The diploma thesis is focused on the society's view of the problems of legalization of euthanasia. The thesis is divided into two main parts, the theoretical and the empirical one. The theoretical part consists of the basic terms related to the given problems, further of historical development of euthanasia, countries where euthanasia is legalized, arguments of proponents and opponents of euthanasia and paliative care. The practical part follows after theoretical information and deals with analysis of data gained by a questionnaire research and interpretation of individual findings relating to respondents' general awareness of euthanasia and differences in the view of euthanasia between lay public and professionals. At the end of the thesis, the concrete recommendations in future discussions about euthanasia are proposed on the basis of gained information.

Analysis of pharmacoterapy hospice care patients Author: Jakub Sládek Tutor: doc. PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and purpose: The therapy of hospice care patients is accompanied by many changes and pitfalls that need to be balanced when choosing appropriate therapy. In the teoretic part we can find available information about paliative therapy of hospice care patients, with emhasis on pain therapy. The aim of this thesis is the analysis of pharmacotherapy hospice care patients. Methods: The data were collected in a hospice from September 2019 to November 2019. The farmacotherapy was revised every first day of the month. Informations from personal, drug, family and occupational social history of patients were noted into an electronic database and, after revision, were classified and evaluated by frequency analysis. In four randomly selected patients was described the management of drug-related problems (DRP). Results: In total we noted medical therapy in 40 patients, women were 75 % of this number. Average patient's age was 72.4 years for men and 74.6 for women. Patients most often used drugs from group N (drugs of the nervous system) according to the ATC classification. We indentified 115...

