Orientador: Iscia Teresinha Lopes-Cendes, Carmen Passos Lima / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T07:38:24Z (GMT). No. of bitstreams: 1 Viana_DaniloVilela_M.pdf: 17449794 bytes, checksum: 5628cf41f1e3b3dae3d2ad85bb64f5d4 (MD5) Previous issue date: 2006 / Resumo: O câncer de cólon e reto é a quinta causa de mortalidade por câncer no Brasil. Sua taxa de mortalidade vem apresentando um aumento contínuo desde 1979. Entre os fatores de risco mais importantes para essa doença está a história familial de câncer de cólon e reto ou de pólipos adenomatosos. O propósito do presente estudo foi investigar a qualidade das histórias familiais (HF) registradas nos prontuários médicos e estimar a freqüência dos agregados familiais e das síndromes hereditárias de câncer nos pacientes com diagnóstico de câncer de cólon e reto atendidos no Hospital de Clínicas da UNICAMP. Um estudo retrospectivo foi delineado para avaliar os prontuários dos pacientes que tinham confirmação histopatológica do diagnóstico de adenocarcinoma de cólon ou reto. Inicialmente, 415 prontuários que apresentavam codificação para a doença foram selecionados a partir do livro de cirurgias e de uma lista de pacientes atendidos nos ambulatórios de oncologia clínica, radioterapia e proctologia. Foram excluídos 104, sendo realizada a revisão de 311 prontuários. Numa segunda fase do estudo todos esses pacientes foram convocados para um entrevista com médico geneticista para obtenção de nova história familial, e comparação subseqüente dos dados, na qual a história familial previamente registrada foi classificada como completa ou incompleta. Dentre os 311 prontuários revisados, 193 (62%) tinham HF de câncer registrada. No total, 95 pacientes compareceram à entrevista, dos quais 66 tinha HF registrada no seu prontuário para que fosse feita comparação. Dessas 66 HF, 21 (32%) puderam ser consideradas completas e 45 (68%) incompletas. Pelo menos um critério clínico para câncer hereditário foi preenchido por 39 pacientes. Agregação familiar de CCR foi encontrada em 19% dos indivíduos entrevistados. Estes achados demonstram que a coleta e o correto preenchimento das histórias familiais nos prontuários dos pacientes com câncer são freqüentemente negligenciados, o que poderia influenciar negativamente na qualidade da assistência médica a eles prestada. As formas hereditárias de câncer hereditário, em especial a síndrome de Lynch (câncer colorretal hereditário sem polipose - HNPCC), são subdiagnosticadas, impossibilitando que medidas preventivas e diagnóstico precoce sejam oferecidos às suas famílias. / Abstract: Colorectal cancer is the 5th mortality cause by cancer in Brazil, and has been showing a continuous increase in mortality since 1979. Among the most important risk factors for this disease is family history of CRC or adenomatous polyps. The purpose of the present study was to investigate family histories (FH) recorded in medical charts for completeness and accuracy and to estimate the frequency of cancer aggregates and cancer syndromes in colorectal cancer patients treated in a general hospital. A retrospective study was assembled to evaluate archived charts of patients with pathological diagnosis of colorectal adenocarcinoma. Four hundred and fifteen medical records with ICD-10 coding of colorectal cancer were selected from the list of pacients who had had consultation in the clinical oncology, radiation oncology or proctology clinics, from which 104 were excluded because of misclassification or unconfirmed diagnosis. 311 charts were fully reviewed, and these patients invited for a personal interview by a medical geneticist. FH obtained from chart reviews were compared to data obtained from personal interviews and subsequently classified as complete or incomplete. Among the 311 charts, 193 (62%) had FH of cancer recorded. Overall, 95 patients attended the interviews, 66 of whom had a FH recorded in their hospital charts allowing accuracy comparisons. Of these, 21/66 (32%) FH could be considered complete and 45/66 (68%) incomplete. Thirty-nine patients met at least one criterion for hereditary cancer. Familial aggregates of colorectal cancer were found in 18 families (19%). In conclusion, the data in this study showed that FH in medical charts were often flawed or carried important omissions, which could influence negatively medical attention delivered to patients, and that hereditary forms of cancer, especially hereditary non-polyposis colorectal cancer, were underdiagnosed, making it impossible to extend the benefits of early diagnosis and preventive measures to at risk family members. / Mestrado / Genetica Medica / Mestre em Ciências Médicas

