Made available in DSpace on 2016-04-27T18:12:42Z (GMT). No. of bitstreams: 1 Carolina Morato Facanha Bandeira Dantas.pdf: 1064364 bytes, checksum: 3d2b88f7be7da06c9cfb30735d70bba0 (MD5) Previous issue date: 2009-08-04 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This research had as objective to describe, apply and verify the effectiveness of a homecare program for elderly patients, new hearing aid wearers, taking into account the family and/or caretaker s influence during the fitting process. Method: The study had a design based on quantitative-qualitative, descriptive and exploratory perspective. Ten elderly subjects, candidates for hearing aid use who were unable to be seen at the clinic, thus needing homecare, took part from the study. The subjects were divided in two groups: Group I Experimental Group: the subjects had a caretaker/ family member to meet their needs; and Group II Control Group: subjects who did not have caretaker/family member. A questionnaire: The International Outcome Inventory for Hearing Aids (IOI-HA) prepared by Cox and Alexander (2002) was applied at the 4th homecare program session. In order to complement the program s evaluation, a question was made to all subjects: What the homecare service meant to you? Results: There was no statistically significant association (p<0.05) between having a caretaker and achieving a higher score at the questionnaire. All subjects attributed positive scores at the questionnaire, and the answer to the question showed a high degree of satisfaction with their hearing aids. Conclusion: The homecare program developed for this study was applied and it was effective, revealing also that the results of its application are independent on the family/caretaker s influence / Esta pesquisa teve como objetivo descrever, aplicar e verificar a efetividade de um programa de atendimento domiciliar ao indivíduo idoso novo usuário de aparelhos de amplificação sonora (AAS), considerando a influência da família e/ou do cuidador no processo de adaptação. Método: Para tal optamos por uma perspectiva quanti/qualitativa, descritiva e exploratória. Participaram deste estudo dez indivíduos idosos candidatos ao uso de AAS que estavam impossibilitados de comparecer ao local de atendimento, necessitando do atendimento domiciliar. Os indivíduos foram distribuídos em dois grupos: Grupo I - Experimental, os indivíduos que tinham cuidador/ familiar e Grupo II - Controle, os indivíduos que não tinham cuidador/ familiar. A fim de avaliar o programa de atendimento domiciliar ao novo usuário de AAS foi aplicado o questionário The International Outcome Inventory for Hearing Aids (IOI-HA), elaborado por Cox e Alexander (2002), na quarta sessão do programa de atendimento, pela própria pesquisadora. Para complementar a avaliação, foi feita a pergunta para todos os indivíduos: O que significou o atendimento domiciliar para o senhor/senhora? Resultados: Observamos que não houve associação estatisticamente significante (p<0,05) entre ter cuidador e apresentar maior pontuação do questionário. Todos os indivíduos atribuíram sentidos positivos ao uso dos AAS e valorizaram o programa de atendimento domiciliar. Conclusão: O programa para o atendimento domiciliar desenvolvido para este estudo mostrou-se efetivo e os resultados de sua aplicação independem da influência da família e/ou cuidador, pois não foram encontradas diferenças estatisticamente significantes, no grau de satisfação apresentado pelos idosos usuários de AAS

<p>How can we develop usable and work process-oriented ICT systems for shared homecare?</p><p>Shared homecare involves different professionals, consists of mobile work and requires immediate and ubiquitous access to patient-oriented information, supporting an integrated view on the care process.</p><p>This thesis presents a new collaborative design method for user needs analysis and requirements specification in the context of health information systems development; the Multi-disciplinary Thematic Seminar (MdTS) method. The thesis also describes the MdTS method’s application and two different usability evaluations of the developed system.</p><p>The MdTS addresses a significant problem with health information technologies; they tend to support collaborative work of healthcare professionals poorly, sometimes leading to a fragmentation of workflow and disruption of healthcare processes. Based on human-computer interaction methods, MdTS implies a multiple-user needs analysis by thorough investigation of the entire interdisciplinary cooperative work and its transformation into technical specifications in order to develop appropriate information and communication technology (ICT) for the users’ differing work situations.</p><p>Application of the MdTS resulted in a prototype, the OLD@HOME Virtual Health Record (VHR), adapted to the specific demands in shared homecare. Through mobile devices each care professional accessed patient information in profession-specific views from an integrated platform.</p><p>This thesis provides an interesting case, illustrating how mobile ICT can support shared homecare, thereby bridging health and social care activities and improving knowledge about joint work processes.</p><p>Results from the usability evaluations were overall positive. Information needed at point of care was available on mobile devices and presented in an understandable manner. However, the evaluations also indicated that it is difficult to transfer results from one homecare setting to another due to differences in operational routines.</p><p>In conclusion, application of the MdTS method, in this study, succeeded in elicitation of correct user needs and in transferring correct requirements specifications to system developers for implementation.</p>

