The aim of this study is to investigate how social services handles and experiences threats in the workplace with focus on prevention and how follow up work is conducted. Data collection involved six qualitative interviews with four social workers and two unit managers. The results indicate that social workers normalizes threats at the workplace and that the leadership is crucial for both prevention and follow up. Routines at work are important but social workers are rarely informed or updated about these routines. Social workers experience that follow up is not a priority by their unit managers and after a threat social workers have a lack of time to take care of themselves. Unit managers experience the importance of routines for prevention of threats in the workplace. As unit managers they have the biggest responsibility when threats occur in the workplace and follow up should include an individual plan for every social worker. Both social workers and unit managers agrees that the experience is enough when determining if a threat is real or not.

Background Multiple sclerosis (MS) is an autoimmune disease characterised by inflammatory damage to the central nervous system (CNS). Accumulated CNS injury can be quantified as brain atrophy, definable as a reduction in brain parenchymal fraction (BPF). BPF correlate with disability in MS and is used routinely as an endpoint in clinical trials. In 2009/2010, a new MS clinical care program, that includes follow-up of BPF, was introduced at Umeå University Hospital (NUS). Levels of neurofilament light polypetide (NFL) and glial fibrillary acidic protein (GFAP) in cerebrospinal fluid (CSF) are markers of axonal and astrocytic injury, respectively, and also potential surrogate biomarkers for BPF decline. The goals of this thesis were to establish age-adjusted values of BPF in healthy individuals and to relate these to the BPF values from individuals with MS as well as to the levels of NFL and GFAP in CSF. Another goal was to investigate if expanded disability status scale (EDSS)-worsening could be predicted in a clinical MS cohort and if BPF measurements could contribute to such predictions. Methods A group of 111 healthy individuals volunteered to participate in the studies. A total of 106 of these underwent MRI with BPF measurements, 53 underwent lumbar puncture (LP) with measurement of NFL and GFAP and 48 underwent both MRI and LP. Three different automatic and one manual method were utilised to determine BPF. A literature search on BPF in healthy individuals was performed for the purpose of a systematic review. For studying disability progression in MS, all individuals with MS followed at NUS and included in the Swedish MS registry were included if they had matched data on BPF, EDSS and lesion load as part of clinical follow-up (n=278). Results BPF as well as NFL and GFAP levels in CSF were all associated with age. NFL was associated with BPF and GFAP, but only the association with GFAP was retained when adjusting for age. Significant differences were found between different methods for BPF determination. In the MS population, BPF was associated with EDSS. Only progressive disease course could predict EDSS worsening. Conclusion The data on BPF and levels of NFL and GFAP in CSF of healthy individuals can aid in the interpretation of these variables in the setting of MS. Knowledge on differences in BPF data from different methods for BPF determination can be useful in comparing data across studies, but also highlights the need for a commonly accepted gold standard. The correlation between GFAP and NFL levels in CSF may indicate an association between glial and axonal turnover that is independent of the aging effect on the brain. However, the low number of volunteers for LP precluded clear conclusions. An association between BPF and EDSS was seen in the MS group. The ability to predict EDSS worsening in the clinical MS cohort was limited.

Sequential experimentation is often employed in process optimization wherein a series of small experiments are run successively in order to determine which experimental factor levels are likely to yield a desirable response. Although there currently exists a framework for identifying optimal follow-up designs after an initial experiment has been run, the accepted methods frequently point to multiple designs leaving the practitioner to choose one arbitrarily. In this thesis, we apply preposterior analysis and Bayesian model-averaging to develop a methodology for further discriminating between optimal follow-up designs while controlling for both parameter and model uncertainty.

Two-level factorial experiments are widely used in experimental design because they are simple to construct and interpret while also being efficient. However, full factorial designs for many factors can quickly become inefficient, time consuming, or expensive and therefore fractional factorial designs are sometimes preferable since they provide information on effects of interest and can be performed in fewer experimental runs. The disadvantage of using these designs is that when using fewer experimental runs, information about effects of interest is sometimes lost. Although there are methods for selecting fractional designs so that the number of runs is minimized while the amount of information provided is maximized, sometimes the design must be augmented with a follow-up experiment to resolve ambiguities. Using a fractional factorial design augmented with an optimal follow-up design allows for many factors to be studied using only a small number of additional experimental runs, compared to the full factorial design, without a loss in the amount of information that can be gained about the effects of interest. This thesis looks at discovering regularities in the number of follow-up runs that are needed to estimate all aliased effects in the model of interest for 4-, 5-, 6-, and 7-factor resolution III and IV fractional factorial experiments. From this research it was determined that for all of the resolution IV designs, four or fewer (typically three) augmented runs would estimate all of the aliased effects in the model of interest. In comparison, all of the resolution III designs required seven or eight follow-up runs to estimate all of the aliased effects of interest. It was determined that D-optimal follow-up experiments were significantly better with respect to run size economy versus fold-over and semi-foldover designs for (i) resolution IV designs and (ii) designs with larger run sizes.