M.Tech. / Objective: Translation and validation of the Afrikaans version of the Roland Morris Disability Questionnaire and the Oswestry Disability Index. Methods: The English questionnaires were translated into Afrikaans. The translations were then scrutinized by a focus group in order to determine its face validity. After face validity was established, the content validity was determined by two subject experts. Both the original and the translated versions of the questionnaires were given to a study group to complete on two separate occasions. The results from the study group were then put through various psychometric evaluations in order to determine its concurrent validity and reliability. Results: Results indicated that the Oswestry Disability Index had a significant level of reliability (α=0.830) and although the reliability of the Roland Morris Disability Questionnaire was below a significant level (α<0.7) it was still deemed reliable as it corresponded with its English counterpart. Both the Roland Morris Disability Questionnaire and Oswestry Disability Index indicated significant levels of concurrent validity; however the Roland Morris Disability Questionnaire seemed to have a higher level of concurrent validity. Conclusion: Both the Roland Morris Disability Questionnaire and the Oswestry Disability Index were translated successfully and can now be used within the Afrikaans population as an alternative to the English versions. Low back pain is a very common medical problem with a great impact on a patient’s health and quality of life. According to a review conducted by Papageorgiou et al. (1995), 60-80% of the general world population will suffer from low back pain in some stage of their life. In South Africa, De Wet, Losco and Moodley (2003) conducted a study on the incidence and prevalence of low back pain on 355 ABSA Bank and Unibank employees. The results of the study showed that the lifetime incidence of low back pain was 63%, the 6 month prevalence of LBP was 41% and the point prevalence of LBP was 9.6%. Treatment was sought by 46.94% of the sample population primarily from pharmacies, chiropractors, medical doctors, and physiotherapists. In addition, the study also showed that this condition is costing the South African economy millions each year due to lost working days as a result of absenteeism. As a result, disability questionnaires are increasingly used for clinical assessment, outcome measurement of treatment of low back pain. However, the use in different cultural groups has led to the need for the translation and the cross-cultural adaptation of these questionnaires to aid practitioners in the accurate assessment of low back pain.

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Submitted in fulfillment of the requirements for the Degree of Master of Technology in Nursing, Durban University of Technology, 2014. / Brief background to the study The national guidelines for maternity care in South Africa recommend that a standardised maternity case record be used by all facilities at all levels of care in order to improve the quality of care for pregnant women. According to the National Department of Health, this will facilitate continuity and quality of care for women during pregnancy, labour and post-partum. Aim of the study The aim of the study was to assess whether the implementation of the new maternity case record has improved the quality of care for pregnant women. Methodology An exploratory, descriptive study using both quantitative and qualitative design was used to conduct the study. Data was collected through a retrospective record review using a checklist for the quantitative strand, and from midwives using unstructured interviews for the qualitative strand. The quantitative data set was analysed using the Statistical Package for the Social Sciences version 21.0 and the qualitative strand was analysed using the Tesch’s method of data analysis. Results The results of the record review revealed that although the recording was done fairly well, there were a number of activities and interventions that were recorded poorly or not recorded at all in some primary health care clinic. The midwives verbalised that many mistakes and mismanagement of ante-natal care clients emanated from the structure and the design of the new maternity case record. Recommendations Recommendations include the following: communication of policies and protocols to the midwives should be done timeously, provision of in-service education and/or updates on new developments, strengthening of supportive supervision, the Nursing colleges be kept up-to-date with new developments in nursing practice and that a broader study involving other districts and provinces be conducted.

