A medical examination couch is a primary piece of equipment in the health care delivery system. Unfortunately, the current design of examination couches used by Australian general and nursing practitioners is inadequate. Incompatibility of the couches with physical (anthropometric) dimensions and a majority of medical procedures contribute to risks of Cumulative Trauma Disorders (CTDs) or musculoskeletal problems among practitioner-users. The inappropriate height, width and gynaecological attachments of the existing couches also cause patient discomfort. This research aimed to develop a new examination couch design in order to improve practitioners' effectiveness, efficiency, health and safety while enhancing patient comfort. Ergonomics and user inclusivity were implemented in the vital stages of the couch development process. Practitioner and patient surveys, reviews of patient positions, medical procedures and equipment, Hierarchical Task Analysis (HTA) and an ergonomic analysis of couches in the Australian market were conducted to develop design criteria. The design criteria development demonstrated that adjustable height, head, body and foot sections were the major features, and adjustable gynaecological footpads and instrument placement (drawers) were the most important attachments. A wide variety of anthropometric data was applied to the development of design specifications and adjustments. To produce a prototype for a new examination couch design developed from the ergonomic research and initial user surveys, the researcher collaborated with a medical couch manufacturer, Metron Medical Australia Pty Ltd. Through this collaboration, the developed criteria and specifications were applied to actual production processes. User trials (a focus group, practitioner and patient surveys and personal communication) were conducted to investigate the effectiveness and efficiency of the couch prototype in a real clinical environment. From the trials, modifications to particular couch features were identified if they were considered difficult to operate, unnecessary or uncomfortable for patients. For example, the mechanism of the gynaecological footpads, which comprised three different adjustment controls, had to be simplified in order to avoid confusion and time consumption. The footpads had also to be equipped with straps or half a shoe to increase patient comfort and security. The collaborating manufacturer will need to adapt the design modifications from the user trials and conduct more extensive engineering research and value analysis for a final production couch model. Nevertheless, this research succesfully demonstrated the significance of ergonomics and user-centred design in developing design criteria more effectively, detecting usability problems before the couch is brought to the market, and in saving the manufacturer's overall product development costs.

Orientador: César Cabello dos Santos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T20:25:56Z (GMT). No. of bitstreams: 1 Brandalise_PatriciaAndrade_M.pdf: 1718214 bytes, checksum: fb36dfb38c6e51cfd4849e6c0346f1ba (MD5) Previous issue date: 2011 / Resumo: Introdução: A discussão sobre a melhor maneira de realizar o seguimento de mulheres que foram submetidas ao tratamento de câncer de mama ainda persiste e não há consenso quanto a melhor prática. As normativas internacionais, baseadas em estudos clínicos aleatorizados, orientam que o exame físico periódico e a mamografia anual são suficientes e que outros exames que possibilitem a detecção precoce de metástases não têm impacto na sobrevida destas pacientes. Porém, a opinião das mulheres sobre este assunto não foi ainda avaliada adequadamente. Objetivos: Avaliar a opinião das pacientes que estavam em acompanhamento clínico após o tratamento de câncer de mama com exames complementares de cintilografia óssea, radiografia de tórax e ecografia abdominal sobre a suspensão destes exames em seu seguimento. Sujeitos e métodos: Durante o período de março de 2007 a junho de 2008, pacientes em acompanhamento por câncer de mama no ambulatório do Hospital da Mulher Prof.Dr. José Aristodemo Pinotti-Centro de Atenção Integral à Saúde da Mulher (CAISM) foram submetidas a um questionário que avaliava a opinião a respeito da interrupção do seguimento com exames complementares. Estas pacientes estavam necessariamente fora de tratamento com quimioterapia ou radioterapia, mas foram incluídas as que estavam em tratamento adjuvante hormonal. Foram excluídas as pacientes com doença metastática. Resultados: Foram submetidas ao questionário 116 pacientes. A maioria das mulheres