet de programmes éducatifs délivrés par des équipes hospitalières multidisciplinaires, d’autres ont recruté des patients en soins primaires, mais les programmes étaient conduits par des infirmières ou des assistants des médecins généralistes. Ce type de programme ne reflète pas la situation actuelle en France où la plupart des patients sont suivis en ambulatoires par leurs médecins généralistes. Il semblait nécessaire de connaître plus précisément l'effet de programmes d'éducation du patient délivrés par les médecins généralistes auprès de leurs propres patients. L’objectif principal de l’étude ETIC (Education thérapeutique des patients insuffisants cardiaques) était d’évaluer si un programme d’éducation des patients insuffisants cardiaques délivré par leurs médecins traitants et suivis en médecine générale, améliorait leur qualité de vie. Cette étude interventionnelle, contrôlée, randomisée en grappes, a inclus 241 patients insuffisants cardiaques chroniques suivis par 54 médecins généralistes pendant 19 mois. Les médecins généralistes du groupe intervention ont été sensibilisés pendant 2 jours au programme d’éducation du patient et entrainés à adapter leurs propres objectifs d'éducation aux attentes du patient. Plusieurs séances d'éducation ont été simulées au cours de la formation des médecins. La 1re séance comportait un bilan éducatif explorant le mode de vie et les habitudes alimentaires, l'activité physique, les activités de loisirs, les projets et les ressources des patients. Les patients bénéficiaient de 4 séances d’éducation tous les 3 mois pendant 12 mois puis d’une séance d’éducation de synthèse au 19e mois de suivi. Le critère d’évaluation principal était la qualité de vie mesurée par une échelle de qualité de vie générique, la MOS 36-Item Short Form Health Survey (SF-36), et par une échelle de qualité de vie spécifique de l’insuffisance cardiaque, le Minnesota Living with Heart Failure Questionnaire (MLHFQ). La moyenne d’âge des patients était 74 ans (± 10.5), 62% était des hommes, et leur fraction d’éjection ventriculaire gauche moyenne était de 49.3% ± 14.3%. A la fin du suivi, le score MLHFQ moyen dans les groupes intervention et témoin étaient respectivement 33.4 ± 22.1 versus 27.2 ± 23.3; p = 0.74, intra-cluster coefficient [ICC] = 0.11. A la fin du suivi, la moyenne des scores SF-36 mental et physique dans les groupes intervention et témoin étaient respectivement 58 ± 22.1 versus 58.7 ± 23.9 (p = 0.58, ICC = 0.01) et 52.8 ± 23.8 versus 51.6 ± 25.5 (p = 0.57, ICC = 0.01). Le nombre de patients insuffisants cardiaques à fraction d’éjection conservée (ICFEp) était de 93 (80.9%) dans le groupe intervention et de 94 (74.6%) dans le groupe témoin (p = 0.24). Une étude exploratoire a été réalisée pour décrire les traitements prescrits dans la population de cette étude : évaluation de l’adhésion des médecins généralistes aux recommandations pour les patients à fraction d’éjection réduite (ICFEr) et description des traitements prescrits aux patients ICFEp. Le programme d’éducation du patient délivré dans le cadre de l’étude ETIC, n’a pas fait la preuve d’une amélioration de la qualité de vie des patients. D’autres recherches sont nécessaires pour améliorer la qualité de vie de ces patients. Les stratégies et les méthodes d’éducation restent un champ de recherche à développer. / The European Society of Cardiology guidelines recommend non-pharmacological management to improve patients’ quality of life. In France, patient education programs delivered by hospital multidisciplinary teams in outpatient clinics have been assessed for their impact in patients with heart failure (HF). Some international studies assessed patient education interventions for heart failure patients recruited in the hospital. These programs were delivered by hospital multidisciplinary teams. Others have recruited patients with heart failure in primary care but the patient education programs were delivered by nurses or general practitioner assistants. This does not reflect the situation of the majority of patients in France, most of whom are ambulatory and cared for by general practitioners (GPs). Therefore, more evidence is needed on the effect of patient education programs delivered by GPs. As GPs are the doctors closest to patients, we hypothesized that their patient education could improved the HF patients quality of life. The ETIC (Education thérapeutique des patients insuffisants cardiaques) trial aimed to determine whether a pragmatic education intervention in general practice could improve the quality of life of patients with chronic heart failure (CHF) compared with routine care. This cluster randomised controlled clinical trial included 241 patients with CHF attending 54 general practitioners (GPs) in France and involved 19 months of follow-up. The GPs in the intervention group were trained during an interactive 2-day workshop to provide a patient education program. Several patient education sessions were simulated during the 2-day workshop. Patients had a further four education sessions, at 4, 7, 10 and 13 months, followed by an overview session at 19 months. The primary outcome was patients’ quality of life, as measured by the MOS 36-Item Short Form Health Survey (SF-36), a generic instrument, and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The mean age of the patients was 74 years (± 10.5), 62% were men and their mean left-ventricular ejection fraction was 49.3% (± 14.3). At the end of the follow-up period, the mean MLHFQ scores in the Intervention and Control Groups were 33.4 ± 22.1 versus 27.2 ± 23.3 (p = 0.74, intra-cluster coefficient [ICC] = 0.11). At the end of the follow-up period, SF-36 mental and physical scores in the Intervention and Control Groups were 58 ± 22.1 versus 58.7 ± 23.9 (p = 0.58, ICC = 0.01) and 52.8 ± 23.8 versus 51.6 ± 25.5 (p = 0.57, ICC = 0.01), respectively. Patients with heart failure with preserved ejection fraction (HFpEF) in the intervention group and in the control group were respectively: 93 (80.9%) and 94 (74.6%) (p = 0.24). A comprehensive data set of this trial was used to assess the prescription behaviour of GPs: GP’s guideline adherence for pharmacotherapy of heart failure with reduced ejection fraction (HFrEF) patients and to describe pharmacotherapy of HFpEF patients. Conclusions Patient education delivered by GPs to elderly patients with stable heart failure in the ETIC program did not demonstrate an improvement in their quality of life compared with routine care. Further research on improving the quality of life of elderly patients with CHF in primary care is needed. Patient education strategies and methods, as well as relevant tools and adapted criteria used to assess them, remain a field of research to develop. This area of investigation will be the following of this work.