Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Missouri--Columbia, 1996. / Typescript. Includes bibliographical references (leaves 61-73). Also available on the Internet.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1992.

abstract: With new trends in drug development and testing, it must be determined whether the current state of balance of ethos (the moral norm) and regula (the legal framework) can successfully protect patients while keeping the door to scientific innovation open. The rise of the Clinician Investigator (CI) in both academic and private research introduces a challenge to the protection of subjects in the conflicting dual role of physician and scientist. Despite the constant evolution of regulation and ethical standards, questions about the roles' combined effectiveness in relation to this challenge persist. Carl Elliot describes the suicide of a patient-subject enrolled in an industry-funded physician-run anti-psychotic pharmaceutical drug trial in a 2010 Mother Jones article. Elliot provides a personal account of discrepancies seen in the ethical principles of beneficence, respect for subjects and justice. Through analysis of the problems presented in the case as a model for potential dangers in clinical research, the effectiveness of ethics and law in protecting human subjects is examined. While the lag between ethical standard and regulation has historically shown to cause similar issues, the misconception of current regulation and ethical standards may be contributing to the decrease in subject protections. After IRB approval of subject protections in the research protocol, CIs have been shown to downgrade their responsibility to maintaining ethos through the course of the trial. And, despite their experience in patient-centered ethos as a physician, CIs may be inclined to substitute these values for the ethos of a researcher, with the goal to avoid therapeutic misconception. Maintaining personal responsibility for subjects beyond regulatory structure, and promoting the welfare of the subjects in regards to the ethical standard of research investigators, will provide added security for subjects and decrease opportunity for exploitation in future research. / Dissertation/Thesis / M.S. Biology 2012

Numerous separate legal norms dealing with the individual spheres of everyday life exist in the Czech Republic at present; some acts mutually overleap and complement one another. Provision of healthcare and healthcare services is regulated by numerous international and national regulations in compliance with adherence to the basic human rights. The healthcare law issues are particularly dealt with by Act No. 372/2011 Col. on healthcare services and the conditions of their prevision, which became effective on 1 April 2012 and substituted Act No. 20/1966 Col. on people health care. Acceptance of the Healthcare Service Act completed the post-revolution changes in healthcare. The Act represents a relatively comprehensive system of rules, among others it regulates the rights and obligations of patients, healthcare providers and healthcare staff in provision of healthcare services. Recodification of the private law was completed in 2012. Act No. 89/2012 Col., the Civil Code was passed within that. It became effective on 1 January. This thesis is divided into five chapters including the conclusion. The first chapter tries to outline the development of the legal norms in healthcare and social sphere in our country. The development of the social-healthcare policy of the state from the late 19th century was later slowed down by the world economy crisis, the Second World War and the consequent normalization. The second chapter gives a brief introduction in the healthcare issues and is divided into several subchapters. It defines the basic terms health and disease. It specifies the individual models of human approach to health, the structure of the Czech healthcare; a part of the chapter deals with the physician-patient relation, particularly with its modification from the paternalistic approach of a physician to a patient to the partnership relation, in which a physician and a patient become equal partners. The third chapter introduces the international and national regulations forming a part of the current healthcare legislation. This legal norm expresses the willingness of the society not only in the Czech Republic to protect the basic values of a human being in healthcare provision. The fourth part of the thesis focuses in detail on selected spheres of provision of healthcare and healthcare services under the effectiveness of Act No. 372/2011 Col. on Healthcare Services and the newly passed Act No. 89/2012 Col., the Civil Code. The new regulation introduces a new type of contractual relation, a contract of healthcare, which should regulate the legal mode of the healthcare provision, including the position of a healthcare provider and a patient in healthcare provision. It also includes a complex regulation of intervention into natural person's integrity and the necessity of his/her agreement with such an intervention. This part of the thesis examines the relation between the Healthcare Service Act and the new Civil Code. The aim of the thesis was to map the previous and the new healthcare legislations and to specify the basic differences in the legal norms, and to assess the consequences of the changes in the regulations for a patient upon comparison of both the legal norms. This thesis is a theoretical one, based on detailed studying and on a content analysis of particularly regulations, specialized literature and further available sources. The conclusion, i.e. the fifth chapter summarizes selected problems of provision of healthcare and healthcare services. The new civil code is based on the requirements of the modern society and provides much higher improvement of patient rights. This levels the legal positions of both the involved subjects, the physician and the patient. Healthcare provision is however primarily regulated by the Act on Healthcare Service Provision and the Conditions of their Provision, namely in more detail than by the new Civil Code, which is in the subsidiarity relation to the special regulation.