A importância dos serviços de assistência odontológica prestada pela Faculdade de Odontologia da Universidade de São Paulo reflete nos dados obtidos do Anuário Estatístico da Universidade de São Paulo. Somente na disciplina de Cirurgia, foram realizados 1075 atendimentos cirúrgicos, no ano de 2000 saltando para 5686 em 2007. A cada paciente gera-se um prontuário que contém informações de cunho pessoal, da história médica, odontológicas, e de imagens que lhe atribui alto valor legal e de pesquisa. Com a alta procura pelos serviços oferecidos pela faculdade, o número de documentos gerados por paciente cresce proporcionalmente e constata-se que o arquivamento dos prontuários de toda a faculdade é frágil e sujeito à ocorrência de eventos que poderiam danificar o material. A morosidade na busca por dados dos pacientes, a perda de informações, e a dificuldade em realizar estudos epidemiológicos levaram à motivação para o desenvolvimento e avaliação de um prontuário virtual e seu respectivo Banco de Dados da disciplina de Cirurgia da Faculdade de Odontologia da Universidade de São Paulo. Um modelo de ficha para transcrição eletrônica, com os mesmos itens da ficha clínico-cirúrgica, foi elaborado e utilizado para a transcrição das informações dos pacientes atendidos no ambulatório de Cirurgia, no curso noturno, no ano de 2008. Um protótipo de prontuário virtual foi desenvolvido e os dados coletados de 417 pacientes foram inseridos e armazenados localmente num Banco de Dados desenvolvido para WEB, visando uma nova forma de acesso à informação. A partir dos testes de uso retrospectivo e prospectivo, concluímos que o protótipo do prontuário virtual representa uma importante ferramenta baseada em tecnologias de informação, de uso epidemiológico, de pesquisa e de avaliação dos requisitos necessários para o desenvolvimento de um prontuário virtual com mais robustez e flexibilidade. / The importance of the dental aid services offered by the School of Dentistry of the University of São Paulo reflects on the data from the Statistical Yearbook of the University of São Paulo. In the discipline of Oral Surgery by itself, 1075 surgical appointments were done in 2000, which has increased greatly to 5686 in 2007. To every new patient admitted by the service, a record file is created and contains personal information, health and dental history, and images, thus setting a high legal and research value on the patient record file for the institution. With the high demand for these dental services, the number of documents by patient proportionally augments and it can be seen in the entire institution fragility of the files archiving and risk of events occurrence that could damage the material. The slowness of retrieving patient data, lack of information, and difficulties motivate the development and evaluation of an electronic health record and its respective database in the discipline of Oral Surgery of the School of Dentistry of the University of São Paulo. A sheet form for electronic transcription, with the same content of the surgical-clinical questionnaire form, was elaborated to transcript the health information of the patients admitted at the Oral Surgery Service, in the nocturnal graduation course during 2008. A prototype of an electronic health record was created and the collected data were processed and stored in a web-based local database, aiming to an innovative access mode to information. By the tests of retrospective and prospective use of the electronic health record, we concluded the prototype of the electronic health record represents an important tool based in technologies of information, useful to epidemiology, research and evaluation of required features to development of an electronic health record more robust and flexible.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

A importância dos serviços de assistência odontológica prestada pela Faculdade de Odontologia da Universidade de São Paulo reflete nos dados obtidos do Anuário Estatístico da Universidade de São Paulo. Somente na disciplina de Cirurgia, foram realizados 1075 atendimentos cirúrgicos, no ano de 2000 saltando para 5686 em 2007. A cada paciente gera-se um prontuário que contém informações de cunho pessoal, da história médica, odontológicas, e de imagens que lhe atribui alto valor legal e de pesquisa. Com a alta procura pelos serviços oferecidos pela faculdade, o número de documentos gerados por paciente cresce proporcionalmente e constata-se que o arquivamento dos prontuários de toda a faculdade é frágil e sujeito à ocorrência de eventos que poderiam danificar o material. A morosidade na busca por dados dos pacientes, a perda de informações, e a dificuldade em realizar estudos epidemiológicos levaram à motivação para o desenvolvimento