For years social workers have been involved in the investigation of sexual abuse of children. This involvement of social workers is therefore no new concept. In the involvement of social workers in this field there has been a close relationship between social workers and especially the judiciary for several years. Apart from the legal profession other professional role players are also involved in the investigation of the sexually molested child. This research focuses particularly on the different roles of the members of the multidisciplinary team during the investigation of sexual abuse of children. A multidisciplinary team approach brings together different role players in this way to make use of the knowledge and strengths of all to the benefit of the victim so that effective service can be rendered. The researcher is of the opinion that if the multidisciplinary team acts in a more efficient way, more prosecution of sexual crimes committed against children could be brought about. / Thesis (M.A. (MW))--North-West University, Potchefstroom Campus, 2010.

For years social workers have been involved in the investigation of sexual abuse of children. This involvement of social workers is therefore no new concept. In the involvement of social workers in this field there has been a close relationship between social workers and especially the judiciary for several years. Apart from the legal profession other professional role players are also involved in the investigation of the sexually molested child. This research focuses particularly on the different roles of the members of the multidisciplinary team during the investigation of sexual abuse of children. A multidisciplinary team approach brings together different role players in this way to make use of the knowledge and strengths of all to the benefit of the victim so that effective service can be rendered. The researcher is of the opinion that if the multidisciplinary team acts in a more efficient way, more prosecution of sexual crimes committed against children could be brought about. / Thesis (M.A. (MW))--North-West University, Potchefstroom Campus, 2010.

No description available.

Background and aims: Many adults with congenitally malformed hearts are at risk for complications such as decreased function and capacity of the heart due to the heart defect and previously surgery. This advocates self-management behaviours related to medical treatments, physical activity, preventions of endocarditis, some restrictions regarding suitable employment and spare time activities, birth control and pregnancy, but also lifestyle concerns such as refraining from smoking and healthy eating. Sufficient knowledge and support are requirements for successful self-management. The overall aim of this thesis was to describe educational needs, develop a tool for assessing knowledge and to evaluate the effects of a follow-up model providing education and psychosocial support to adults with congenitally malformed hearts. Subjects and methods: Adults (≥18 years of age) with the ten most common heart defects namely ventricular septal defect, atrial septal defect, coarctation of the aortae, aortic valve stenosis (defined as uncomplicated heart defects) and tetralogy of Fallot, complete transposition of the great arteries, congenitally corrected transposition of the great arteries, Ebstein anomaly and Eisenmenger syndrome (defined as complicated heart defects) were included in the studies. To apprehend the educational needs (I), sixteen adults with heart malformations, ranging from 19-55 years of age, were interviewed and data were analysed qualitatively using phenomenographic method. As a tool to evaluate knowledge, an instrument named Knowledge scale for adults with Congenital Malformed Hearts (KnoCoMH) was developed and psychometrically evaluated (II) in 19 + 114 adults with the ten most common heart defects average age 34 ± 13.5. A model for follow-up was described and initially evaluated (III) by 55 adults with the most common heart defects and finally tested in a randomised controlled trial (IV) with a total of 114 adults with congenitally malformed hearts (56 participants in intervention group and 58 in control group with average age 34 ± 13.5). The intervention group recived a model for follow-up with individualise and computer-based eduction and psychosocial support by a multidisciplinary team. Results: Two-way communication when given information was found to be crucial in order to enhance knowledge (I). Knowledge was seen as a tool for managing important areas in life. The KnoCoMH (II) was found to be a valid and reliable scale and can now be used to estimate knowledge in adults with congenitally malformed hearts. The model for follow-up (III) was effective in improving and maintaining knowledge (IV) about self-management in adults with heart malformation.

