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A comparison of breastfeeding practices of clients of midwives and physicians at the University of Michigan a research report submitted in partial fulfillment ... for the degree of Masters in Science (Parent-Child Nursing) ... /Richards, Diana E. January 1992 (has links)
Thesis (M.S.)--University of Michigan, 1992.
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A comparative study of insulin and non-insulin dependent diabetics on measures of therapeutic relationship, self-disclosure and disease controlGetting, Ila Jean. January 1982 (has links)
Thesis (M.S.)--University of Wisconsin--Madison, 1982. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 61-66).
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How do physicians perceive and respond to low income patients?Saleh, Rania. January 1900 (has links)
Thesis (M.Sc.). / Written for the Faculty of Dentistry, [Dept. of Dental Sciences]. Title from title page of PDF (viewed 2009/07/08). Includes bibliographical references.
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A comparison of breastfeeding practices of clients of midwives and physicians at the University of Michigan a research report submitted in partial fulfillment ... for the degree of Masters in Science (Parent-Child Nursing) ... /Richards, Diana E. January 1992 (has links)
Thesis (M.S.)--University of Michigan, 1992.
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O ensino da comunicação na graduação em medicina: uma abordagem / Learning communications skills im medical school: a approachRossi, Pedro Santo [UNIFESP] January 2004 (has links) (PDF)
Made available in DSpace on 2015-12-06T23:05:18Z (GMT). No. of bitstreams: 0
Previous issue date: 2004 / A partir da importância atribuída à comunicação na relação médico-paciente com fator de boa adesão ao tratamento, surgiu o interesse em saber quando e como s contempla o ensino/aprendizagem de comunicação nos cursos de graduação em medicina. As recomendações sobre o desenvolvimento da competência "comunicação" preconizadas nas novas Diretrizes Curriculares Nacionais acrescentam uma justificava a mais para a pesquisa. Delimitado o campo da pesquisa, revisada a literatura e optado pelo referencial metodológico da pesquisa qualitativa, foram entrevistados doze egressos de cursos de medicina que estavam iniciando residência em Clínica Médica e nove professores, coordenadores de ensino de cursos de graduação em medicina. A análise da entrevistas, feita sob o olhar fenomenológico, privilegia o vivido. Aparece uma grande diversidade de concepções sobre o que seja a comunicação, contudo das falas dos entrevistadores emergem categorias de análise que mostram, em essência, uma tendência para considerar a competência comunicação como uma habilidade instrumental para se conseguir tirar informações e se fazer entender no procedimento médico. A temporalidade (o quando) também apresenta uma gama de possibilidades, distribuída entre as matérias iniciais e as atividades finais do curso. A forma (o como) de ensino/aprendizagem se distribui entre disciplinas básicas e atividades práticas. Em essência, o aprendizado se revela como produto da vivência pessoal ao longo do curso e da experiência na prática junto ao paciente. / The importance attributed to communication in the physician-patient relations as a
factor of satisfactory adherence to treatment has spurred an interest in determining when
and how the teaching/learning of communication in undergraduate medical courses should
be contemplated. The recommendations on the development of the “communication”
competence, advocated in the new National Curricular Guidelines, are one more reason
to justify this study. Once the field of investigation was outlined, the literature reviewed
and a choice of the qualitative research methodological criterion made, interviews were
conducted with twelve graduates from the medical schools who were starting residency in
Medical Practice and nine teachers who acted as area coordinators for undergraduate
medical programs. The analysis of the interviews, made from a phenomenologic
perspective, favors the experience lived. A broad range of concepts came up on what
communication is, but, on the other hand, a number of analysis categories arose from the
interviewees’ statements which show, in essence, a trend to consider communication
competence as an instrumental skill to obtain information and make oneself understood
in the medical procedure. Temporality (when) also points to a number of possibilities,
spread out between the early disciplines and the final activities of the course. The form
(how) of teaching/learning is distributed between basic disciplines and practical activities.
