Esta tese consiste em um estudo sobre o trabalho e a prática médica observados a partir do tipo ideal Werberiano da medicina tecnológica qual seja: a prática médica especializada, equipada e fragmentada, que começou a ser exercida no Brasil apartir nos anos sessenta. Elegemos para esse estudo médicos oncologistas clínicos inseridos em serviços públicos e privados de saúde. A eleição dos oncologistas clínicos se deu pelo reconhecimento da oncologia como uma prática muito especializada e amparada por equipamentos e procedimentos que se fortaleceu no Brasil na década de sessenta.Pretendeu-se compreender as singularidades dessa prática focalizando a formação, o tipo de cuidado ofertado aos pacientes, a inserção dos médicos no mercado público e privado e a relação entre eles. Inicia-se com uma abordagem geral da prática médica baseada no saber sobre as doenças, no processo histórico e cultural da apreensão desta prática e suas repercussões na sociedade e no mercado de trabalho. Em seguida apresentamos uma revisão sumária da trajetória da oncologia no Brasil, a representação social do câncer, as políticas de saúde da área e a relação entre os médicos, o estado e a sociedade nesse campo. Esse conjunto foi caracterizado como Projeto Médico Oncológico.Utilizou-se, no trabalho de campo, a pesquisa qualitativa e empregou-se como técnica entrevistas com seis profissionais médicos oncologistas que trabalham no Instituto Nacional do Câncer e no setor privado de saúde. Foi realizada uma entrevista piloto visando apresentar na íntegra os temas abordados nas demais entrevistas. A partir do olhar e das reflexões dos médicos são apresentadas quatro categorias para discussão e considerações. Finalizando o estudo apresenta através das categorias obtidas no trabalho de campo uma problematização do modelo idealizado na medicina tecnológica. / This thesis consists of a research on the medical work and practice, based on Webers ideal type of technological medicine, of the specialized medical practice, equipped and fragmented, that started in Brazil in the 1960s. We selected for this research clinical oncologists working in public and private health services. The choice for clinical oncologists was due to the recognition of oncology as a highly specialized, equipment and protocol-driven practice that grew stronger in Brazil during the 1960s.We attempted to comprehend the particularities of this practice, focusing on education the type of care that was given to patients, the placement of doctors in the public and privates sectors and their connection. It begins with an overview of the medical practice based on knowledge of diseases, on the historical and cultural process of learning the practice and its repercussions on society and on the job market.Following, we present a summary of the history of Oncology in Brazil, the social significance of cancer, the health policies for that area and the relationship between doctors, the State and society in that field. This section was named Medical Oncological Project.During fieldwork, we used quality assessment through interviews with six oncologists that worked both in the Instituto Nacional do Câncer (National Institute for Cancer) and in the private health sector. We conducted a pilot interview in order to fully present the topics that would be brought up in the interviews that followed.Based on the doctors points of view and thoughts, we present four categories for discussion and comments. In closing the research, we present a problematic consideration of the ideal model for technological medicine based on the categories obtained from the fieldwork.