Bakgrund: Den svårt skadade traumapatienten kräver ett multidisciplinärt och tvärprofessionellt omhändertagande vid ankomst till akutmottagningen. En av anestesisjuksköterskans arbetsuppgifter är att delta i omhändertagandet av traumapatienter. Detta kräver att anestesisjuksköterskan kan arbeta i ett anpassat arbetstempo samt kunna arbeta tvärprofessionellt i en stressad miljö. Rött traumalarm ökar kraven på anestesisjuksköterskan som skall inneha fördjupade medicinska- och omvårdnadskunskaper vid omhändertagandet av traumapatienter. Syfte: Studiens syfte var att belysa hur anestesisjuksköterskor upplevde deltagandet vid rött traumalarm. Metod: En kvalitativ design användes och besvarades med semistrukturerade intervjuer. Studien innefattade tio anestesisjuksköterskor från två mellanstora sjukhus i södra Sverige. Intervjuernas datamaterial analyserades med hjälp av en kvalitativ latent innehållsanalys. Resultat: Anestesisjuksköterskor i studien beskrev ett engagemang till det akuta omhändertagandet samt en vilja till att leverera en kvalitativ vård. Traumaomhändertagandet upplevdes ibland som utmanande, framförallt om det var flertalet skadade eller om patienten var svårt skadad. Samtidigt beskrevs ett ansvar över att vara en resurs för teamet och en länk för patienten under omhändertagandet. Struktur och trygghet var viktiga faktorer till ett lyckat teamsamarbete. För att arbetet kring patienten skulle ske på ett systematiskt och patientsäkert sätt, betonade anestesisjuksköterskorna vikten av utbildning inom traumasjukvård. Slutsats: Anestesisjuksköterskans deltagande i rött traumalarm kräver god kunskap inom såväl traumasjukvård som förmågan till samarbete och kommunikation. Kommunikation och samarbete visade sig oftast fungera väl, men då brister uppstod påverkades traumaomhändertagandet negativt, vilket även innefattade patientsäkerheten. Studien visar att traumaledaren har en avgörande betydelse gällande teamets förmåga till ett lyckat traumaomhändertagande. / Background: The severely injured trauma patient requires a multidisciplinary and interdisciplinary medical care on arrival to the emergency department. One of the nurse anaesthetists tasks is to participate in the care of trauma patients. This requires that the nurse anaesthetists can work in an adapted pace of work and be able to work interdisciplinary in a stressed environment. Red-trauma emergency increases the demand for nurse anaesthetist who shall hold in-depth medical and nursing skills in the care of trauma patients. Objective: The aim of this study was to illustrate the nurse anaesthetist experiences of taking part in red-trauma alarm. Method: The study had a qualitative approach and was answered by semi-structured interviews. The study included ten nurse anaesthetists from two middle large hospitals in southern Sweden. The data from the interviews were analyzed by using a qualitative latent content analysis. Results: Nurse anaesthetists in the study described an attraction to the acute care and a desire to deliver quality care. Trauma care perceived sometimes as challenging, especially if it was the most damaged, or if the patient was seriously injured. At the same time the nurse anaesthetists described a responsibility as being a resource for the team and a link to the patient during care. Structure and security were important factors in a successful team collaboration. So, that the work around the patient would be done in a systematic and patient safely, the nurse anaesthetists emphasize the importance of education in trauma care. Conclusion: The nurse anaesthetist attending in red-trauma emergency requires good knowledge in both trauma care as the ability to co-operation and communication. Communication and co-operation shown to usually work well, but when the deficiencies arose impacted negatively trauma care, which also included patient safety. The study have shown that the trauma leaders expertise have an essential role for a successful trauma-care.