Fundamentally, learning comes out as a product of personal experience throughout the
course and of the practical experience with the patient. / BV UNIFESP: Teses e dissertações
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Retrospective analysis of ethics consultations at the Boston Medical CenterNaito, Tatsuhiko 12 March 2016 (has links)
OBJECTIVE: The vast majority of physicians frequently faces ethical dilemmas and feels overwhelmed as a result. Those at Boston Medical Center are no exception. Various studies show more adept handling of ethical issues can improve the quality of care and patient safety by reducing moral distress of physicians and fostering better patient-physician relationship. The method of Preventive Ethics, which actively identifies recurrent themes and underlying systematic issues among ethics consultations, is more effective than the traditional, case-by-case approach in reducing the number of ethical conflicts. The purpose of this study is to identify common themes prompting ethics consultations and any hotspots among recurrent ethical dilemmas at Boston Medical Center by using the Armstrong Clinical Ethics Coding System.
METHODS: A total of 32 ethics consultations handled by the BMC Ethics Committee between October 2010 and April 2013 were reviewed. Each consultation was coded using the Armstrong Clinical Ethics Coding System. The data was analyzed to identify the types of ethical dilemma that are most prevalent at BMC. The consultations involving the most frequently occurring issues were evaluated further to expose common themes among these cases and potential underlying systematic failures.
RESULT: "Clinical Candidacy or Risk / Benefit Analysis" (6.25%), "Concern About Decision Maker Choices" (14.6%) and "Futility / Inappropriate or Nonbeneficial Treatment" (13.5%) were the most prevalent types of ethical issues at BMC. Not only are these three frequently occurring, they also have a very high tendency to occur simultaneously. Further analysis of consultations involving these three issues revealed that at BMC, there are frequent instances of conflict, in which family members serving as healthcare proxies disagreed with physicians in deciding the best interest of patients with severe ailments, ultimately precipitating ethics consultations.
DISCUSSION: Comparison with similar retrospective studies previously carried out at other institutions suggests that consultation involving the issue of futility may be more frequently occurring at BMC, which might be coming from unique systematic problems. Several interventions such as improved policies or educational training in physician-family communication should be considered.
CONCLUSION: According to the principles of Preventive Ethics, the issue of physician-healthcare proxy conflict regarding patient futility should be issue to be addressed at BMC. The Armstrong Clinical Ethics Coding System can serve as a much needed standard documentation format for ethics consultations, which would open up the possibility of more detailed future studies
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A legitimação bioética e jurídica das diretivas antecipadas sobre a terminalidade da vida no Brasil. / Bioethics and legal legitimacy of advance directives about the terminally life in Brazil.Rafael Esteves 23 July 2015 (has links)
Este trabalho volta-se ao estudo das diretivas antecipadas sobre o fim da vida na relação médica no Brasil. Pretende-se verificar a legitimidade bioética e a legitimidade e possibilidade jurídicas da prática das diretivas antecipadas sobre o fim da vida como objetivo central. Busca-se aferir a adequação, bioética e jurídica, das diretivas antecipadas como veículo próprio de autodeterminação da pessoa diante de suas possibilidades existenciais e da formulação de seu projeto de vida e de morte digna. Ademais, especificamente, procura-se determinar a possibilidade jurídica das diretivas antecipadas no Ordenamento brasileiro: a coerência com as garantias constitucionais e a existência de institutos aptos a tal prática. Propõe-se sustentar a legitimação jurídica das diretivas antecipadas no Brasil, indicando possíveis caminhos às soluções interpretativas no plano jurídico, e os efeitos na relação médica a partir, também, das considerações bioéticas. Com essa finalidade, pretende-se averiguar a compatibilidade entre as normas deontológicas de origem bioética e as normas jurídicas de status constitucional de proteção à pessoa humana. A tese também propõe a análise do contexto em que as diretivas antecipadas são utilizadas para (i) problematizar as ideias de capacidade e competência para a prática desse ato de autonomia pessoal, (ii) problematizar sobre como a perspectiva familiar, a perspectiva técnica dos profissionais da saúde e a perspectiva do Poder Judiciário contingenciam a liberdade desse ato e (iii) aferir a eficácia desses atos no espaço clínico e familiar. Para tanto, será empreendido estudo teórico mediante pesquisa bibliográfica e de referências, que levantará as publicações, nacionais e internacionais, sobre os temas da tese. O levantamento bibliográfico compreenderá, preferencialmente, obras sobre filosofia, ética, bioética e direito, que permitam a análise das questões teóricas envolvidas no estudo. O desenvolvimento do trabalho estrutura-se em três capítulos. O primeiro pretende estabelecer as bases conceituais e os fundamentos legais das diretivas antecipadas. O segundo capítulo apresentará a sistematização entre os valores bioéticos e jurídicos que se relacionam a tal prática. O capítulo três apresentará as questões fundamentais pertinentes à validade e eficácia da prática das diretivas antecipadas no Brasil. A partir das premissas construídas ao longo do desenvolvimento, o desfecho da pesquisa pretende reforçar seu argumento central demonstrando, então, a legitimação bioética e a legitimidade e a possibilidade jurídicas das diretivas antecipadas sobre o fim da vida no atual contexto brasileiro.