entrevistadas relatou que se sentiria insegura caso parasse de realizar os exames (84%). As variáveis que se relacionaram com uma maior chance (OR) de as mulheres se sentirem inseguras foram: percepção de doença inicial (OR=7,0), idade menor que 50 anos (OR=4,01), maior escolaridade (OR=3,45) e menor tempo de seguimento (OR=2,83). Conclusões: A maioria das pacientes entrevistadas mostrou-se insegura quanto à possibilidade de suspender o seguimento que vinha sendo realizado com exames complementares. A insegurança é mais pronunciada nas mulheres com precepção de doença inicial, mais jovens, com maior escolaridade e menor tempo de tratamento / Abstract: Introduction: The discussion about the best way to perform the follow-up of women with breast cancer still persists and there is no consensus on best practice. International guidelines, based on randomized clinical trials suggests that periodic physical examinations and annual mammograms are sufficient and other exams that enable early detection of metastases have no impact on survival of these women. However, the opinion of the women about a new model of follow up was not accessed yet. Objectives: Evaluate the opinion of women who were in follow up for breast cancer with bone scans, chest X- rays and abdominal echograpy about the interruption of these exams. Subjects and methods: During the period from March 2007 until June 2008 patients monitored for breast cancer were subjected to a questionnaire regarding their opinion about the discontinuation of supplementary follow-up exams, these patients were necessarily out of treatment with chemotherapy or radiotherapy, but women who were on hormonal adjuvant treatment were included. We excluded patients with metastatic disease. Results: 116 patients were submitted to the questionnaire. The majority of interviewed women said that they would feel insecure if stopped performing the supplementary exams (84%). The variables correlated with a higher Odds Ratio (OR) for insecurity were: patients with a perception of their disease as initial (OR=7.0), patients younger than 50 years-old (OR = 4.01), with higher educational level (OR = 3.45) and shorter follow-up (OR=2.83). Conclusions: The majority of interviewed patients are insecure about the possibility of suspending the current follow up with supplementary exams. The insecurity is more pronounced in women with a self perception of early disease, younger ones with higher educational level and shorter follow up time / Mestrado / Oncologia Ginecológica e Mamária / Mestre em Ciências da Saúde

Submitted by Priscila Bermudes Peixoto null (pribpeixoto@hotmail.com) on 2017-12-14T18:38:58Z No. of bitstreams: 1 Priscila-Final-CapaDura.pdf: 1600815 bytes, checksum: 5357ed9f92e5048fd0732fd516af1ac0 (MD5) / Submitted by Priscila Bermudes Peixoto null (pribpeixoto@hotmail.com) on 2017-12-21T12:31:26Z No. of bitstreams: 1 Priscila-Final-CapaDura.pdf: 1600815 bytes, checksum: 5357ed9f92e5048fd0732fd516af1ac0 (MD5) / Approved for entry into archive by Laura Odette Dorta Jardim null (laura@franca.unesp.br) on 2018-01-17T19:05:55Z (GMT) No. of bitstreams: 1 Priscila-Final-CapaDura.pdf: 1600815 bytes, checksum: 5357ed9f92e5048fd0732fd516af1ac0 (MD5) / Made available in DSpace on 2018-01-17T19:05:55Z (GMT). No. of bitstreams: 1 Priscila-Final-CapaDura.pdf: 1600815 bytes, checksum: 5357ed9f92e5048fd0732fd516af1ac0 (MD5) Previous issue date: 2017-11-29 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O objetivo desse trabalho consiste em analisar o debate de cunho eugenista acerca da adoção do exame médico pré-nupcial ocorrido nos meios ligados à medicina e às práticas sanitárias no Brasil, nas primeiras décadas do século XX. A medicina social, baseada em doutrinas higienistas e eugenistas, buscou intervir mais diretamente no cotidiano da população, estabelecendo normas de conduta, sob o pretexto de prevenir moléstias e epidemias. O exame pré-nupcial foi um dos aspectos desta orientação mais ampla. Sua realização era defendida por médicos que pretendiam impedir ou adiar casamentos quando um dos nubentes apresentasse alguma doença ou fatores considerados degenerativos, sempre orientados por supostas medidas preventivas imprescindíveis ao que acreditavam ser o aprimoramento racial. Observando que discurso eugênico classificou determinados indivíduos como inferiores e pretendia impedir a reprodução destes, esta pesquisa busca compreender em que medida a questão da raça esteve presente na proposta de intervenção matrimonial. Tomando como referência a noção de discurso como um conjunto de regras adequado à sua prática, constituído por