Malgré son organisation d’inspiration libérale, la profession de médecin accepte depuis longtemps l’exercice sous forme illibérale. Ce mode d’exercice médical concerne tous les médecins, aujourd’hui nombreux, exerçant leur art au profit et pour le compte d’un employeur public ou privé. Il présente la particularité d’être organisé selon une bipartition théorique faisant la différence entre les médecins dont l’exercice est soumis au droit public, et ceux dont l’exercice relève du droit privé. L’organisation de l’exercice médical subordonné reprend en effet le schéma selon lequel les agents publics doivent être distingués des salariés de droit privé, conséquence de la dualité droit public/droit privé qui caractérise le système juridique français. Cependant, tout comme la différenciation entre les agents publics et les salariés de droit privé s’est affaiblie, celle existant en théorie entre les médecins illibéraux de droit public et les médecins illibéraux de droit privé a perdu de sa pertinence, tant ces deux catégories de professionnels se sont rapprochées, liées en pratique par une même notion : la subordination. Les différentes branches du droit applicables aux médecins illibéraux ont été réciproquement attirées les unes par les autres et ont évolué par des mécanismes d’emprunts mutuels. Ce mouvement d’attraction, dont le développement a fait naître un mode d’exercice médical illibéral uniformisé, marque l’abolition de la distinction entre médecine subordonnée de droit public et médecine subordonnée de droit privé / Despite being organized on a liberal inspiration, the medical profession can be practiced through a subordinate relationship. This way of practicing the medical profession includes every doctor who fulfills his professional duties in the profit and for a public or private employer. It is unique by its organization, according to a theoretical division making the difference between doctors ruled by public laws, and doctors who practice under private laws. It follows a particular scheme, in which civil servants are differenciated from salaried employees ruled by private laws, a direct result, typical of the french legal system, of the traditional duality between public and private law.However, like the differenciation between civil servants and salaried employees ruled by private laws, which has lost most of its strongness, the separation between subordinate doctors ruled by public laws and subordinate doctors ruled by private laws is not relevant anymore, because these two types of doctors, linked by one key concept, the subordination, have kept getting closer over time. The different rules that apply to the subordinate doctors have reach out to each other and have progressed with mutual borrowings. These attraction moves have created a homogeneous medical practice, by erasing the differences between subordinate doctors ruled by public laws and those who are governed by private laws

No description available.

Obstructed labour contributes significantly to the morbidity and mortality among both mothers and babies in Ethiopia nationwide, and also in the West-Wollega region where this study was conducted. The researcher used a retrospective hospital based review of maternity files to quantify the problem of obstructed labour in the selected hospital. The findings revealed that maternal and perinatal mortality due to obstructed labour amounted to 1.4% and 7.5% respectively. Most of these complications could be prevented by proper antenatal care and careful attentive monitoring during delivery with proper use of the partogram which will indicate the occurrence of complications in good time when successful and life saving interventions are still available. The findings clearly show that poor documentation in general and very sporadic usage of the partogram in particular contributes significantly to the complications for mother and child. Re-introduction of proper documentation and careful use of the partogram are advocated / Health Studies / M.A. (Public Health)

The history of psychiatry is littered with serious failures of governance, to the detriment of mentally disordered people, especially those resident in psychiatric hospitals. Current mental health providers, increasingly focussed on community care, have also struggled to develop effective internal governance systems. Nine peer-reviewed research papers, published by the author (mostly with others) and the wider literature, reveal deficits in mental health governance at a jurisdictional, professional, and corporate level. In this thesis new governance solutions are developed against this background, built on contemporary principles in mental health and healthcare management. A new model of mental health governance is presented, based on the key demands of the strategic and regulatory environment, articulated as rights, risks and recovery. This integrated healthcare governance approach, covering provider policy, staff training and service audit, can monitor and ensure the protection of patients’ rights, as well as those of others; it also promotes the management of clinical risks, and of patients’ recovery outcomes. Rights-based risk-reduction training is the core interventional element of the model, whilst the monitoring element can be formalised as part of a Balanced Scorecard reporting system. This thesis makes a contribution to research methodology, theory and practice in mental health, human rights, healthcare management and governance. The model generates specific propositions for testing in mental health governance, with the potential for application in wider settings of service provision.

