Il presente lavoro di ricerca ha l'obiettivo di analizzare i primi minuti del colloquio clinico tra ginecologo e paziente, allo scopo di individuare gli elementi verbali e non verbali che caratterizzano questo scenario comunicativo. I colloqui sono stati videoregistrati e il comportamento è stato codificato mediante un software specifico, Theme, che ha permesso di rilevare sequenze comportamentali ripetute nel corso dell'interazione, denominate T-pattern. Il campione è costituito da 32 colloqui ginecologo-paziente, suddivisi in funzione delle variabili di ricerca. La prima variabile è la patologia della paziente (endometriosi o patologia oncologica), la seconda variabile è il numero di medici presenti al colloquio (un medico o più medici), la terza variabile è il ruolo rivestito nel corso del colloquio (medico o paziente). I risultati ottenuti hanno mostrato un effetto significativo della patologia e del ruolo sulla manifestazione di una serie di comportamenti verbali e non verbali. L'analisi dei T-pattern ha evidenziato che i gruppi di colloqui si differenziano in base all'organizzazione temporale e ritmica dell'interazione. / This research's aim is the analysis of the initial minutes of the clinical consultation in gynaecology, in order to identify the verbal and nonverbal aspects that characterize this communicative context. The interactions were video recorded and the behaviour coded using specific software, Theme that made possible the detection of repeated interactive behavioural patterns, called T-patterns. A total of 32 interactions between gynaecologists and patients were considered in this work. The interactions were grouped according to the research variables. The first variable is patient's disease (endometriosis or gynaecological cancer), the second one is the number of physicians taking part in the interaction (one physician or more physicians), the third one is the role during the consultation (physician or patient). The results showed that patient's disease and role have a significant effect on some verbal and nonverbal behaviour. T-pattern analysis illustrated that the consultations differ because of the temporal and rhythmic interactive organization.

Oggi, l'Italia è un paese multietnico. Dietro i movimenti migratori non vi sono però solo dati statistici, ma persone con culture e storie personali diverse, con cui gli operatori a contatto con gli immigrati devono confrontarsi. Ciò ha condotto alla nascita della mediazione linguistico-culturale, un settore sorto nella fase più acuta del fenomeno dell'immigrazione, gli anni Novanta, per rispondere alle esigenze specifiche di assistenza medica e legale degli immigrati. L'intento del presente lavoro di ricerca è quello di studiare l'interazione verbale e non verbale tra medico o infermiere e paziente straniero nel contesto della mediazione linguistica-culturale in una struttura socio-sanitaria. All'interno dell'interazione verbale si analizzeranno le teorie della cortesia linguistica applicate a un contesto socio-sanitario multietnico. Si andrà a verificare se esiste una lingua di mediazione, se la lingua inglese funge da lingua franca nell'interazione verbale medico o infermiere e paziente straniero e se esistano strategie empatiche comunicative verbali e non verbali comunemente utilizzate in corsia dal personale ospedaliero. Si studierà inoltre come l'analisi della conversazione, in particolare l'analisi delle strategie empatiche comunicative verbali e non verbali, possa essere utilizzata a fini didattici e pedagogici nella formazione linguistica e interculturale di studenti di medicina nel nuovo contesto sociosanitario multiculturale. / Italian society has undergone massive transformation, arising today as a true multiethnic society. Migration movements are not simply a phenomenon of statistical data but involve people from different cultures and personal backgrounds. Immigration is behind the onset of community interpreting in Italy at the beginning of the '90s. Community interpreters catered for all medical and legal needs of immigrants. Today, it is common practice in Italy that doctors and nurses interact with immigrant patients. The aim of the thesis is to study verbal and non-verbal strategies of communication between doctors or nurses and immigrant patients in this new multiethnic medical environment. The study will examine strategies of politeness theory, whether English is a lingua franca in the doctor or nurse and immigrant patient interaction and whether there are empathic verbal and non-verbal strategies of communication commonly used in the hospital ward by doctors and nurses. The study will also examine how conversational analysis, in particular the analysis of empathic verbal and non-verbal strategies of communication can be used for didactic and pedagogical purposes so as to prepare medical students linguistically and culturally to interact with their future patients in this new multiethnic medical environment.

In master study is analyzed the problem of code of doctor’s ethics in legal dimension. The relevance of doctor’s ethics is highlighted by the new viewpoints in Lithuanians’ lives, often not corresponding with the old understanding of ethics, which is natural for Lithuanian mentality. The objective of the research is to research the role of doctor’s ethics code in the formation of medical practice and while growing the society’s interest in the quality of doctor-patient relation and to analyze the interaction between Lithuania’s doctor’s ethics principles and law that fine-tunes health care in Lithuania. IN study was made the research with the purpose to analyze the interaction between the principles of doctor’s ethics code and the principles of Lithuania’s law that fine-tunes the health care. The results of the research show that the set of analyzed pieces of legislation does not guarantee the universal definition of doctor’s ethics norms and. For this reason the relevance of doctor’s ethics code exists.

No description available.