conflitos e tensões internas, procura-se demonstrar como os eugenistas tentaram impor seu saber à sociedade, ou seja, quais eram suas motivações para transformar o exame pré-nupcial em uma lei aplicável em todo o país. Analisa-se ainda as controvérsias e objeções reclamadas por seus críticos, notando como estas e a própria realidade do país contribuíram para que determinadas políticas eugênicas não fossem adotadas, a exemplo da obrigatoriedade do exame pré-nupcial. / The aim of this paper is to analyze the eugenicist medical discourse about the premarital medical examination occurred in the medical environment and the sanitary practices in Brazil, in the early decades of the twentieth century. The social medicine, based on the hygienist and eugenicist doctrines, would intervene in the daily basis of the population by establishing standards of conduct, intending to prevent diseases and epidemics. The prenuptial exam was one of the aspects of this wider orientation. The defense of its realization, gathered doctors who could prevent or postpone marriages when one of the spouses had any disease, always guided by supposed preventive and necessary measures concerning what they believed to be a racial enhancement. Noticing that the eugenic speech classified some people as inferior and it was supposed to stop their reproduction, this research aims to understand in which measure the question about race was present in the proposal of matrimonial intervention. Taking as a reference the notion of the discourse as a group of rules appropriate to its practice, constituted by conflicts and intern tensions, we are going to show how the doctors tried to impose their knowledge to society, in other words, what were their motivations to transform the premarital examination in an applicable law in all over the country. It also analyzes the controversies and objections claimed by the critics, noting how these and the reality of the country contributed to the fact that certain eugenic policies were not adopted, such as the compulsory prenuptial examination. / 15/08002-8

The topic of my thesis is "Experiences of children with preparation for medical examination and intervention". Children are more sensitive and therefore more vulnerable, with respect to their age and development it is necessary to carefully consider what to tell them and how. Each child has the right for sufficient information given at the right time and the right way, taking into account its age and intellectual maturity. Adequate communication protects a child from stress and needless anxiety. The theoretical section of the thesis is divided into 3 parts. The first one deals with the child's right to information and also the game specialist profession. The second part focuses on the psychological preoperative preparation in general, communication specifics in dealing with children and on preparation at different periods of age. The third part is devoted to the physical preoperative preparation. The empirical section has two objectives. The first one is to see if in children's wards the child´s preparation before examination or medical intervention is performed and by whom. The second objective is to determine whether the preparation performed affects fear and anxiety experienced by the child prior to the examination or intervention. In the research section the qualitative research technique of non-standardized interview was used. The interview the individual, anonymous, was conducted with the consent of the child and its parents, sometimes with participation of the parents. The research survey was carried out between October 2009 and February 2010. The research sample consisted of 19 respondents (11 girls and 8 boys), children aged 5 to 17 years who underwent an examination or medical intervention in 5 hospitals of the Czech Republic. The outcomes of the research show that most respondents were preparing for the examination by their mothers or doctors in a medical facility, one third of respondents were not given any concern in this respect. The most frequently used form of the preparation was oral communication. The preparation carried out by the game specialist was the best appreciated by the children. The preparation decreased the respondents´ feeling of fear or anxiety. The findings and results of the survey may provide the medical facilities management with an incentive to improve the quality of nursing care provided in terms of children´s informedness as required by the Convention on the Rights of the Child, the Convention on Human Rights and Biomedicine and the Charter of the Rights of the Hospitalized Child.