How can we develop usable and work process-oriented ICT systems for shared homecare? Shared homecare involves different professionals, consists of mobile work and requires immediate and ubiquitous access to patient-oriented information, supporting an integrated view on the care process. This thesis presents a new collaborative design method for user needs analysis and requirements specification in the context of health information systems development; the Multi-disciplinary Thematic Seminar (MdTS) method. The thesis also describes the MdTS method’s application and two different usability evaluations of the developed system. The MdTS addresses a significant problem with health information technologies; they tend to support collaborative work of healthcare professionals poorly, sometimes leading to a fragmentation of workflow and disruption of healthcare processes. Based on human-computer interaction methods, MdTS implies a multiple-user needs analysis by thorough investigation of the entire interdisciplinary cooperative work and its transformation into technical specifications in order to develop appropriate information and communication technology (ICT) for the users’ differing work situations. Application of the MdTS resulted in a prototype, the OLD@HOME Virtual Health Record (VHR), adapted to the specific demands in shared homecare. Through mobile devices each care professional accessed patient information in profession-specific views from an integrated platform. This thesis provides an interesting case, illustrating how mobile ICT can support shared homecare, thereby bridging health and social care activities and improving knowledge about joint work processes. Results from the usability evaluations were overall positive. Information needed at point of care was available on mobile devices and presented in an understandable manner. However, the evaluations also indicated that it is difficult to transfer results from one homecare setting to another due to differences in operational routines. In conclusion, application of the MdTS method, in this study, succeeded in elicitation of correct user needs and in transferring correct requirements specifications to system developers for implementation.

Syftet med denna studie är att utvärdera ett HVB-hem vilket bedriver miljö- och individualte-rapeutisk behandling av ungdomar i åldrarna 16-19 år. Vidare syftar studien till att utvärdera verksamhetens arbetssätt vid kritiska händelser enligt critical incident-metoden. Således fin-ner författarna följande frågeställningar relevanta för utvärderingen: Vilka slags kritiska hän-delser uppstår i verksamheten enligt personalens upplevelser? Hur löses/slutar de kritiska händelserna i verksamheten? Är lösningarna av de kritiska händelserna förankrade i miljöte-rapeutisk teori? Utvärderingen grundas i uppgifter från nio respondenter, varav en av respondenterna är utvärderingens författare. Datainsamlingen utgörs i sin tur av observationer, frågeformulär och kompletterande intervjuer. Materialet består av 50 stycken kritiska händel-ser varav 47 händelser redovisas i tabeller under resultat och analys samt kopplas till miljöte-rapeutisk teori och tidigare forskning. I materialet framkommer sex stycken kärnproblem: hot och våld, yrkesroll och arbetsgrupp, alkohol och narkotika, bryter mot verksamhetens struk-tur, ungdomar mot arbetsgruppen samt förändring hos enskild ungdom. Analysen av resultatet visar på att samtliga lösningar i utvärderingen är förankrade i miljöterapeutisk teori. / The purpose of this study is to evaluate an institution which carries out milieu and individual therapy regarding youth. Furthermore, the purpose of this study is to evaluate the way of working in critical situations according to critical incident-method. Therefore, the author found the following questions relevant to this evaluation: Which sort of critical situations arise according to employee’s experiences? How can we solve these critical situations within the operation? Are the solutions of these critical situations anchored to the milieu therapeutic theory? The evaluation is based upon information from 9 respondents, of which one of the respondents is the evaluator’s writer. The collected information represents observation, question formulas and supplementary interviews. The material consists of 50 critical situations in which 47 situations account for tables under the result of analysis plus connection to the milieu therapeutic theory and earlier research. In the material 6 core problems emerge: threats and violence, occupational roll, and work groups, alcohol and nar-cotics break towards the operational structure, youth towards work groups and shifts in indi-vidual youths. The result shows that all solutions are supportive of the milieu therapeutic theory.