The primary objective of the current study was to attempt to establish whether there is a need for a dysphagia training programme for nurses and speech-language therapists working with acute tracheostomised patients in critical care units in South Africa. The research design that was adopted for this project was within a mixed methods approach framework. An exploratory descriptive survey design using semi-structured face-to-face interviews was used. The final sample consisted of interviews with 20 speech-language therapists from eight different hospitals with critical care facilities and 12 nurses from four different hospitals with such facilities. Data from the close ended questions were analysed using descriptive statistics, while remaining data from open ended questions were thematically analysed and the constant comparison method was applied. The data demonstrated that all speech-language therapists and 10 out of the 12 nurses were in agreement that there was a need for a dysphagia training programme for nurses in critical care for tracheostomised patients presenting with dysphagia. An important and unexpected result of this study was that speech-language therapists themselves required additional training in this area. The data demonstrated that the majority of speech-language therapists and nurses were of the view that they had received minimal theoretical and practical hours on tracheostomy screening, assessment and management at an undergraduate level. Overall, the results of the current study suggested varied practices in the screening, assessment and management of tracheostomy and dysphagia, particularly with regard to blue dye testing, suctioning protocols and cuff inflation and deflation protocols. The research significance and implications of the study included the need to improve undergraduate training for speech-language therapists and nurses in the area of dysphagia and tracheostomy, to alert professional training bodies regarding institution of additional licensing and qualifications for speech-language therapists and nurses in the area of dysphagia and tracheostomy, and to thereby improve the situation of clinicians practising in dysphagia and tracheostomy management through the development of guidelines, protocols and position papers. An important implication of this research is that it established the need for a dysphagia training programme for both speech-language therapists and nurses in critical care in dysphagia and tracheostomy, and thereby monitoring the efficacy of this programme and measuring/monitoring the outcomes of multidisciplinary teamwork in the assessment and management of dysphagia and tracheostomy in critical care.

A prestação do serviço de Odontologia dentro do ambiente hospitalar teve início devido aos benefícios observados com o trabalho de equipes multidisciplinares no cuidado com a saúde. De modo geral, os pacientes são atendidos pelos cirurgiõesdentistas dentro dos hospitais terciários porque sua condição de saúde impede a realização dos procedimentos em consultórios ou unidades de saúde, devido, entre outros, à dificuldade de locomoção ou falta de equipe treinada para atender portadores de enfermidades sistêmicas. Estudos que enfocam esse tema têm observado benefícios importantes na condição de saúde do paciente. Dessa forma, o presente trabalho teve como objetivos: Caracterizar o Serviço de Odontologia Hospitalar no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, nos seguintes aspectos: 1) assistencial: relacionar as atividades quanto ao número de atendimentos por tipo, procedência do paciente (internado ou ambulatorial), patologias de base e enfermaria específica; 2) financeiro: identificar a receita SUS dos procedimentos odontológicos realizados e identificar os custos do Serviço de Odontologia Hospitalar, e 3) percepção dos profissionais cirurgiõesdentistas e Chefes das especialidades médicas usuárias dos serviços de odontologia hospitalar, quanto aos serviços prestados, e a satisfação dos usuários pacientes. Foi realizada uma pesquisa exploratória descritiva com dados relativos ao ano de 2016, através de um estudo de caso. Para identificar a percepção dos profissionais e satisfação dos pacientes com os serviços odontológicos prestados pelo Hospital foram aplicados (em 2017) questionários específicos. Os resultados demonstraram prevalência de atendimentos ambulatoriais, sendo que os principais procedimentos realizados foram tratamentos periodontais, cirurgias e laserterapia. Quanto ao aspecto financeiro, observou-se que nem todos os procedimentos são reembolsados pelo SUS e seus custos ultrapassam o valor recebido. A receita media SUS e o custo por atendimentos foram R$ 59,91 e R$ 5,36 respectivamente. O estudo permitiu também concluir que a percepção / satisfação nas três esferas analisadas é positiva em relação do serviço prestado. Espera-se que as informações encontradas forneçam subsídios para a melhoria contínua do serviço existente dentro do hospital, bem como para outros gestores que desejam implantar a Odontologia Hospitalar em outros centros de referência. / The provision of Dentistry service within the hospital environment began due to the benefits observed with multidisciplinary healthcare providers working together. In general, patients are attended by dentists at tertiary referral hospitals