研究動機與問題：本研究最主要的目的希望能夠將最易被大家忽略的健保醫療檢驗資源使用問題，從實務面上探討，並指認出有效使用醫療檢驗資源的關鍵因素，針對這些因素與措施進行評估，歸納出具體明確可行的方向，提供主管機關做為費用管控的參考，為我國健保永續經營貢獻一份力量。 本研究根據研究動機與目的，設定三個研究問題：1.影響醫師有效的使用醫療檢驗資源的因素有哪些？2.藉由桃園縣執業醫師的看法了解有效使用醫療檢驗資源關鍵因素為何？3.不同執業院所、服務科別、職別的醫師對有效的使用醫療檢驗資源看法是否有差異？ 研究資料與方法：以文獻回顧法、問卷調查法、深度訪談法蒐集資料及驗證資料；研究過程分三個階段進行，第一階段為背景資料與文獻資料的蒐集，瞭解醫療檢驗資源使用現況與問題，並透過訪談實務界菁英驗證文獻與補充資料不足；第二階段依文獻分析與彙整內容設計問卷與訪談大綱；第三階段將回收的問卷編碼、整理後以Excel/2003版與SPSS for window12.0版套裝軟體進行資料分析；深度訪談資料透過內容分析法予以歸納整理分析。獲得研究答案，達成研究目的。 研究結果與建議：量化研究部分，本研究共分送488份問卷，回收318份，回收率為65.1％。並以卡方檢定樣本與母群體並無差異，可代表母群體。質化研究部分，深度訪談三位年資10年以上實務界菁英，建構本研究實務上的概念。歸納研究結果：醫療檢驗資源有效使用的關鍵影響因素有「醫療風險」、「病人就醫行為」與「照護之連續性」3項。根據研究結果，為有效使用醫療檢驗資源，必需減少醫療風險、規範病人就醫行為與進行照護流程改造。 / Background:The purpose of this research is to find out the influencing factors related to the usage of resources for medical examinations under the Taiwanese National Health Insurance (NHI). From the practical point of view, this research focuses on, the first, defining the efficient use of medical test and then finding out the critical factors effecting the efficient usage from medial practitioners’ viewpoints in Taoyuan County, Taiwan. It is expected to provide advisory values to improve the global budget system of NHI. Research Questions: 1.What are the factors influencing doctors to utilize medical examination efficiently? 2.What are the certified medical doctors of Taoyuan County thinking about these factors? 3.Concerning the above factors, do there exist systematic differences among medical doctors from different hospitals, rank of medical doctors and fields of profession? Methods: In this study, author utilizes literature review, questionnaires, and in-depth interview. The survey was divided into three stages. First, related information was collected to clarify the problems of medical examination usage in present situation from both interviewing medical practitioners and literature review. In the 2nd stage, a general questionnaire was designed to administrate to selected medical doctors in Taoyuan County in mid-2008. The last stage was data coding and analyzing by using Excel/2003 and SPSS for Windows. The return rate was 65% (318/488) and there is no difference between population and sample after consistency test. Results and Suggestions The results show that the key factors of efficient medical examination usage are medical risk-aversion of doctors, clinical shopping of patients, and the need to medical care continuity. These exist a greater viewpoint differences between different level of hospital than different ranks or specialties of doctors. These results will lead the author to suggest that the Bureau of NHI needs to promote adequate mediation mechanism to reduce medical risk, to promote inter-hospital patient information sharing system, and to improve the logistic of continuity care.

Arbetsuppgifterna på ett fartyg kan innefatta hård fysisk påfrestning samt arbete i mörker, påhög höjd och i slutna utrymmen vilket betyder att sjöfolk måste vara lämpliga för tjänstgöringen.De nationella reglerna för medicinsk lämplighet för sjöfolk skiljer sig trots att deninternationella standarden är densamma för alla. Syftet med denna rapport är att åskådliggöraskillnaderna mellan regelverken om läkarintyg för sjöfolk i de skandinaviska länderna ochundersöka historien bakom de svenska föreskrifterna.Vår slutsats är att det skulle gagna Sverige att återinföra Sjömansläkare, som troligtvis är merkompetenta än en icke specialiserad läkare vad gäller tjänstbarhetsbedömning för sjömän.Systemet med sjömansläkare är fortfarande i bruk och fungerar väl i både Danmark ochNorge.Slutligen sammanfattas rapporten av författarnas egna reflektioner kring ämnet i relation tillresultatet. Förslag till vidare forskning återfinns i slutet. / The duties onboard any ship include moments of hard physical labour, work in darkness, aloftand within enclosed spaces which means that a seafarer must be fit for duty. The nationalrequirements for medical fitness of seafarers differ between countries, although they are allbased on the same international standard. The aim of this report is to compare the differencesbetween the regulations concerning medical certificates for seafarers in the Scandinaviancountries and to investigate the history of the Swedish regulations.We conclude that Sweden would benefit from the reintroduction of the old system ofSeaman’s Doctors, who presumably are more competent than a doctor not specialized injudging the fitness of a seafarer. This system is still in operation and working well in bothDenmark and Norway.Finally this report consists of the authors’ own reflexions regarding the medical examinationsand certificates for seafarers. We also include a few suggestions for further research.