Made available in DSpace on 2014-12-17T15:16:15Z (GMT). No. of bitstreams: 1 LarissaCLT_DISSERT.pdf: 1897660 bytes, checksum: f5f73ae1d43d82964c26599045fa5f10 (MD5) Previous issue date: 2011-12-16 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Introduction: The intrinsic gait disorders in individuals with Parkinson's disease (PD) are one of the most disabling motor symptoms. Among the therapeutic approaches used in attempts to improve the motor function, especially the gait pattern of individuals, stands out the treadmill gait training associated with the addition of load. However, there are few findings that elucidate the benefits arising from such practice. Objective: To assess the effects of adding load on the treadmill gait training in individuals with PD. Material and Methods: A controlled, randomized and blinded clinical trial, was performed with a sample of 27 individuals (18 men and 9 women) with PD, randomly assigned to three experimental conditions, namely: treadmill gait training (n=9), treadmill gait training associated with addition of 5% load (n=9) and treadmill gait training associated with addition of 10% load (n=9). All volunteers were assessed, during phase on of Parkinson's medication, regarding to demographic, clinical and anthropometric (identification form) data, level of disability (Hoehn and Yahr Modified Scale), cognitive function (Mini Mental State Examination), clinical functional - in those areas activity of daily living and motor examination (Unified Parkinson's Disease Rating Scale - UPDRS) and gait cinematic analysis was performed through Qualisys Motion Capture System?. The intervention protocol consisted of gait training in a period of 4 consecutive weeks, with three weekly sessions, lasting 30 minutes each. The post-intervention assessment occurred the next day after the last training session, which was performed cinematic analysis of gait and the UPDRS. Data analysis was performed using the software Statistical Package for Social Sciences? (SPSS) 17.0. Results: The age of volunteers ranged from 41 to 75 years old (62,26 ? 9,07) and the time of clinical diagnosis of PD between 2 to 9 years (4,56 ? 2,42). There was a reduction regarding the score from motor exam domain (p=0,005), only when training with the addition of a 5% load. As for the space-time variables there was no significant difference between groups (p>0,120); however, the training with addition of 5% load presented the following changes: increase in stride length (p=0,028), in step length (p=0,006), in time balance of the most affected member (p=0,006) and reduction in support time of the referred member (p=0,007). Regarding angular variables significant differences between groups submitted to treadmill gait training without addition load and with 5% of load were observed in angle of the ankle at initial contact (p=0,019), in plantar flexion at toe-off (p=0,003) and in the maximum dorsiflexion in swing (p=0,005). While within groups, there was a reduction in amplitude of motion of the ankle (p=0,048), the only workout on the treadmill. Conclusion: The treadmill gait training with addition of 5% load proved to be a better experimental condition than the others because it provided greater gains in a number of variables (space-time and angular gait) and in the motion function, becoming a therapy capable of effectively improving the progress of individuals with PD / Introdu??o: As desordens da marcha em indiv?duos com doen?a de Parkinson (DP) representa um dos sintomas motores mais incapacitantes. Dentre as abordagens terap?uticas empregadas, na tentativa de aperfei?oar a fun??o motora, principalmente o padr?o de marcha, destaca-se o treino de marcha na esteira associado ? adi??o de carga. Todavia, poucos s?o os achados que elucidam os benef?cios oriundos de tal pr?tica. Objetivo: Verificar os efeitos da adi??o de carga no treino de marcha na esteira em indiv?duos com DP. Materiais e M?todos: Trata-se de um ensaio cl?nico, controlado, randomizado e cego, realizado com uma amostra de 27 indiv?duos com DP (18 homens e 9 mulheres), distribu?dos aleatoriamente, em tr?s condi??es: treino de marcha na esteira (n=9), treino de marcha na esteira com adi??o de 5% de carga (n=9) e treino de marcha na esteira com adi??o de 10% de carga (n=9). Todos os volunt?rios foram avaliados, estando na fase on do medicamento antiparkinsoniano, quanto aos dados demogr?ficos, cl?nicos e antropom?tricos (formul?rio de identifica??o), n?vel de incapacidade f?sica (escala de Hoehn e Yahr modificada), fun??o cognitiva (mini-exame do estado mental), estado cl?nico-funcional em rela??o aos dom?nios atividade de vida di?ria e exame motor (Unified Parkinson s Disease Rating Scale UPDRS) e a an?lise cinem?tica da marcha foi realizada por meio do sistema Qualisys Motion Capture System?. O protocolo de interven??o consistiu num per?odo de 4 semanas consecutivas de treino, sendo 3 sess?es semanais, com dura??o de 30 minutos cada. A an?lise dos dados foi realizada por meio do software Statistical Package for Social Sciences? (SPSS) 17.0, adotando-se n?vel de signific?ncia de 5%. Resultados: A idade dos volunt?rios variou entre 41 e 75 anos (62,26 ? 9,07) e o tempo de diagn?stico cl?nico da DP entre 2 e 9 anos (4,56 ? 2,42). Houve diminui??o do escore quanto ao dom?nio exame motor (p=0,005), apenas no treino com adi??o de 5% de carga. Quanto ?s vari?veis espa?o-temporais n?o foram encontradas diferen?as significativas entre os grupos (p>0,120); entretanto, o treino com adi??o de 5% de carga apresentou as seguintes altera??es: aumento no comprimento da passada (p=0,028), no comprimento do passo (p=0,006), no tempo de balan?o do membro mais afetado (p=0,006) e redu??o no tempo de apoio, do membro referido (p=0,007). Em rela??o ?s vari?veis angulares foram verificadas diferen?as significativas, entre os grupos submetidos ao treino apenas na esteira e com adi??o de 5% de carga, no ?ngulo do tornozelo no contato inicial (p=0,019), na flex?o plantar no toe-off (p=0,003) e na m?xima dorsiflex?o no balan?o (p=0,005). Enquanto que, dentro dos grupos, houve redu??o na amplitude de movimento do tornozelo (p=0,048), no treino apenas na esteira. Conclus?o: O treino de marcha na esteira com adi??o de 5% de carga demonstrou ser uma condi??o experimental superior ?s demais, por ter proporcionado ganhos em uma maior quantidade de vari?veis (espa?o-temporais e angulares da marcha) e na fun??o motora, tornando-se uma terapia capaz de beneficiar efetivamente a marcha de indiv?duos com DP