Although integrated primary care psychology services are becoming increasingly common, the literature lacks adequate research support for the longitudinal durability of treatment effects following the conclusion of brief primary care interventions. This study served as a follow-up program evaluation of psychological services for depression and anxiety provided at the Medical College of Virginia’s Ambulatory Care Center in Richmond, Virginia. Data were collected on 47 adult primary care patients who received treatment for depression and/or anxiety between six and 18 months prior to the follow-up telephone call. Data were collected on the trajectory of depression scores throughout and following treatment, treatment received by patients in the interim, and reasons provided by patients for discontinuing treatment. Analyses of these data indicated that primary care psychology services were effective in reducing patient anxiety and depression as measured by the GAD-7 and PHQ-9 respectively, even when controlling for additional treatment in the interim, and that patients as a group continued to improve over time following the conclusion of treatment. These preliminary results should be interpreted with caution, however, due to the study’s small sample size and lack of a control group. Study limitations, strengths, and future directions are addressed.

Residential buildings have served as homes for the humankind throughout the years and the energy focus is relatively new in comparison. The interest of the energy perspective has increased alongside with the stricter laws and goals in the European Union and the Swedish Building Board. In multiple cases, the calculated energy usage of the buildings are usually lower than the real time measured energy consumption, showing the importance of performing energy follow-ups of the buildings. The goal of this thesis is revolving around the understanding of the the problems, performance and importance of energy follow-ups in the building process. This study will only focus on the energy focus of residential buildings in the building process, while only taking the Swedish laws into consideration. A literature study was performed as an intention to understand the subject and its problems more thoroughly. The literature study contains the Swedish laws regarding the subject, the structure of the building process and possible failure points, while also looking at multiple studies regarding the difference between the calculated and the measured values. Furthermore, inquiries were sent out to multiple municipalities and companies with questions related to the subject. In the answers from the different respondents, the result showed that both municipalities and companies stores energy statistics in web-based programs and requires real measurements to perform energy follow-ups. One municipality describes that there was a vague understanding of the consequences or penalties of not performing an energy follow-up according to the time-plan. Furthermore, the company A described that there was a lack of knowledge of how or where measurements should be performed in detail and where responsibility should be placed if not everything is fulfilled according to the contract. The companies set up their own local goals that surpasses the rules of the BBR and the companies very rarely breaks the energy limits. Company B has only failed to meet the energy limits once and that project was sold off to another actor. Company B also describes that they have never failed to perform an energy follow-up according to the time-plan and doesn’t know what to do if it would happen. Another municipality refers multiple times to their goals regarding the climate and energy limits, however, the methodology on how to achieve these goals aren’t described. Lastly, the there’s no form of cooperation between the municipalities or the companies. Differences in energy performance, between the calculated and the real, is often a result of many different factors, which is not always easy to define. Throughout the building process, it is of high importance to keep focus on the energy question in every step. Good and correct knowledge has to be present the whole process to give the best prerequisites for a good performing building. Bad energy performance leads to higher cost for the habitants. Loose terms in laws and regulations can lead to bad energy calculations and leave room for influencing the calculation to show wanted results. Good energy declarations require proper measurements and