Introduction : Les personnes âgées vivant à domicile font des chutes qui peuvent entraîner des conséquences graves. La possibilité de les détecter et d’intervenir rapidement grâce à la vidéosurveillance intelligente constitue une avenue prometteuse. Objectif : L’étude vise à explorer la perception et la récep-tivité des acteurs du système de santé face à l’utilisation de cette technologie sous trois aspects : la transmission des images, l’accessibilité de leur clientèle à cette technologie et son introduction dans leur pratique. Méthodologie : Sept groupes de discussion focalisée ont permis de recueillir le point de vue de 31 participants. Une analyse de contenu avec le logiciel N’Vivo a été réalisée. Résultats : Les participants estiment que les images de chute pourraient parve-nir au CLSC, au proche aidant, au 911 ou à une centrale de surveillance. Ils considèrent que des critères d’admissibilité seraient nécessaires pour favoriser l’accessibilité à la vidéosurveillance intelligente qui, croient-ils, pourrait améliorer les interventions en termes de gestion des urgences lors de chutes et de déter-mination de leurs causes. Conclusion : Les participants sont favorables à la technologie proposée, mais ils requerraient une période d’adaptation afin d’ajuster leur pratique. Ils suggèrent la réalisation d’un projet pilote qui validerait cette technologie. / Introduction: Elderly living at home fall and this may result in severe consequences. However, rapid detection and effective intervention using an intel-ligent videomonitoring system is very promising. Objective: The study aims at exploring the perception and receptiveness of healthcare providers regarding this technology from three angles: image transmission, the accessibility of their cli-ents to such a system, and its introduction in their practice. Methodology: Seven focus groups allowed 31 healthcare providers to express their points of view. A content analysis was performed with N’Vivo software. Findings: Participants reckon that CLSC, caregivers, the 911 or a central call center might receive im-ages of falls. They believe that admission criteria might have to be developed in order to ensure accessibility to the videomonitoring system which, they think, could improve their interventions in terms of emergency management when falls occur as well as of cause seeking. Conclusion: The participants are in favour of using the intelligent videomonitoring system, but they might require an adaptation period in order to adjust their practices. They have recommended that a pilot study be carried out to confirm its feasibility in a real-life setting.

Multiple transitions between care settings have been reported to affect the quality of life of the older adults and their families. In Canada, there have been no studies that have examined transitions between care settings at the end of life in older adults who are on homecare. The aim of this thesis was to address this gap, and to describe transitions between care settings in older homecare clients towards the end of their life and examine what personal, health system and health service use factors predict these transitions. The sample used in this study was the cohort of individuals 65 years and older(n=7866) who died in Manitoba within the fiscal years 2003-2006, and who received homecare for at least 30 days in the last year of their life. The outcome variables in this study were transitions and independent variables included demographic (e.g., age, sex), health service use (homecare days) and system factors (e.g., hospital bed supply). The study involved secondary data analysis of anonymized administrative data (the hospital, homecare and personal care home (PCH) data), vital statistics data, health insurance registry, census data, and annual provincial statistical reports. Descriptive and inferential data analyses methods were used to analyze the data in the study. It was found in the study that more than half of the homecare clients had one or more transitions between care settings in their last month of life, and more than half of the homecare clients in the study died in hospitals. Homecare clients who were males, in the 75-84 years age group, received more homecare days and lived in regions of high hospital bed supply were more likely to have one or more transitions in the last month of their life, and those who were single, in the lower income quintile groups, lived in regions of high physician and PCH bed supply had lower odds of having one or more transitions. The findings suggest the need for increasing palliative care and homecare services to reduce transitions and hospital deaths at the end of life. Increasing physician supply, particularly in rural areas should also be considered. Future studies should also attempt to classify which of the transitions towards the end of life were essential or burdensome.