because their health condition which prevents the procedures to be performed in the clinic or health units, due, among others, to the difficulty of locomotion or lack of trained personnel to attend patients with systemic diseases. Studies that focus on this theme have observed important benefits in patient\'s health condition. Thus, the present study aimed to characterize the activities and procedures performed by the team of dental surgeons at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP in 2016 under the following aspects: 1) assistential: to relate the activities regarding the number of attendances according to the patient origin (ambulatory or nursery) and base pathology; 2) financial: identify the oral care procedures SUS revenues obtained and the costs incurred providing the service, and 3) stakeholders perception / satisfaction: evaluate the perception / satisfaction regarding the contribution of the service in the three mains spheres that comprise it: the dentists who provides care, the physician who works together with the dentistry staff and the patient. To meet these objectives, the descriptive exploratory research was chosen through case reports. To measure the perception / satisfaction specific questionnaires were applied for each group in 2017. The results demonstrated the prevalence of ambulatory care and the main procedures performed were periodontal treatments, surgeries and laser therapy. As for the financial aspect, it was observed that the service is deficient, since not all procedures are reimbursed by SUS and the costs exceed the amount received. In average, SUS reimbursed R$5,36 per procedure while the calculated costs were R$ 59,91. The study also concluded that the perception / satisfaction in the three spheres analyzed are positive in relation to the service provided. It is expected the results obtained will provide subsidies for the continuous improvement of the existing service within the hospital, as well for other managers who wish to implement Oral Service Medicine in other referral hospitals.

INTRODUÇÃO: Observado inicialmente em países desenvolvidos, o envelhecimento populacional atualmente é uma realidade presente também em países em desenvolvimento. O diabetes mellitus consiste em uma doença de caráter crônico, envolve acompanhamento e tratamento por toda a vida, e apresenta dificuldades no monitoramento e na garantia de uma boa adesão dos pacientes às orientações das equipes de saúde. OBJETIVO: Estudar as características dos idosos com diagnóstico de diabetes mellitus tipo 2, cadastrados em uma unidade de saúde da família, em relação à assistência à saúde, parâmetros clínicos de monitoramento e estado nutricional, a partir da avaliação dos prontuários clínicos destes pacientes. MÉTODO: O estudo é descritivo, com abordagem quantitativa, com fonte de dados secundários. O grupo de estudo é composto por usuários atendidos em uma unidade de saúde da família de Ribeirão Preto-SP, com diagnóstico confirmado de diabetes mellitus tipo 2, cadastrados no Sistema de Informação da Atenção Básica (SIAB), com idade igual ou superior a 60 anos, apresentando ao menos uma consulta de acompanhamento no último ano. Foram compilados dados referentes aos hábitos de vida, assistência à saúde e estado nutricional no primeiro ano de acompanhamento na unidade e no ano da coleta da dados. As informações referentes aos dois períodos estudados foram comparadas por meio de estatística descritiva. Para a comparação de médias das variáveis foi usado o teste t de Student para dados pareados. RESULTADOS: Foram analisados os prontuários de 60 idosos, com média de 9 anos de acompanhamento no serviço. Os diagnósticos das comorbidades mais frequentes foram hipertensão arterial sistêmica, dislipidemias e obesidade. Entre os parâmetros bioquímicos, houve redução de hemoglobina glicada (HbA1C), glicemia de jejum e lipídios para homens e redução de colesterol total, HDL colesterol e LDL colesterol entre as mulheres. Ocorreu redução na frequência dos registros de orientação alimentar no segundo período, com orientação específica de nutricionista em apenas 15% dos prontuários. A orientação mais frequente relatada referiu-se ao fracionamento das refeições. Além do nutricionista, o farmacêutico e fisioterapeuta foram os profissionais com maior frequência de visitas domiciliares. Os registros de participação em grupos de educação em saúde representaram apenas 5% da amostra. CONCLUSÃO: Os resultados encontrados evidenciam atendimento clínico eficiente no monitoramento e controle do diabetes mellitus, porém reforçam a necessidade de estímulo às práticas de promoção e prevenção da saúde no âmbito da atenção básica, com o objetivo de prevenção de complicações relacionadas ao envelhecimento e ao diabetes mellitus, contribuindo para melhora da qualidade de vida dos usuários do serviço, aumento da resolutividade da atenção básica e redução dos custos para o Sistema Único de Saúde. / INTRODUCTION: Initially observed in developed countries, the aging population is now present in developing countries. The diabetes mellitus consists in a chronic disease that involves monitoring and treatment for a lifetime, with difficulties to monitoring and to assurance a patient compliance to health team recommendations. OBJECTIVE: To study type 2 diabetes mellitus aged