as the standard equipment today provides somewhat lacking data with monthly values, which makes it difficult to study the reasons to higher energy consumption. For better understanding abnormal energy consumption, more detailed values are often necessary. In terms of applicability, this study can contribute to the awareness to the different issues that has occurred from the study, for example the required education and the responsibility in more detail. A few conclusions can be made from this study, the lack of knowledge in terms of responsibility, consequences or penalties and how measurements should be made in detail. Another conclusion are that web-based programs are used for energy follow-ups and require real values and there’s no cooperation between different actors related to this subject. / Bostäder har använts som hem för människor genom tiderna och energiperspektivet i dessa bostäder är relativt nytt i jämförelse. Energiperspektivets intresse har blivit större samtidigt som hårdare krav och mål har formulerats i EU och i lagboken BBR. I flertal fall är den beräknande energin för en byggnad lägre än den uppmätta mängden under användning, vilket visar vikten av att utföra en så kallad energiuppföljning för respektive byggnad. Målet med detta exjobb handlar om att få en förståelse kring problemen, utförandet och vikten i energiuppföljningar som existerar i flertal fall inom byggprocessen. Den här studien kommer bara fokusera på bostäder i byggprocessen och bara ta hänsyn av de svenska lagarna kring området. En litteraturstudie utfördes för att kunna fördjupa sig inom ämnet och dess problem. Denna litteraturstudie innehåller relevanta svenska lagar för ämnet, strukturen av byggnadsprocessen och möjliga felkällor, men även studera flertal rapporter angående skillnaden mellan den beräknande och den uppmätta energianvändningen. Slutligen skickades flera enkäter till energiexperter i kommuner och företag med relevanta frågor till ämnet. I svaren från respektive respondent visade resultatet att både kommuner och företagen använder dataprogram angående energianvändningen. Dessa dataprogram kräver en verklig uppmätning av energin i hushållen för att kunna utföra en energiuppföljning. Kommun A beskriver att det finns en dålig uppfattning angående de konsekvenser och straffen som förekommer om en energiuppföljning inte utförs i tid enligt tidsplanen. Fortsättningsvist beskriver företag A att det är en begränsad förståelse angående hur och var uppmätningar ska utföras i detalj, men även också vem som ska ta ansvar om någonting går fel enligt byggkontraktet. Företagen sätter upp lokala mål som är lägre än BBRs krav vilket har lett till att fel uppstår väldigt sällan. Företag B beskriver också att de aldrig har misslyckats med att utföra en energiuppföljning enligt tidsplanen men vet inte vad som ska göras om det skulle hända. Kommun B refererar flertal gånger till deras energi- och klimatmål men metodiken av att uppfylla dessa mål är inte beskrivet. Slutligen finns det ingen form av samarbete kring energiuppföljningar mellan de kommuner och företag som har svarat på enkäten. Skillnaden mellan den beräknande- och den uppmätta energiprestandan beror ofta av flertal olika faktorer som är svårt att definiera. Det är viktigt att ha någon form av energifokus genom hela byggnadsprocessen och inte bara i ett fåtal steg. Detta fokus måste vara bra och ha rätt kunskap för att kunna ge de bästa förutsättningarna till en bra bostad från ett energiperspektiv. Byggnader med en dålig energiprestanda leder till en hög kostnad genom förvaltningsfasen. Obestämda termer i lagboken som ”bör” leder till dåliga beräkningar som inte har en liknande struktur och kan vara gjord för att visa ett lägre värde. Energideklarationer som är bra kräver riktiga mätningar och bättre mätningsverktyg som inte ger otillräcklig information i till exempel månadsvärden, vilket leder till en dålig förståelse till vad som händer angående energianvändningen i huset. Användbarheten av studien består till mesta av att upplysa om de problemen som existerar idag som till exempel den behövda utbildningen och kompetensen kring ansvar, straffen och var mätningar ska sättas i detalj. Några slutsatser som studien har kommit fram till är den otillräckliga kunskapen i ansvar, konsekvenser och straff samt mätningar ska sättas beskrivas mer i detalj. Slutligen används dataprogram för att utföra energiuppföljningar som kräver verkliga mätningar och det finns ingen form av samarbetet mellan olika aktörer angående energiuppföljningar.