Orientadores: Joel Sales Giglio, Cibele Andrucioli de Matos Pimenta. / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-05T19:18:30Z (GMT). No. of bitstreams: 1 Elias_AnaCatarinadeAraujo_D.pdf: 2016555 bytes, checksum: fc9eb54fe87d798e109996a98478e447 (MD5) Previous issue date: 2005 / Resumo: Em dissertação de mestrado, desenvolvemos o estudo da Intervenção Terapêutica Relaxamento, Imagens Mentais e Espiritualidade (RIME) para re-significar a Dor Espiritual de pacientes terminais. A continuidade da pesquisa no Doutorado consistiu na operacionalização de um Curso de Capacitação sobre o uso da RIME por profissionais da saúde (Fase 1), na análise da vivência destes profissionais na sua aplicação e na avaliação do uso desta Intervenção junto aos doentes (Fase 2). Os sujeitos foram uma enfermeira, uma médica, três psicólogos e uma terapeuta alternativa voluntária, todos eles experientes ou estudiosos em Cuidados Paliativos, selecionados por convite e que atenderam onze pacientes terminais internados em hospitais públicos das cidades de Campinas, Piracicaba e São Paulo. Este estudo teve como base teórica metodológica a Pesquisa-Ação e a Fenomenologia. Os resultados qualitativos foram colhidos através da Entrevista Semi-Estruturada, do Questionário Estruturado e do Diário, e foram analisados pelo método Análise do Conteúdo através da técnica Análise Temática. Os resultados quantitativos foram analisados pelo método Descritivo através dos dados colhidos pelo instrumento Escala Visual Analógica de Bem-Estar ¿ EVA modelo expressões faciais coloridas, utilizando-se o Teste de Wilcoxon. Na análise da vivência dos profissionais foram encontradas cinco categorias e quinze subcategorias. Na análise da natureza da Dor Espiritual foram encontradas seis categorias e onze subcategorias. Na aplicação da RIME observamos diferença estatisticamente significativa (p<0,0001) isto é, no final das sessões os doentes relataram maior nível de Bem-Estar do que no início da sessão, o que indica que a RIME favoreceu a re-significação da Dor Espiritual dos pacientes terminais. O Programa de Treinamento proposto mostrou-se eficaz para preparar profissionais de saúde para o uso da Intervenção RIME, capacitando-os para o processo de cuidar e para prestar assistência espiritual dentro de uma perspectiva acadêmica / Abstract: In this essay of mastership we developed the study of the Therapeutical Intervention ¿Relaxation, Mental Images and Spirituality¿ (RIME) applied for terminal patients. The continuity for the research in the Doctorship consisted in operating a Course of Capacitance on the RIME Intervention usage by the health area professionals (Phase1) and on the analysis of the living experiences of these professionals in the application and evaluation of the RIME use in the patients (Phase2). The participants were a nurse, a female doctor, three psychologists and an alternative volunteer therapist, all experienced ones or scholars at Palliative Cares, they were selected by invitation and were in charge of caring of eleven terminal outpatients in public hospitals of Campinas, Piracicaba and São Paulo. This study had as a theory methodological base the Action-Research and the Phenomenology. The qualitative results were caught through the Semi-Structured Interview, the Structural Questionnaire and the Diary, and they were analyzed by the Contents Analysis method through the Thematically Analysis techniques. It is descriptive through the data, which were caught by the Analogical Visual Scale instrument of Welfare-AVS, in-color faces model, by using the Wilcoxon test. In the analysis of the professionals experiences were found five categories and fifteen sub-categories. In the analysis of the Spiritual Pain constitution, six categories were found with eleven sub-categories. In the application of the RIME was observed statistically expressive difference (p<0,0001) that is, at the end of each session the patients reported a greater level of welfare than at the beginning, indicating that the RIME favors the re-signification of the Spiritual Pain in the terminal patients. The purposed training program showed itself effective in preparing health area professionals for the use of the RIME Intervention, qualifying them to care and give spiritual assistance inside an academic perspective / Doutorado / Ciencias Biomedicas / Doutor em Ciências Médicas

Dilemmas in thanatology in the 21st century In the thesis "Dilemmas in thanatology in the 21st century" I focused on the definition of the contradictory questions about the end of human life. I found that most of the respondents of different age groups, who were involved in the care process and responded to the questionnaire, are acquainted with the issue of thanatology. They assess this issue as emotionally challenging, difficult and professionally untreated. In addition, I investigated the needs of helping professions in the issue of communication barriers in the topic of death and dying. I came to the conclusion that communication on this subject is displaced, missing training and there is a lack of the literature on this topic. Due to the unrepresentativeness of the survey I assess the result obtained only as the orientation indicator according to the issue under the investigation. This result rather opens up further contradictory questions in the thanatology.

In the theoretical part the terms hospice, home hospice care and palliative care are defined. History, principles, objectives and the concept of hospice care in the Czech Republic are mentioned. The phases of psychological responses to a serious illness undergone by a patient and the patients´ reaction to impending death are described. The traditional model of dying in the Czech Republic in the home environment, the gradual institutionalization and the taboos surrounding death, and the new inception of humane methods in the care for the dying after the year 1989 are particularized. The current types of hospice care in the Czech Republic and especially home hospice care are described in detail, and also the needs of the dying and those of their loved ones, which is the main topic of my thesis. The aim of this work is to survey the availability of palliative home care services in the Vysočina region, to compare the range of offered services, to map the users´ experience and to identify the risk factors in providing this care. In the realized qualitative research the availability of these services was surveyed through the content analysis of data by the technique of official documents and virtual data analysis. In order to map the users´ experience, managers of two agencies providing home hospice care in the town of Třebíč were addressed, as well as the users or their families to whom these agencies provide their services. The interview method, the technique of a semi-structured interview was used. There are eight providers of home hospice care in the Vysočina region. The Vysočina region supports not only home hospice care, but also supported the establishment of residential hospice services in the Long-Term Care Hospitals in three towns in the Vysočina region and the Palliative Care Department in the Jihlava hospital. These facilities have partially substituted a non-existent hospice in the Vysočina region. Hospice care in the Vysočina region is relatively new. It is necessary to get some experience and discover possible shortcomings. The complexity of the care for the seriously ill can be extended, which may enable the seriously ill patients to stay at home with their relatives as long as possible. Although home hospice care has its limits in terms of pain alleviation and complications resulting from a disease, the users´ experience is satisfactory and meets their expectations. The contribution of the thesis lies in uncovering deficiencies in home hospice care and the provision of identified information to the care providers and other health care workers, thus enhancing the awareness of this care among health professionals and family members of seriously ill patients.