Since 2002, the Canadian state has mandatorily tested applicants for permanent residence for HIV (Human immune deficiency virus). The policy and practices associated with this screening have never been critically scrutinized. Authoritative claims about what happens in the conduct of the immigration medical examination are at odds with the experience of immigrant applicants living with HIV. This is the analytic entry point into this inquiry that is organized within the theoretical and methodological frame offered by institutional ethnography and political activist ethnography. Analysis is connected to broader research literatures and the historical record. The goal of this study is to produce detailed, contextualized understandings of the social and ruling relations that organize the lives of immigrants to Canada living with HIV. These are generated from the material conditions of their lives. An assumption about how organization happens is the social and reflexive production of knowledge in people’s day-to-day lives through which connections between local and extra-local settings are empirically investigable. I investigate the organization of the Canadian immigration process. How is this institutional complex ordered and governed? How is immigration mandatory HIV testing organized, and with what consequences to HIV-positive applicants to Canada? This is a text-mediated organization where all the sites are connected by people’s work and the texts they circulate. The positive result of an immigration HIV test catalyzes the state’s collection of medical data about an applicant. These are entered into state decision-making about the person’s in/admissibility to Canada. I focus on a key component of the immigration process, which is medical examination and HIV testing with this, along with the HIV test counselling practices that happen (or not) there. The reported absence of the latter form of care causes problems and contradictions for people. This investigation adopts the standpoint of these persons to investigate their problems associated with HIV testing. The main empirically supported argument I make is that the Canadian state’s ideological work related to the HIV policy and mandatory screening ushers in a set of institutional practices that are highly problematic for immigrants with HIV. This argument relies on data collected in interviews, focus groups, observations, and analysis of texts organized under Canada’s Immigration and Refugee Protection Act (S.C., 2001, c. 27) and textually mediated, discursively organized concepts that shape people’s practice. Canadian immigration medical policy makers should make use of these findings, as should civil society activists acting on behalf of immigrants to Canada living with HIV. I make nine specific recommendations for future action on HIV and immigration in Canada.

Since 2002, the Canadian state has mandatorily tested applicants for permanent residence for HIV (Human immune deficiency virus). The policy and practices associated with this screening have never been critically scrutinized. Authoritative claims about what happens in the conduct of the immigration medical examination are at odds with the experience of immigrant applicants living with HIV. This is the analytic entry point into this inquiry that is organized within the theoretical and methodological frame offered by institutional ethnography and political activist ethnography. Analysis is connected to broader research literatures and the historical record. The goal of this study is to produce detailed, contextualized understandings of the social and ruling relations that organize the lives of immigrants to Canada living with HIV. These are generated from the material conditions of their lives. An assumption about how organization happens is the social and reflexive production of knowledge in people’s day-to-day lives through which connections between local and extra-local settings are empirically investigable. I investigate the organization of the Canadian immigration process. How is this institutional complex ordered and governed? How is immigration mandatory HIV testing organized, and with what consequences to HIV-positive applicants to Canada? This is a text-mediated organization where all the sites are connected by people’s work and the texts they circulate. The positive result of an immigration HIV test catalyzes the state’s collection of medical data about an applicant. These are entered into state decision-making about the person’s in/admissibility to Canada. I focus on a key component of the immigration process, which is medical examination and HIV testing with this, along with the HIV test counselling practices that happen (or not) there. The reported absence of the latter form of care causes problems and contradictions for people. This investigation adopts the standpoint of these persons to investigate their problems associated with HIV testing. The main empirically supported argument I make is that the Canadian state’s ideological work related to the HIV policy and mandatory screening ushers in a set of institutional practices that are highly problematic for immigrants with HIV. This argument relies on data collected in interviews, focus groups, observations, and analysis of texts organized under Canada’s Immigration and Refugee Protection Act (S.C., 2001, c. 27) and textually mediated, discursively organized concepts that shape people’s practice. Canadian immigration medical policy makers should make use of these findings, as should civil society activists acting on behalf of immigrants to Canada living with HIV. I make nine specific recommendations for future action on HIV and immigration in Canada.