INTRODUÇÃO: O acometimento de artérias ou veias tronculares periféricas por neoplasias malignas é raro. Quando o tratamento cirúrgico é realizado sendo constatado o acometimento arterial pela neoplasia, a melhor conduta é a ressecção conjunta seguida de reconstrução arterial imediata, restabelecendo o eixo vascular e evitando a isquemia de tecidos nobres com suas possíveis conseqüências. OBJETIVOS: O objetivo desse trabalho é analisar os resultados do tratamento cirúrgico de pacientes portadores de neoplasias malignas, submetidos a ressecções tumoral e vascular associadas à reconstrução vascular, avaliando principalmente a morbidade, a mortalidade e a perviedade primária relacionadas às reconstruções arteriais. MÉTODOS: Foram acompanhados os pacientes portadores de neoplasias malignas em regiões cervical, abdominal ou extremidades inferiores, operados eletivamente no período de setembro de 1997 a setembro de 2004 no Hospital do Câncer A.C.Camargo em São Paulo, submetidos à ressecções tumoral e vascular associadas à reconstrução arterial (associada ou não à reconstrução venosa de segmento venoso ressecado no mesmo feixe). O seguimento vascular foi em ambiente ambulatorial, realizando-se exame clínico vascular e exames de imagem para o acompanhamento das reconstruções. Foram analisadas: as características clínicas dos pacientes, as reconstruções vasculares, as complicações vasculares e não vasculares precoces (até 30 dias); as complicações vasculares e não vasculares tardias (após 30 dias), a perviedade primária das reconstruções arteriais e a sobrevida dos pacientes. RESULTADOS: foram operados 36 pacientes, sendo divididos em grupos de acordo com a localização das neoplasias: Cervical (14), Extremidade (13) e Abdome (9). No grupo Cervical, foram realizadas 17 reconstruções (16 arteriais e 1 venosa) nos 14 pacientes, predominantemente com a veia safena. Houve uma oclusão sintomática precoce do enxerto carotídeo com seqüelas importantes e uma oclusão sintomática tardia de enxerto carotídeo sem seqüelas (esse paciente também apresentou oclusão de enxerto arterial para o membro superior sem isquemia grave). No grupo Extremidade, foram realizadas 23 reconstruções (13 arteriais e 10 venosas) nos 13 pacientes, predominantemente com a safena. Houve uma rotura precoce de enxerto arterial femoral, tratada por meio de ligadura e evoluindo sem seqüelas. No grupo Abdome, foram realizadas 13 reconstruções (9 arteriais e 4 venosas) nos 9 pacientes, predominantemente com prótese. Uma paciente apresentou oclusão tardia sintomática de ramo do enxerto aorto-bifemoral, sendo realizado enxerto femoral cruzado, evoluindo sem seqüelas. Não houve diferença estatística entre os índices de perviedade arterial primária entre os grupos (p=0,593). Em relação às reconstruções venosas, houve cinco oclusões sintomáticas. O tempo de seguimento mediano nos grupos Cervical, Extremidade e Abdome foi respectivamente de 11,5, 25 e 18 meses, sendo significantemente menor no grupo Cervical (p=0,034). Houve duas amputações de membro não relacionados às complicações dos enxertos. Não houve óbitos no período intra-hospitalar, sendo todos decorrentes da evolução da doença neoplásica (11 do grupo Cervical, 8 do Extremidade e 3 do Abdome). CONCLUSÕES: 1. as reconstruções arteriais associadas à ressecção de tumores malignos com acometimento arterial em segmentos cervical, abdominal ou extremidades inferiores podem ser realizadas com baixos índices de morbi-mortalidade; 2. não houve diferença entre os índices de perviedade primária das reconstruções arteriais realizadas nos grupos estudados / INTRODUCTION: Arteries or peripheral truncular veins are rarely affected by malignant neoplasias. When arteries affected by neoplasia are observed during surgical treatment, the best approach is in bloc resection followed immediately by arterial reconstruction to reestablish the vascular axis and avoid ischemia of important tissues with the possible consequences. OBJECTIVES: The objectives of this study were to analyze the surgical treatment results from patients with malignant neoplasias who underwent tumor and vascular resection associated with vascular reconstruction and, in particular, to evaluate morbidity, mortality and primary patency relating to arterial reconstruction. METHODS: Patients with malignant neoplasias in the cervical, abdominal or lower extremity regions who underwent elective surgery between September 1997 and September 2004 at Hospital do Câncer A.C. Camargo, São Paulo, were followed up. These patients underwent tumor and vascular resections associated with arterial reconstruction (with or without reconstruction of the venous segment resected in the same bundle). The vascular follow-up was in an outpatient environment, through clinical vascular examination and imaging examinations to monitor the reconstructions. The patients\' clinical characteristics, vascular