INTRODUCTION : Les soins de première ligne au Québec vivent depuis quelques années une réorganisation importante. Les GMF, les cliniques réseaux, les CSSS, les réseaux locaux de service, ne sont que quelques exemples des nouveaux modes d’organisation qui voient le jour actuellement. La collaboration interprofessionnelle se trouve au cœur de ces changements. MÉTHODOLOGIE : Il s’agit d’une étude de cas unique, effectuée dans un GMF de deuxième vague. Les données ont été recueillies par des entrevues semi-dirigées auprès du médecin responsable du GMF, des médecins et des infirmières du GMF, et du cadre responsable des infirmières au CSSS. Les entrevues se sont déroulées jusqu’à saturation empirique. Des documents concernant les outils cliniques et les outils de communication ont aussi été consultés. RÉSULTATS : À travers un processus itératif touchant les éléments interactionnels et organisationnels, par l’évolution vers une culture différente, des ajustements mutuels ont pu être réalisés et les pratiques cliniques se sont réellement modifiées au sein du GMF étudié. Les participants ont souligné une amélioration de leurs résultats cliniques. Ils constatent que les patients ont une meilleure accessibilité, mais l’effet sur la charge de travail et sur la capacité de suivre plus de patients est évaluée de façon variable. CONCLUSION : Le modèle conceptuel proposé permet d’observer empiriquement les dimensions qui font ressortir la valeur ajoutée du développement de la collaboration interprofessionnelle au sein des GMF, ainsi que son impact sur les pratiques professionnelles. / INTRODUCTION: Primary care in the Province of Quebec has undergone a substantial reorganisation over the last several years, on several fronts. Family Medicine Groups (FMG's), designated medical clinics, regional health boards, and local health networks, are only a few examples of new health care delivery components which have been created during this reorganisation. METHODS: This is a case study based on a single Family Medicine Group created during a second wave of innovation. Data was collected via semi-directed interviews with the head physician of the FMG, the group of physicians and nurses within the FMG, the nursing director of the FMG, and the director of nursing at the regional health board. Interviews were conducted until all available contacts were exhausted. The author also accessed the clinical guidelines and the documents used for communication within the FMG. RESULTS: Practice activities in the FMG did evolve over time as a result of mutual clinical and administrative interactions between nurses and physicians. Participants noted a visible improvement in health outcomes as well as increased accessibility to health care by patients. The impact on physician workload, and overall capacity in terms of number of patients followed, after creation of the FMG, were inconsistent. CONCLUSION: This proposed analytic model allows empiric measurement of the added value of FMG's for the development of inter-professional cooperation, and its impact on professional practices.

INTRODUCTION : Les soins de première ligne au Québec vivent depuis quelques années une réorganisation importante. Les GMF, les cliniques réseaux, les CSSS, les réseaux locaux de service, ne sont que quelques exemples des nouveaux modes d’organisation qui voient le jour actuellement. La collaboration interprofessionnelle se trouve au cœur de ces changements. MÉTHODOLOGIE : Il s’agit d’une étude de cas unique, effectuée dans un GMF de deuxième vague. Les données ont été recueillies par des entrevues semi-dirigées auprès du médecin responsable du GMF, des médecins et des infirmières du GMF, et du cadre responsable des infirmières au CSSS. Les entrevues se sont déroulées jusqu’à saturation empirique. Des documents concernant les outils cliniques et les outils de communication ont aussi été consultés. RÉSULTATS : À travers un processus itératif touchant les éléments interactionnels et organisationnels, par l’évolution vers une culture différente, des ajustements mutuels ont pu être réalisés et les pratiques cliniques se sont réellement modifiées au sein du GMF étudié. Les participants ont souligné une amélioration de leurs résultats cliniques. Ils constatent que les patients ont une meilleure accessibilité, mais l’effet sur la charge de travail et sur la capacité de suivre plus de patients est évaluée de façon variable. CONCLUSION : Le modèle conceptuel proposé permet d’observer empiriquement les dimensions qui font ressortir la valeur ajoutée du développement de la collaboration interprofessionnelle au sein des GMF, ainsi que son impact sur les pratiques professionnelles. / INTRODUCTION: Primary care in the Province of Quebec has undergone a substantial reorganisation over the last several years, on several fronts. Family Medicine Groups (FMG's), designated medical clinics, regional health boards, and local health networks, are only a few examples of new health care delivery components which have been created during this reorganisation. METHODS: This is a case study based on a single Family Medicine Group created during a second wave of innovation. Data was collected via semi-directed interviews with the head physician of the FMG, the group of physicians and nurses within the FMG, the nursing director of the FMG, and the director of nursing at the regional health board. Interviews were conducted until all available contacts were exhausted. The author also accessed the clinical guidelines and the documents used for communication within the FMG. RESULTS: Practice activities in the FMG did evolve over time as a result of mutual clinical and administrative interactions between nurses and physicians. Participants noted a visible improvement in health outcomes as well as increased accessibility to health care by patients. The impact on physician workload, and overall capacity in terms of number of patients followed, after creation of the FMG, were inconsistent. CONCLUSION: This proposed analytic model allows empiric measurement of the added value of FMG's for the development of inter-professional cooperation, and its impact on professional practices.