e avaliação de um prontuário virtual e seu respectivo Banco de Dados da disciplina de Cirurgia da Faculdade de Odontologia da Universidade de São Paulo. Um modelo de ficha para transcrição eletrônica, com os mesmos itens da ficha clínico-cirúrgica, foi elaborado e utilizado para a transcrição das informações dos pacientes atendidos no ambulatório de Cirurgia, no curso noturno, no ano de 2008. Um protótipo de prontuário virtual foi desenvolvido e os dados coletados de 417 pacientes foram inseridos e armazenados localmente num Banco de Dados desenvolvido para WEB, visando uma nova forma de acesso à informação. A partir dos testes de uso retrospectivo e prospectivo, concluímos que o protótipo do prontuário virtual representa uma importante ferramenta baseada em tecnologias de informação, de uso epidemiológico, de pesquisa e de avaliação dos requisitos necessários para o desenvolvimento de um prontuário virtual com mais robustez e flexibilidade. / The importance of the dental aid services offered by the School of Dentistry of the University of São Paulo reflects on the data from the Statistical Yearbook of the University of São Paulo. In the discipline of Oral Surgery by itself, 1075 surgical appointments were done in 2000, which has increased greatly to 5686 in 2007. To every new patient admitted by the service, a record file is created and contains personal information, health and dental history, and images, thus setting a high legal and research value on the patient record file for the institution. With the high demand for these dental services, the number of documents by patient proportionally augments and it can be seen in the entire institution fragility of the files archiving and risk of events occurrence that could damage the material. The slowness of retrieving patient data, lack of information, and difficulties motivate the development and evaluation of an electronic health record and its respective database in the discipline of Oral Surgery of the School of Dentistry of the University of São Paulo. A sheet form for electronic transcription, with the same content of the surgical-clinical questionnaire form, was elaborated to transcript the health information of the patients admitted at the Oral Surgery Service, in the nocturnal graduation course during 2008. A prototype of an electronic health record was created and the collected data were processed and stored in a web-based local database, aiming to an innovative access mode to information. By the tests of retrospective and prospective use of the electronic health record, we concluded the prototype of the electronic health record represents an important tool based in technologies of information, useful to epidemiology, research and evaluation of required features to development of an electronic health record more robust and flexible.

M.Cur.(Medical & Surgical Nursing: Critical Care General) / The majority of Africans use traditional medicine, but do not divulge this information to the nurses and doctors when admitted to critical care units. For this reason, patients develop complications, and these makes it difficult for nurses and medical doctors in critical care units to assess and to provide comprehensive quality care, as they treat only the visible clinical manifestations. The purpose of this study was to explore and describe the factors leading to non- divulgence by patients who used traditional medicines in critical care units of a Westrand mine hospital, in order to describe strategies to facilitate divulgence. The researcher used a qualitative, exploratory, descriptive and contextual research design. The population was composed of the patients who were envisaged to have used traditional medicines in the critical care unit of a Westrand mine hospital. Twelve participants were purposively selected from the critical care unit register because these patients displayed the symptoms of having used traditional medicine. Semi-structured individual interviews were conducted. Ethical principles were adhered to. Trustworthiness was ensured by using namely; credibility, transferability, dependability and confirmability. A qualitative open coding method of data analysis was used according to Tesch’s protocol. The following theme and subthemes emerged from the data analysis: Fear and anxiety as the main theme. Subthemes were 1. Fear to divulge secrets. 2. Fear of negative attitudes from nurses and 3. Fear to lose rights, norms and values. It is recommended that the strategies described be used in clinical practice, nursing education and for further research regarding divulgence of the use of traditional medicine to the nurses and doctors, in order to provide a comprehensive assessment and treatment of the patients in critical care units.