reconstructions, early vascular and non-vascular complications (within 30 days), late vascular and non-vascular complications (beyond 30 days), primary patency of arterial reconstructions and survival were analyzed. RESULTS: Thirty-six patients underwent surgery and were grouped according to neoplasia location: Cervical (14), Extremity (13) and Abdomen (9). In the Cervical group, 17 reconstructions were performed (16 arterial and 1 venous) in 14 patients, predominantly using the saphenous vein. There were one early symptomatic occlusion of the carotid graft with significant sequelae and one late symptomatic occlusion of the carotid graft without sequelae (this patient also presented arterial graft occlusion to the upper limb, without severe ischemia). In the Extremity group, 23 reconstructions were performed (13 arterial and 10 venous) in 13 patients, predominantly using the saphenous vein. There was one early rupture of a femoral arterial graft, with treatment by means of ligature and evolution without sequelae. In the Abdomen group, 13 reconstructions were performed (9 arterial and 4 venous) in 9 patients, predominantly using a prosthesis. One patient presented a late symptomatic occlusion in a branch of the aortobifemoral graft, for which a femoral crossover graft was performed, which evolved without sequelae. There was no statistical difference in primary arterial patency rates between the groups (p=0,593). Five symptomatic occlusions relating to venous reconstructions occurred. The median follow-up for the Cervical, Extremity and Abdomen groups were 11,5, 25 and 18 months, respectively: significantly shorter in the Cervical group (p=0,034). There were two limb amputations, unrelated to graft complications. There were no deaths while in hospital. Deaths occurred only as a result of neoplastic disease evolution (11 Cervical, 8 Extremity and 3 Abdomen patients). CONCLUSIONS: 1. arterial reconstructions associated with resection of malignant tumors affecting arteries in the cervical, abdominal or lower extremity segments can be performed with low morbidity-mortality rates; 2. there is no difference between primary patency rates of the arterial reconstructions performed, regarding the groups studied

Neste trabalho foi proposto o estudo prospectivo de gestações após a 40a semana, objetivando: a) verificar os índices de morbidade e mortalidade perinatais; b) identificar os testes de avaliação da vitalidade fetal mais adequados para a vigilância destas gestações; c) comparar os resultados dos testes de avaliação da vitalidade fetal com os resultados perinatais na 1a e 2a semana, após a 40a semana de gestação, para testar o protocolo do Serviço. Para a realização do estudo, selecionaram-se 52, gestantes divididas em 2 grupos: GI (1a semana) com 32 gestantes e GIl (2a semana) com 20 gestantes. Acompanhou-se a vitalidade fetal com a Cardiotocografia de Repouso e Intraparto, Teste da Estimulação Sônica, Avaliação do Volume do Líquido Amniótico através da Técnica dos Quatro Quadrantes, Perfil Biofisico Fetal e Dopplerfluxometria Uterina e Umbilical, realizados 2 vezes na semana. Os resultados neonatais e os índices de morbidade foram: Índices de Apgar no 10 e 50 minutos (alterados < 7), pH da artéria umbilical (alterado < 7,20), peso dos recém-nascidos, tempo de internação dos recém-nascidos, oligoidrâmnia, líquido amniótico meconial, alterações na cardiotocografia com presença de desacelerações e índices de cesárea. O estudo permitiu como resultados e conclusões: a) a incidência de oligoidrâmnio foi de 44,23%, líquido meconial de 28,85%, cardiotocografia alterada, 50,00% e partos cesáreos, 57,70%, não havendo óbito fetal ou neonatal. Não houve alterações significativas nos índices de Apgar, pH da artéria umbilical e tempo de internação dos recém-nascidos. b) A cardiotocografia e, principalmente, a avaliação do volume do líquido amniótico, pelo índice de líquido amniótico, foram os métodos mais adequados na detecção de alterações verificadas neste grupo de gestantes. Do parâmetro ultra-sonográfico do Perfil Biofisico Fetal, apenas o Volume do Líquido Amniótico demonstrou ser importante. A Dopplerfluxometria (uterina e umbilical) não revelou nenhuma utilidade na vigilância destas gestações. c) A distribuição dos casos com oligoidramnia, líquido meconial, cardiotocografia alterada, índices de cesárea e pH da artéria umbilical < 7,20, semelhante na 41a semana (GI) e 42a semana (GIl), valida o protocolo do Serviço. d) Adicionalmente, este estudo permite ainda as seguintes observações: 1) importância da oligoidrâmnia e líquido meconial na determinação dos elevados índices de cesáreas; 2) incidência elevada (50,00) de nulíparas nesta casuística. / This study proposed pros.pectively the evaluation of the gestations after 40 weeks with these objectives: a) Analysis of the perinatal outcome. b) Identification of the proper test