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Percursos de interação transcultural nos serviços de saúde / Possible routes of transcultural interaction in health servicesElaine Cristina Camillo da Silva 22 June 2009 (has links)
Este estudo teve como proposições: compreender o processo da interação entre profissionais de saúde e usuários estrangeiros nas Unidades Básicas de Saúde (UBS) e Programa Saúde da Família (PSF); conhecer o significado da experiência dos profissionais de saúde ao interagir com os usuários estrangeiros; evidenciar questões bioéticas na experiência de interação entre profissionais e usuários estrangeiros. Utilizou-se como referencial teórico o Interacionismo Simbólico e como referencial metodológico a Teoria Fundamentada nos Dados, até a codificação axial. A análise dos dados, apresentada como ordenamento conceitual, levou à definição de quatro grandes temas: (1) procurando comunicar-se; (2) percebendo limites; (3) percebendo interação como processo; (4) percebendo perspectivas diferentes. O percurso de interação profissional usuário estrangeiro foi desencadeado a partir de uma escolha: atender a todos indiscriminadamente, tornando possível a aproximação. Perceber ou não no usuário estrangeiro sua dignidade de pessoa humana parece ser determinante na abertura do profissional à interação, na sua disposição a buscar estratégias. / This study had the following objectives: to understand the interaction processes among health professionals and foreign users in the Unidades Básicas de Saúde (UBS) and the Program for Family Health (PSF); to get to know the significance of the health professionals experience as they interact with foreign users; to put in evidence bioetiques issues in the experience of professionals and foreign users interaction.It was used as a theorical referential the Symbolic Interacionism and as methodological reference a Grounded Theory up to an axial coding. Data analysis presented as conceptual ordering, lead to the definition of four great issues: (1) trying to communicate; (2) detecting limits; (3) recognizing interaction as a process; (4) recognizing different perspectives. The route of professional foreign users interaction was developed from one choice: attend everyone (indiscriminately) making approximation possible. To recognize or fail to recognize in the foreign user the dignity of human person seems to be the determining factor for the openness of the professional to the interaction, in his disposition to seek strategies.