Backgrund: Cancer är en av Sveriges och världens vanligaste folksjukdomar. När sjukdomen inte längre går att bota övergår vården från kurativ till palliativ vård. En del av patienterna i livet slutskede väljer att vårdas i hemmet och detta utgör en känslig period för både patienten och närstående. Närstående och familjemedlemmar vårdar och utför omvårdnadsuppgifter som annars skulle utföras av vårdpersonal. För att kunna utföra vården har närstående och anhörigvårdare stor behov av stöd. Syfte: Att belysa närståendes behov av stöd, vid palliativ vård i livets slutskede i hemmet. Metod: En kvalitativ litteraturstudie med induktiv ansats. Resultat: Närstående och anhörigvårdare uttrycker behov av emotionellt stöd och brist på egen tid för återhämtning på grund av vårdarrollen. Att få information och undervisning om sjukdomen och sjukdomens symptom visade sig vara en viktig faktor som påverkade närståendes trygghetskänsla för att ge god palliativvård i hemmet. Slutsats: Studien visar att vårdarrollen kan vara en mycket påfrestande upplevelse med konsekvenser i form av ohälsa. Genom att ge stöd och utveckla en familjecentrerad palliativ vård kan sjukvårdspersonal minska närståendes sårbarhet och förebygga hälsa. Klinisk betydelse: Det är angeläget att främja sjuksköterskors medvetande om närståendes utsatthet och behov av stöd, för att vårdpersonalen lättare vägleda och stötta närstående. / Background: Cancer is one of Sweden's and the world's most common diseases. The ability to cure the disease has increased in recent years, but to cure the disease is not always possible. Caring force then changes to the palliative care with the aim of preventing and relieving suffering. Big part of cancer patients choose to receive palliative care in the home at the end of live and this is sensitive period for both patient and relatives. In order to provide the care have relatives and carers great need of support. Aim: Highlighting relatives need support, in palliative terminal care in the home. Method: A qualitative literature review with an inductive approach. Results: Family care givers experiences and express the need for emotional support and lack of time for recovery due to caring role. Gaining access to information and education about the disease and the symptoms of the disease appeared to be an important factor affecting closely related to confidence to provide good palliative care in the home. Conclusion: The study shows that caring role can be a very stressful experience with the consequences in the form of ill-health. By providing support and develop a family-centered palliative care can reduce health care professionals affiliated vulnerability and prevent health. Clinical significance: It is state to promote nurses awareness about relatives vulnerability and need for support. By mapping the various aspects of closely related experiences and needs can caregivers help guide and support related individually through the strenuous life situation.

Made available in DSpace on 2010-04-20T20:20:26Z (GMT). No. of bitstreams: 1 163072.pdf: 573659 bytes, checksum: 272ba865f4040b4494c6131f2655caa6 (MD5) Previous issue date: 2007-05-03T00:00:00Z / O objetivo do presente trabalho é apresentar possíveis aplicações de métodos de avaliação financeira em práticas preventivas de uma seguradora especializada em saúde, especificamente na atenção domiciliar, utilizando conceitos de valor presente líquido (VPL), taxa interna de retorno (TIR), retorno sobre o investimento (ROI), retorno sobre o patrimônio (ROE ¿ em inglês, return on equity) e valor econômico adicionado (EVA® ¿ em inglês, economic value added), e, adaptados para uma análise gerencial, não-contábil, para conseguir demonstrar a contribuição destes para atingir uma análise mais consistente da atenção domiciliar estudada. Os resultados obtidos mostraram a viabilidade na aplicação desses indicadores financeiros para analisar os programas de atendimento domiciliar, e são necessários mais estudos para verificar também a aplicabilidade em programas de medicina preventiva.