for fetal well-being assessment for this gestation. c) Comparation of these tests results with perinatal outcome at the first and second weeks after 40 weeks, therefore, testing the protocol of this Service. It recruited 52 patients divided in two groups: GI (1st week) with 32 patients and Gil (2nd week) with 20 patients. The fetal surveillance was assessed by antepartum and intrapartum cardiotocography, acoustic stimulation test, amniotic fluid volume assessment by the ultrasonographic four quadrant technique (amniotic fluid index), fetal biophysical profile and umbilical and uterine doppler velocimetry, ali tests were performed twice weekly. The neonatal outcome results and morbidity parameters were: Apgar index in 1st and s\" minutes (alterated < 7), umbilical artery pH (alterated < 7,20), the new born weight, oligohydramnios, meconium stained, deceleration (DIP 11 or umbilical deceleration) and cesarean section rates. The study permitted these results and conclusions: a) The oligohydramnios, meconium stained, cardiotocography alterations and cesarean section incidences were 44,23%, 28,85%, 50,00% and 57,70%, respectively. There was no fetal death. b) The cardiotocography and amniotic fluid assessment by the amniotic fluid index, were the best tests to detect the alterations verified. The amniotic fluid volume was the most important parameter in the fetal biophysical profile. Doppler (uterine and umbilical) revealed no utility. c) The equal distribution of the oligohydramnios, meconium stained, altereted cardiotocography, cesarean section and umbilical artery pH < 7,20 cases in the group studied reassure the Service protocol. d) In addition this study also permitted observation of: 1) The importance of the meconium stained in the cesarean section rate. 2) The nuliparus elevated incidence (50,00%) in this group.

Com o aumento na prevalência das doenças crônicas, pesquisadores têm feito reflexões e investigações sobre a necessidade de novas abordagens para o cuidado dos pacientes. Neste contexto, o algoritmo seria uma ferramenta interessante, com informações precisas para a harmonização das condutas clínicas dos farmacêuticos na prática da Atenção Farmacêutica. Os algoritmos constituem o núcleo dos protocolos clínicos, que retratam o fluxo principal do atendimento e são representados graficamente por meio de fluxograma, estruturado em etapas que se inter-relacionam, apresentando pontos de decisão. O objetivo deste trabalho foi identificar a percepção de farmacêuticos sobre a utilização de algoritmos na prática da Atenção Farmacêutica, sendo classificado como um estudo descritivo, quantitativo, baseado em levantamento de dados em uma população composta por 20 farmacêuticos. Para a coleta dos dados foi utilizada a técnica Delphi, que consiste num processo de comunicação em grupo visando à convergência de opiniões, obtidas em três interações, por meio de questionários. O primeiro questionário forneceu 181 opiniões e destas, 58 (32%) foram consideradas válidas, ao término da terceira interação, pois apresentaram 100% de concordância entre os participantes do estudo. Em seguida, as opiniões foram separadas por semelhança para a composição das categorias, com o intuito de homogeneizar as informações e, assim, identificar as ideias relacionadas à importância, às vantagens e desvantagens, bem como, o interesse da aplicabilidade de algoritmos na prática clínica farmacêutica. Desta maneira, foram obtidas 19 categorias, sendo seis para o questionamento sobre a importância, cinco sobre as vantagens, duas sobre as desvantagens e seis relacionadas ao interesse da aplicabilidade desta ferramenta na prática clínica. Posteriormente, pôde-se identificar em três das quatro perguntas iniciais, uma categoria em comum, reconhecida por \"facilitar a prática da Atenção Farmacêutica\". Esta foi considerada a categoria central por representar 40% das opiniões válidas ao longo do estudo. Isto evidencia que as justificativas sobre o interesse da utilização baseiam-se nas vantagens, bem como, na importância que o instrumento oferece. Portanto, a percepção dos farmacêuticos sobre a utilização de algoritmos na prática da Atenção Farmacêutica considera o instrumento um facilitador das ações relacionadas à promoção da saúde, podendo proporcionar também, a comunicação e a interação multiprofissional, além de harmonizar as condutas clínicas, bem como diminuir potenciais erros técnicos e gastos desnecessários. / The increase in the prevalence of chronic diseases have been taken researchers to reflect and explore new strategies to deal in practice involving patient care. In this context, the algorithm would be an interesting tool, which works with accurate and quick information and would help in the harmonization of the conducts, i. e., in the pharmacotherapeutic follow-up, at the Pharmaceutical Care.The algorithms are the core of clinical protocols that