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Violencia laboral externa tipo amenaza contra médicos en servicios hospitalarios de Lima Metropolitana, Perú 2014Tuya-Figueroa, Ximena, Mezones Holguín, Edward, Monge, Eduardo, Arones, Ricardo, Mier, Milagros, Saravia, Mercedes, Torres, José, Mayta-Tristan, Percy 12 1900 (has links)
Objetivos. Estimar la frecuencia y los factores asociados a la violencia laboral externa tipo amenaza (VLETA) contra médicos en servicios de salud hospitalarios de Lima Metropolitana, Perú. Materiales y Métodos. Se desarrolló un estudio transversal analítico que incluyó médicos del Ministerio de Salud (MINSA), la Seguridad Social (EsSalud) y el subsector privado. Se midió la frecuencia de VLETA durante toda la práctica profesional, en los últimos doce meses y en el último mes. Se midieron variables relacionadas al médico, al agresor y al servicio de salud. Se estimaron razones de prevalencia (RPs) cruda y ajustada mediante un modelo lineal generalizado familia Poisson con bootstrap no paramétrico. Resultados. Participaron 406 médicos. El 31,5% fueron víctimas de VLETA al menos una vez durante su práctica profesional; 19,9% en los últimos doces meses y 7,6% en el último mes. La probabilidad de ser amenazado en los últimos doce meses aumentó si el médico era varón (RPa:1,7;IC95%:1,1-2,8), egresado de una universidad peruana fuera de Lima Metropolitana (RPa:1,5; IC95%:1,1-2,4), laboraba en MINSA (RPa:7,9;IC95%:2,24-50,73) o en EsSalud (RPa:8,68; IC95%:2,26-56,17), y atendía en emergencia (RPa:1,9;IC95%:1,2-3,6) o en sala de operaciones (RPa:1,6 IC95%:1,1-2,3). La edad, los años de práctica profesional o ser médico residente no se asociaron a VLETA. Conclusiones. En los hospitales estudiados, una alta proporción de médicos ha sido víctima de VLETA. Laborar en servicios públicos aumenta dicha probabilidad. Se sugiere implementar estrategias de prevención primaria, identificación y soporte en los establecimientos hospitalarios. / Objectives. To calculate the frequency and factors associated with external workplace violence (EWV) against doctors in health inpatient services in the metropolitan area of Lima (Spanish: Lima Metropolitana), Peru. Materials and methods. A cross-sectional analytic study, which included doctors from the Ministry of Health (MINSA), Social Security (EsSalud), and the private subsector, was carried out. The frequency of EWV was measured throughout the entire professional practice during the previous 12 months and during the last month. Variables related to the doctor, assailant, and health service were measured. Raw and adjusted prevalence ratios (PR) were calculated by means of a Poisson-family generalized linear model with non-parametric bootstrapping. Results. A total of 406 doctors participated; 31.5% were victims of EWV at least once during their professional practice, with 19.9% over the past 12 months and 7.6% during the last month. The chances of being threatened in the last 12 months increased if the doctor was male (adjusted PR [aPR]: 1.7; 95% confidence interval [CI] = 1.1- 2.8), had graduated from a Peruvian university outside of the metropolitan area of Lima (aPR: 1.5; 95% CI = 1.1-2.4), worked at MINSA (aPR: 7.9; 95% CI = 2.24-50.73) or EsSalud (RR: 8.68; 95% CI = 2.26-56.17), and worked in the emergency (aPR: 1.9; 95% CI = 1.2-3.6) or operating room (aPR: 1.6; 95% CI = 1.1-2.3). Age, years of professional practice, or being a medical resident were not associated with EWV. Conclusion. In the hospitals studied, a large number of doctors have been victims of EWV. Working in public services increases the possibility of violence. Implementation of support, identification, and primary prevention strategies in hospitals is recommended.
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The Last Call: Physicians Who Deliver House Calls at the End of Life: A Retrospective Cohort Study of Primary Care Physicians and Their Home Care Practices in Ontario, CanadaScott, Mary 31 March 2022 (has links)
Introduction: Home visits have become increasingly uncommon although evidence suggests they improve healthcare quality and reduce overall expenditures. This thesis identifies the number and proportion of physician delivering home visits at patient’s end of life and describes characteristics of primary care physicians delivering end-of-life home visits and explores associations with delivery.
Method: A retrospective cohort design using population-level health administrative data housed at ICES.
Results: A total of 9,884 physicians were identified, of which 2,568 (25.7%) delivered at least one end-of-life home visit. Variables associated with increased odds of home visit delivery were older age, international training, capitation models of remuneration, and population size.
Conclusions: This research demonstrates primary care physician’s characteristics and home visit practice patterns. This study aims to improve end-of-life primary care at a system and provider level by identifying factors associated with increased service provision. Increasing physician home services could greatly improve the dying experience of Canadians.
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