This diploma thesis describes Opportunities of Social Work in paliative care in Slovak republic and compares seleccted aspects with Czech republic. Main goal of this work was describe system of paliative care in Slovak republic and compare selected aspekts with Czech republic. Empirical part of this work is focused on blind spaces in paliative care and system of paliative care which was mapped especially by literature and ilustrative intriview with one respondent. Work poits to the need to provide social servoces in paliative care.

This diploma thesis deals with counselling management for families of deceased persons in practical matters. The goal of the work is to to describe the contemporary practical reality of social services in counselling for families and survivors. Another aim is to identify the matters in which help for survivors is most necessary. The research in this thesis is qualitative and uses semi-structured interviews as a primary method. It focuses on two groups of respondents, one of which consists of social services managers, while the other includes survivors who have experienced the practical matters of caring for a family member or their decease. The semi-structured interviews are analysed using open coding and subsequently split into categories which emerged from data analysis. Recommendations for social service managers are presented in the conclusion of the thesis based on the results of research surveys. These recommendations include suggestions on counselling for survivors in practical matters. Keywords: expert social counselling, counselling for survivors, paliative care, social services, practical matters

The making of an end of life decision represents worldwide one of the most difficult issues that physicians can be confronted with - not only should it be regarded as consisting of medical and legal aspects, but ethics and moral values are present as well. Furthermore, it shall not be supposed that the economic parameter is negligible, unfortunately even to the contrary. The fact that the decision is often made by physicians under pressure caused by a system of limited resources (and therefore it can not avoid being distorted ) must be kept in mind. At any rate , according to Czech law under which neither assisted suicide nor life termination on the request is allowed, the legality and legitimacy of withdrawal and withholding of medical treatment is based on the argument of informed consent of the patient, advanced directives and the standard of lege artis treatment. These also shall be pleaded as defences in eventual criminal proceedings.

Made available in DSpace on 2016-04-27T18:47:37Z (GMT). No. of bitstreams: 1 Angela Maria Amaral Soares Abou Ali.pdf: 892563 bytes, checksum: 98fb6c694eaa50edffc23a72a56b9e7e (MD5) Previous issue date: 2010-05-11 / This work aims to identify the behavior of whealt professionals and the power relationships within old people under biopower optics and at the context of the paliative care. The social and medical advances has provided new ways to maintain and sustain the life, and there are much more situations such that the life is maintaned by machines, increasing the demand for paliative care. New relationships and demands had stabilished, and it was clear that the professionals are unprepared for such situation. The study of Hospital de Retaguarda Francisco de Assis de Ribeirão Preto/SP analyse the activity of the entity and emphatizes the need of implantation the paliative practice in professional formation of that people that will effectivly act in this area / Este trabalho busca identificar o comportamento dos profissionais de saúde e relações de poder frente a idosos terminais sob a ótica do biopoder, no contexto da prática paliativista. Os avanços sociais e da medicina permitiram prolongar cada vez mais a vida, tornando cada vez mais frequente a sua manutenção por meio de aparelhos, intensificando a demanda por cuidados paliativos. Novas relações e demandas se estabelecem, e torna-se claro o despreparo profissional diante desse novo cenário. O estudo do Hospital de Retaguarda Francisco de Assis de Ribeirão Preto/SP avalia a atuação da instituição e enfatiza a necessidade de se implantar a prática paliativista na formação profissional daqueles que efetivamente atuarão nessa especialidade. O objetivo desse estudo foi Identificar o comportamento dos profissionais de saúde e as relações de poder frente aos idosos em situação de terminalidade É necessário o estudo do comportamento dos profissionais mediante a terminalidade, dada a crescente demanda por esse segmento da saúde e frente ao despreparo de tais profissionais de saúde frente à essa necessidade. Como metodologia, aplicamos questionários aos funcionários que atuam no segmento de cuidados paliativos no Hospital de Retaguarda Francisco de Assis de Ribeirão Preto/SP. Como resultado: a instituição tem cumprido um papel efetivo no treinamento dos profissionais que nela atuam