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-07-20T22:02:47Z No. of bitstreams: 1 AntonioHigorFreireDeMorais_TESE.pdf: 1781383 bytes, checksum: 12a1bd589f80bcd6303ef2f9725860f1 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-07-21T20:58:48Z (GMT) No. of bitstreams: 1 AntonioHigorFreireDeMorais_TESE.pdf: 1781383 bytes, checksum: 12a1bd589f80bcd6303ef2f9725860f1 (MD5) / Made available in DSpace on 2016-07-21T20:58:48Z (GMT). No. of bitstreams: 1 AntonioHigorFreireDeMorais_TESE.pdf: 1781383 bytes, checksum: 12a1bd589f80bcd6303ef2f9725860f1 (MD5) Previous issue date: 2015-11-20 / A Esclerose Lateral Amiotr?fica (ELA) ? uma doen?a neurodegenerativa caracterizada pela fraqueza muscular progressiva que leva o paciente ? morte, geralmente devido a complica??es respirat?rias. Assim, ao passo que a doen?a progride o paciente precisar? de ventila??o n?o-invasiva (VNI) e monitoramento constante. Esta tese apresenta uma arquitetura distribu?da para monitoramento domiciliar de ventila??o noturna n?o-invasiva (VNNI) em pacientes com ELA. A implementa??o desta arquitetura utilizou um computador de placa ?nica (Single Board Computer) e dispositivos m?veis localizados na casa do paciente para mostrar mensagens de alerta para os cuidadores do paciente e um servidor web para monitoramento remoto pela equipe de sa?de. A arquitetura utilizou um software baseado em l?gica fuzzy e vis?o computacional para capturar os dados da tela do ventilador mec?nico e gerar mensagens de alerta com instru??es para os cuidadores. O experimento de monitoramento foi realizado com 29 pacientes por 7 horas cont?nuas diariamente durante 5 dias gerando um total de 126000 amostras para cada vari?vel monitorada com uma taxa de amostragem de uma amostra por segundo. A arquitetura do sistema foi avaliada com rela??o a taxa de acerto para reconhecimento de caracteres e respectiva corre??o atrav?s de um algoritmo para detec??o e corre??o de erros. Al?m disso, a equipe de sa?de avaliou o sistema com rela??o aos intervalos de tempo em as mensagens de alertas foram geradas e se as estas estavam corretas. Dessa forma, o sistema apresentou uma m?dia geral de acertos de 98,72%, e no pior caso 98,39%. Quanto ?s mensagens a serem geradas, o sistema tamb?m concordou em 100% com a avalia??o geral, tendo havido discord?ncia em apenas dois casos com um dos avaliadores. / The Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease characterized by progressive muscle weakness that leads the patient to death, usually due to respiratory complications. Thus, as the disease progresses the patient will require noninvasive ventilation (NIV) and constant monitoring. This paper presents a distributed architecture for homecare monitoring of nocturnal NIV in patients with ALS. The implementation of this architecture used single board computers and mobile devices placed in patient?s homes, to display alert messages for caregivers and a web server for remote monitoring by the healthcare staff. The architecture used a software based on fuzzy logic and computer vision to capture data from a mechanical ventilator screen and generate alert messages with instructions for caregivers. The monitoring was performed on 29 patients for 7 con-tinuous hours daily during 5 days generating a total of 126000 samples for each variable monitored at a sampling rate of one sample per second. The system was evaluated regarding the rate of hits for character recognition and its correction through an algorithm for the detection and correction of errors. Furthermore, a healthcare team evaluated regarding the time intervals at which the alert messages were generated and the correctness of such messages. Thus, the system showed an average hit rate of 98.72%, and in the worst case 98.39%. As for the message to be generated, the system also agreed 100% to the overall assessment, and there was disagreement in only 2 cases with one of the physician evaluators.

This paper deals with one of quality standards in homecare services {--} individual planning during the homecare services. It shows principal and content of individual planning during the assistance with a client on present legislative background. It pays attention to homecare services characteristic and specification of its target group, particularly to skills, knowledge and key competences of employees, who are necessary for discovering clients´ personal goals, activating their resources and settling adequate support. There are also integrated theoretical requirements with practical instructions of methods usage and techniques of individual planning during homecare services with communicative and non-communicative clients. These principals are contact, dialog and relationship between key worker and client. The aim of this material is to give proposal for methodical content of individual planning in homecare services, thus set of rules describing course of this process.