characters, registered in a family health unit, in relation to de health care, medical parameter and nutritional assessment, from medical records of them. METHODS: It\'s a descriptive study, with quantitative approach and secondary data source. The study group is compose of patients treated in a family health unit in Ribeirão Preto - SP, with confirmed type 2 diabetes mellitus diagnosis, register in the Primary Care Information System, aged over 60 years, presenting at least one follow-up visit last year. Data were compiled relating to lifestyle, health care and nutritional status in the first and last year of the monitoring unit. Two periods information were compared using descriptive statistics. To compare the means of the variables we used the Student t test for paired data. RESULTS: The elderly medical records were analyzed with average of nine years in follow-up service. The most common comorbidities diagnosis were hypertension, dyslipidemia and obesity. Among the biochemical parameters, glycated hemoglobin (HbA1c), fasting plasma glucose and blood lipids decreased among men and total cholesterol, HDL cholesterol and LDL cholesterol decreased among women. The frequency of dietary guidance recording decreased in the second period, with specific nutritionist guidance in only 15% of the records.! Fractionation meal is the most frequent orientation reported. In addition to the nutritionist, pharmacist and physiotherapist were professionals with higher frequency of home visits. Records of participation in health education groups accounted for only 5% of the sample. CONCLUSION: The results show efficient medical care in monitoring and control of diabetes mellitus, but reinforce the need for stimulus to promotion and prevention health practices in the scope of primary care, in order to prevent complications related to aging and diabetes mellitus, contributing to improved quality of life for service users, increasing resoluteness of primary care and reducing costs for the Unified Health System.

INTRODUCTION: Mortality associated with hepatitis C virus (HCV) infection is increasing, yet only a small percentage of HCV-infected individuals are aware of their infections, complete treatment, and achieve a cure, defined as a sustained virologic response. In March 2015, the Section of General Internal Medicine at Boston Medical Center (BMC), New England’s largest safety-net hospital, implemented the Adult Primary Care HCV Treatment and Triage Program to increase access to treatment. We are unaware of prior studies that have explored a pharmacist-centered primary care-based HCV treatment model in the era of newer direct-acting antiviral (DAA) medications. OBJECTIVES: To gain a deeper understanding of the roles of each program staff member, as well as an understanding of how primary care providers (PCPs) who refer patients to the program perceive and interact with the program. Such an understanding will help promote implementation and dissemination of the program. METHODS: We conducted in-depth semi-structured interviews with six staff members and with five PCPs in the Section of General Internal Medicine at BMC who refer patients to the program. We asked staff members about their roles and their perception of the program’s impact on patient linkage to HCV treatment. We probed PCPs about their experiences with HCV screening, referral, and follow-up processes, and differences in accessing HCV treatment for their patients prior to and following the implementation of the program. We audiotaped and transcribed interviews, and identified major themes through qualitative analysis. RESULTS: We identified five major themes that characterize how the HCV treatment program delivers care: 1) efficiency (“So here I feel like…they get evaluated…they get treated. Boom, it’s done”); 2) clear and open communication (“…one of the strengths of our program is that we have…a lot of direct contact with patients…”); 3) personalized medicine (“…I've set up the pill box for them [patients]…we tailor it to whatever they need”); 4) high patient engagement (“So if I get a referral for a patient…I call the patient three times. If I haven’t heard from the patient…I send them a letter and I tell the PCP”); 5) patient empowerment through education (“I think patient education is the best thing…if the patient is involved then… they’ll do what they need to do”). Additionally, the public health social worker and the pharmacist play key roles in the program. The social worker supports patients throughout treatment and addresses psychosocial barriers to treatment engagement (“I had a patient…who stopped taking his medication because his apartment was infested with bed bugs…[Social worker] got the patient furniture for free and got an exterminator…”). The pharmacist provides medication management during face-to-face patient visits (“…I go over everything imaginable...proper adherence…adverse effects, interactions…”). CONCLUSIONS: The HCV treatment program at BMC is a promising model to deliver HCV treatment to urban, underserved patient populations. Our findings suggest that public health social workers and pharmacists may be one approach to increasing access to HCV treatment in primary care settings in the era of DAA medications. Further study of the program’s efficacy in improving HCV outcomes is warranted.