Since 2002, the Canadian state has mandatorily tested applicants for permanent residence for HIV (Human immune deficiency virus). The policy and practices associated with this screening have never been critically scrutinized. Authoritative claims about what happens in the conduct of the immigration medical examination are at odds with the experience of immigrant applicants living with HIV. This is the analytic entry point into this inquiry that is organized within the theoretical and methodological frame offered by institutional ethnography and political activist ethnography. Analysis is connected to broader research literatures and the historical record. The goal of this study is to produce detailed, contextualized understandings of the social and ruling relations that organize the lives of immigrants to Canada living with HIV. These are generated from the material conditions of their lives. An assumption about how organization happens is the social and reflexive production of knowledge in people’s day-to-day lives through which connections between local and extra-local settings are empirically investigable. I investigate the organization of the Canadian immigration process. How is this institutional complex ordered and governed? How is immigration mandatory HIV testing organized, and with what consequences to HIV-positive applicants to Canada? This is a text-mediated organization where all the sites are connected by people’s work and the texts they circulate. The positive result of an immigration HIV test catalyzes the state’s collection of medical data about an applicant. These are entered into state decision-making about the person’s in/admissibility to Canada. I focus on a key component of the immigration process, which is medical examination and HIV testing with this, along with the HIV test counselling practices that happen (or not) there. The reported absence of the latter form of care causes problems and contradictions for people. This investigation adopts the standpoint of these persons to investigate their problems associated with HIV testing. The main empirically supported argument I make is that the Canadian state’s ideological work related to the HIV policy and mandatory screening ushers in a set of institutional practices that are highly problematic for immigrants with HIV. This argument relies on data collected in interviews, focus groups, observations, and analysis of texts organized under Canada’s Immigration and Refugee Protection Act (S.C., 2001, c. 27) and textually mediated, discursively organized concepts that shape people’s practice. Canadian immigration medical policy makers should make use of these findings, as should civil society activists acting on behalf of immigrants to Canada living with HIV. I make nine specific recommendations for future action on HIV and immigration in Canada.

Since 2002, the Canadian state has mandatorily tested applicants for permanent residence for HIV (Human immune deficiency virus). The policy and practices associated with this screening have never been critically scrutinized. Authoritative claims about what happens in the conduct of the immigration medical examination are at odds with the experience of immigrant applicants living with HIV. This is the analytic entry point into this inquiry that is organized within the theoretical and methodological frame offered by institutional ethnography and political activist ethnography. Analysis is connected to broader research literatures and the historical record. The goal of this study is to produce detailed, contextualized understandings of the social and ruling relations that organize the lives of immigrants to Canada living with HIV. These are generated from the material conditions of their lives. An assumption about how organization happens is the social and reflexive production of knowledge in people’s day-to-day lives through which connections between local and extra-local settings are empirically investigable. I investigate the organization of the Canadian immigration process. How is this institutional complex ordered and governed? How is immigration mandatory HIV testing organized, and with what consequences to HIV-positive applicants to Canada? This is a text-mediated organization where all the sites are connected by people’s work and the texts they circulate. The positive result of an immigration HIV test catalyzes the state’s collection of medical data about an applicant. These are entered into state decision-making about the person’s in/admissibility to Canada. I focus on a key component of the immigration process, which is medical examination and HIV testing with this, along with the HIV test counselling practices that happen (or not) there. The reported absence of the latter form of care causes problems and contradictions for people. This investigation adopts the standpoint of these persons to investigate their problems associated with HIV testing. The main empirically supported argument I make is that the Canadian state’s ideological work related to the HIV policy and mandatory screening ushers in a set of institutional practices that are highly problematic for immigrants with HIV. This argument relies on data collected in interviews, focus groups, observations, and analysis of texts organized under Canada’s Immigration and Refugee Protection Act (S.C., 2001, c. 27) and textually mediated, discursively organized concepts that shape people’s practice. Canadian immigration medical policy makers should make use of these findings, as should civil society activists acting on behalf of immigrants to Canada living with HIV. I make nine specific recommendations for future action on HIV and immigration in Canada.