reflect the mainstream of the service and are represented by a structured flowchart, which steps are interrelated, showing the decision points. The objective of this study was identify the perception of pharmacists regarding algorithms use in the practice of Pharmaceutical Care. The research was classified as a descriptive, quantitative, based on data collection and was conducted in a population consisting of 20 pharmacists. Delphi technique was used for data collection, which consists on a group communication process. This group is composed by experts and aims to the convergence of opinions, obtained in three interactions, using questionnaires. The first questionnaire provided 181 opinions and 58 (32%) of them were considered valid, at the end of the third interactions, because they presented 100% of agreement among study participants. Then, the views were separated by similarity to form categories, in order to homogenize the information and identify the main ideas about the importance, advantages and disadvantages and the possibility of using algorithms in the clinical practice of pharmacy. Thus, there were obtained 19 categories: six related with the importance of this tool, five with the advantages, two with the disadvantages and six were related to interests of the applicability of this tool in clinical practice. Later, it was possible to identified in three of the four initial questions, a common category, recognized for \"facilitating the practice of Pharmaceutical Care\". This was considered the main category, which represented 40% of valid opinions throughout the study. The explanation for this is the fact that to adopt a new instrument of work, it is needed to be based on the importance and the advantages that this can provide. This shows that the justifications about the interest of use based on the benefits, as well as on the importance that the instrument provides. Therefore, the perception of pharmacists about the use of algorithms in the practice of Pharmaceutical Care considers the instrument a facilitator of actions related to the promotion of health, and can also provide communication and multidisciplinary interaction, in addition to harmonize conduct clinics, as reduction potential of technical errors and unnecessary expenses.

A presente pesquisa busca apresentar considerações sobre as diferentes formas de participação da família na clínica do Acompanhamento Terapêutico (AT). São as peculiaridades desse setting que tornam necessárias as reflexões sobre a família nesta modalidade clínica. A natureza da relação que se configura entre acompanhante-acompanhado é de extrema intimidade, viabilizada pelo número maior de horas, assim como pelo acompanhamento que ocorre no cotidiano do paciente. Tais especificidades trazem em seu bojo a presença familiar enquanto tema a ser considerado. Observam-se quatro formas de presença familiar neste enquadre de atendimento, a saber: 1) no próprio contato com a família, nos atendimentos realizados em consultório; 2) na presença dos familiares durante os acompanhamentos, quando realizados em ambiente domiciliar e extra-domiciliar; 3) na fala do paciente sobre a própria família, e por fim; 4) nas questões apresentadas pelos pacientes durante os atendimentos. Procura-se, através de narrativas literárias sintéticas de casos clínicos, considerar aspectos da relação at-família / famíliaacompanhado na clínica do Acompanhamento Terapêutico. A metodologia é orientada pelo pensamento clínico de Donald. W. Winnicott, pediatra e psicanalista inglês, e do professor Dr. Gilberto Safra, psicanalista brasileiro contemporâneo / The present study discusses considerations about the different forms of family participation during therapeutic follow-up. The peculiarities of this setting make it necessary to reflect on the family in this clinical modality. The nature of the relationship established between companions and those being accompanied is extremely intimate and made possible by the greater number of hours, as well as by the accompaniment that occurs in the daily life of the patients. Such specificities represent the presence of the family as an issue to be taken into consideration. There are four forms of family presence within this context, namely: (1) the contact with the family during the consultations at the doctor\'s office; (2) the presence of family members during followups performed at home or out-of-home settings; (3) patients\' statements about their families; and (4) the questions raised by the patients during medical visits. Synthetic literature narratives of clinical cases were assessed to consider aspects of the relationships \"therapist-family\" and \"family-patient\" during therapeutic follow-up. The methodology was based on Donald W. Winnicott\'s clinical thinking, an English pediatrician and psychoanalyst, and Dr. Gilberto Safra, a contemporary Brazilian psychoanalyst