O tratamento antineoplásico está associado a efeitos adversos sendo inúmeros na cavidade bucal que podem aumentar a morbidade e mortalidade nos pacientes. O suporte odontológico ao paciente com câncer se faz necessário, porém ainda não é uma realidade em vários centros de tratamento oncológicos. O objetivo do presente estudo foi capacitar as equipes de odontologia e equipe multidisciplinar dos centros oncológicos pediátricos da capital e interior do RS, a fim de gerar conhecimento técnico-científico sobre as complicações bucais do tratamento oncológico para melhorias no manejo do paciente infanto-juvenil com câncer. Foi realizado um curso de capacitação de profissionais da área de saúde no manejo de pacientes em tratamento oncológico com carga horária de 3 horas/aula. Os participantes responderam um questionário pré e pós-aula (19 questões). Foi realizada análise descritiva, teste não paramétrico de Wilcoxon para a avaliação do resultado geral préteste/ pós-teste e o teste não paramétrico de McNemar para avaliação das questões de forma individualizada O nível de significância de 5% de probabilidade ou o p-valor correspondente foi considerado. Foram realizadas 11 capacitações contabilizando na amostra final 270 participantes. Os participantes foram 215 (92,3%) do gênero feminino, principalmente dentistas/estudantes de odontologia (24,5%) e técnicos de enfermagem (23,6%) com experiência de até 5 anos (50,7%). A média de acertos no préteste foi de 9,85 (51,89%) e no pós-teste 14,35 (75,57%) sendo esta diferença estatisticamente significante (p>0.001). O aumento médio de acertos após a realização da intervenção foi de 68,66%. Conclui-se que a capacitação foi eficiente para disseminar e aprofundar os conhecimentos sobre o manejo odontológico do paciente em tratamento oncológico e atingiu os principais centros de referência de tratamento do câncer infanto-juvenil do estado. / The antineoplastic treatment is associated with side effects being several of them observed in the oral cavity contributing for patient’s morbidity and mortality. Oral care in cancer patients is necessary, but it is not yet a reality in several cancer treatment centers. The aim of the present study was to perform a training course to dental and multidisciplinary teams in the pediatric cancer centers in southern Brazil, in order to improve knowledge about oral complications in pediatric and juvenile cancer treatment. The training course for health professionals involved the management of patients undergoing oncological treatment with a 3 hours class. Participants answered a pre and post-test (19 questions). Descriptive analysis, non-parametric Wilcoxon test (for overall pre-test / post-test) and McNemar's non-parametric test (questions individually) were performed. The significance level of 5% probability or the corresponding p-value was considered. Eleven trainings were carried out and involved 270 participants. The sample was composed by 215 (92.3%) female, mainly dentists / dental students (24.5%) and nursing technicians (23.6%) with experience of up to 5 years (50.7%). The mean accuracy in the pre-test was 9.85 (51.89%) and in the post-test was 14.35 (75.57%), and this difference was statistically significant (p> 0.001). The average of correct answers after the intervention was 68.66%. It is concluded that the training was efficient to disseminate and improve the knowledge about the oral care of the patients submitted to cancer treatment. Also, we can reached the main centers of reference for pediatric and juvenile cancer in southern Brazil state.