<p><strong>Introduction:</strong> In Ontario alone, an estimated 6,700 people (3,000 women; 3,700 men) will die of lung cancer in 2011 (Canadian Cancer Society, 2011). A diagnosis of cancer is associated with complex decisions; the array of choices of cancer treatments brings about hope, but also anxiety over which treatment is best suited for the individual patient (Blank, Graves, Sepucha et al., 2006). The overall cancer experience depends on the quality of this decision (Blank et al., 2006). Clinical practice guidelines are knowledge translation tools to facilitate treatment decision-making. In Ontario, guidelines have been developed and disseminated with the purpose to inform clinical decisions, improve evidence based practice, and to reduce unwanted practice variation in the province. But has this been achieved? To study this issue, the purpose of the current study was to gain an in-depth understanding and develop a theoretical framework of how Ontario physicians are making treatment decisions with their non-small cell lung cancer patients. The following research questions guided the study: (a) How do physicians make treatment decisions with their stage II, stage IIIA and stage IIIB non-small cell lung cancer patients in Ontario? (b) How do knowledge translation tools, such as Cancer Care Ontario guidelines, influence the decision-making process?</p> <p><strong>Methods:</strong> A qualitative approach of grounded theory, following a social constructivist paradigm outlined by Kathy Charmaz (2006), was used in this study. 21 semi-structured interviews were conducted; 16 interviews with physicians and 5 with health care administrators. The method of analysis integrated grounded theory philosophy to identify the treatment decision-making process in non-small cell lung cancer, from the physician perspective.</p> <p><strong>Findings:</strong> The theory depicts the treatment decision-making process to involve five key “guides” (or factors) to inform the treatment-decision making process: the unique patient, the unique physician, the family, the clinical team, and the clinical evidence.</p> <p><strong>Conclusion:</strong> Decision-making roles in lung cancer are complex and nuanced. The use of evidence, such as, clinical practice guidelines, is one of many considerations. Information from a large number of sources and a wide array of factors, people, emotions, preferences, clinical expertise, experiences, and clinical evidence informs the dynamic process of treatment decision-making. This theory of the treatment decision-making process (from the physician perspective) has implications relevant to treatment decision-making research, theory development, and guideline development for non-small cell lung cancer.</p> / Master of Science (MSc)

Substantial research has been carried out on evaluating the physician-patient interaction and on launching policy initiatives to improve patient-centred care. However, the organizational uptake of strategies to improve patient-centredness has received less attention in research and practice. Against this background, this thesis pursues the question whether strategies to improve patient centred care are associated with, and can be facilitated by quality improvement in European hospitals. The findings suggest that strategies to improve patient-centredness and hospital quality improvement systems are to some extent associated; however, hospital's quality improvement systems are not sufficient in ensuring organization-wide implementation of patient-centred care. Gaps between strategic level and ward level implementation and confounding factors suggest that additional factors facilitate or exert pressure on hospitals to adapt a patient-centred approach. Tools addressing selected domains of patient information, education and health promotion can be embedded into existing quality improvement systems in order to facilitate implementation. / Nombrosos estudis han avaluat la interacció metge-pacient en l'atenció sanitària i es van iniciar múltiples accions de la política de salut per millora l'atenció centrada en el pacient. No obstant això, la implantació d'estratègies per millorar l'atenció centrada al pacient a nivell organitzacional va rebre menys atenció en recerca i en la pràctica. En aquest context aquest estudi pretén avaluar si les estratègies per la millora de l'atenció centrada al pacient estan associades i/o facilitades pels sistemes de la millora de la qualitat en hospitals Europeus. Les troballes d'aquest treball suggereixen que les estratègies de l'atenció centrada al pacient i els sistemes de millora de la qualitat estiguin parcialment associades però, els últims no són suficients per garantir la implantació de les estratègies de l'atenció centrada al pacient per tota la organització hospitalària. Diferències entre la implantació al nivell estratègic i al nivell del departament apunten a altres factors facilitadors o factors externs que potencialment influeixen l'adaptació d'un enfocament centrada al pacient. L'ús d'eines pràctiques per a la millora de la informació, educació i promoció de salut del pacient pot completar els sistemes de millora de la qualitat assistencial existents. / Números estudios han evaluado la interacción médico-paciente en la atención sanitaria y se iniciaron múltiples acciones de la política de salud para mejorar la atención centrada al paciente. No obstante, la implantación de estrategias para mejorar la atención centrada al paciente al nivel organizacional recibió menos atención en investigación y la práctica. En este contexto, este estudio pretende evaluar si las estrategias para la mejora de la atención centrada al paciente están asociadas y/o facilitadas por los sistemas de la mejora de la calidad en hospitales Europeos. Los hallazgos del presente trabajo sugieren que las estrategias de la atención centrada al paciente y los sistemas para la mejora de la calidad asistencial están parcialmente asociadas, sin embargo, los últimos no son suficientes para garantizar la implantación de las estrategias de la atención centrada al paciente por toda la organización hospitalaria. Diferencias entre la implantación al nivel estratégica y al nivel del departamento apuntan a otros factores facilitadores o factores externos que potencialmente influyen la adaptación de un enfoque centrada en el paciente. El uso de herramientas prácticas para la mejora de la información, educación y promoción de salud del paciente puede complementar los sistemas de la mejora de la calidad asistencial existentes.