No description available.

Obstructed labour contributes significantly to the morbidity and mortality among both mothers and babies in Ethiopia nationwide, and also in the West-Wollega region where this study was conducted. The researcher used a retrospective hospital based review of maternity files to quantify the problem of obstructed labour in the selected hospital. The findings revealed that maternal and perinatal mortality due to obstructed labour amounted to 1.4% and 7.5% respectively. Most of these complications could be prevented by proper antenatal care and careful attentive monitoring during delivery with proper use of the partogram which will indicate the occurrence of complications in good time when successful and life saving interventions are still available. The findings clearly show that poor documentation in general and very sporadic usage of the partogram in particular contributes significantly to the complications for mother and child. Re-introduction of proper documentation and careful use of the partogram are advocated / Health Studies / M.A. (Public Health)

Made available in DSpace on 2015-04-16T14:48:47Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 753666 bytes, checksum: 92b93be44332b807eeb674a45c0c66e0 (MD5) Previous issue date: 2008-06-20 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The case study was used in this research work that had the purpose to reach a deeper knowledge about the development and use of the electronic patient record, taking in consideration basically their barriers and challenges. The electronic patient record (EPR) must be understood in its inter-relationship with other organizational actors, such as the Federal Medical Association, Regional Medical Association, representative members of society, in addition to the medical profession, especially physicians and health services providers. In order to accomplish the study objectives an attempt was made to a) use the Activity Theory to understand how the medical practice must be used and applied as a strategy for the development and use of technological tools in the health care field; b) know the evolution of development and use of the patient health record as registered in the literature, c): know, through representatives of CFM, CRM e other representative medical organizations what is the level of their participation and how are they involved and collaborating with the certification of electronic health applications, among other questions. A social and humanist approach to computational information systems was used in this research because it is believed that only through the social involvement and participation of individuals and groups in a process of participative and collaborative development it is possible to reach a technical solution that can have efficacy. The interview and the qualitative content analysis were used for the interpretation and analysis of data that were collected during the research development. / O estudo de caso é utilizado nesta pesquisa com o propósito de se aprofundar o conhecimento sobre o desenvolvimento e uso do prontuário eletrônico, envolvendo, sobretudo, suas barreiras e obstáculos. O prontuário eletrônico do paciente (PEP) deve ser compreendido na sua inter-relação com outros atores, a exemplo do Conselho Federal de Medicina (CFM), Conselhos Regionais de Medicina (CRM s), sociedades de representação, além dos profissionais de saúde, sobretudo os médicos e prestadores de serviços. Para se alcançar este objetivo, foram seguidos tais critérios: a) utilizar a Teoria da Atividade visando compreender como a prática médica deve ser considerada e aplicada como uma estratégia para o desenvolvimento e uso de ferramentas tecnológicas na área de saúde; b): conhecer a evolução do desenvolvimento e uso do prontuário eletrônico do paciente através de uma extensa revisão bibliográfica, c) conhecer através de lideranças do CFM, CRM e órgãos de representação da atividade médica, qual o nível de participação dos médicos e como estão envolvidos e colaborando nas certificações dos projetos de desenvolvimento e aplicações do PEP, entre outras questões. O estudo adotou uma visão mais social e humanista dos sistemas de informação computacionais, pois, só através de um envolvimento social com a participação de indivíduos e grupos em um processo de desenvolvimento participativo e colaborativo pode-se chegar a uma solução técnica eficaz. A entrevista e a analise de conteúdo qualitativa foram utilizadas para a interpretação das informações colhidas durante o desenvolvimento da pesquisa.