Objetivo: avaliar o grau de empatia dos estudantes de medicina e suas mudanças durante o curso médico de uma Faculdade na cidade de São Paulo, Brasil. Método: Estudo descritivo, comparativo e transversal. Amostra não aleatória de 296 alunos. O estudo foi conduzido de Setembro até Dezembro de 2013. A avaliação da empatia foi realizada usando a escala de empatia médica de Jefferson (JSPE) na versão para estudantes de medicina, e a escala multidimensional de reatividade interpessoal de Davis (EMRI) na versão validade e adaptada no Brasil. Ambas escalas foram aplicadas simultaneamente a cada aluno. A JSPE contém 20 itens que são respondidos de acordo com a variante de escala de Likert de sete pontos (Concordo = 7 / Discordo = 1) .Esta escala avalia atributos cognitivos da empatia. A EMRI contém 21 itens que são respondidos de acordo com a escala de Likert de cinco pontos ( Descreve-me muito bem = 5 / Não me descreve muito bem = 1). Esta escala avalia tanto componentes cognitivos quanto afetivos da empatia. Os alunos foram divididos em três grupos de acordo com o ano da graduação: o grupo básico (1º e 2º ano), grupo clínico (3º e 4º ano ) e o grupo do internato (5 º e 6 º ano), e foram comparados os escores de empatia entre os três grupos. Resultados: Ao aplicar JSPE não houve uma diferença significativa quando comparado o escore entre os 3 grupos. Por outro lado ao aplicar a EMRI foi identificado um escore de empatia significativamente menor no grupo do internato quando avaliado o componente afetivo (p < 0,01). Tanto na JSPE quanto na EMRI, as mulheres obtiveram os melhores escores de empatia (p < 0,01) quando comparada aos homens. Os alunos que pretendiam seguir especialidade clínica obtiveram escore de empatia maior quando comparada com especialidade cirúrgica utilizando tanto a JSPE (p=0,05) quanto a EMRI (p < 0,01). Conclusões: O nível de empatia pode mudar e, neste caso, a dimensão afetiva é a mais afetada durante o curso médico. A identificação desta erosão afetiva mostra a necessidade de elaborar estratégias educacionais efetivas que possam contribuir para uma boa formação do futuro profissional médico / Purpose: This study was designed to examine changes in medical students\' empathy during medical school in São Paulo, Brazil. Method: Descriptive, comparative and cross-sectional study. Not randomized sample of 296 students. The study was conducted from September to December 2013. The empathy evaluation was performed using the Jefferson Scale of Physician Empathy (JSPE), version for medical students, and the Davis\'s multidimensional Interpersonal Reactivity Index (EMRI), both of then being applied simultaneously to each student. The JSPE contains 20 items that are answered according to the scale of Likert variant of seven points (7= completely in agreement / 1= completely in disagreement). It is important to emphasize that this scale assesses cognitive attributes of empathy. The EMRI contains 21 items that are answered according to the scale of Likert variant of five ponts (5= describe me very well /1= not describe me very well). This scale assesses cognitive and affective attributes of empathy. The students were divided into three groups, according to the year of professional career: the Basic Group (1st and 2 nd year), the Clinical Group (3rd and 4th year) and the Clerkship group (5th and 6th year). The score of empathy between the three groups was compared. Results: The JSPE scores were similar among the students from the Basic, Clinical and Clerkship groups (p=0.53). On the other hand, the affective dimension of EMRI revealed a significantly lower score in the Clerkship Group (p < 0.01). Women obtained better scores for empathy compared to men, in both scales (p < 0,01). Students who intended to follow clinical careers had higher empathy scores when compared to those who intended to follow surgical careers so when applied to JSPE (p = 0.05) as the EMRI (p < 0.01). Conclusions: The level of empathy can change and in this case, the affective dimension is most affected during medical school. The identification of affective erosion support the need to develop effective educational strategies that contribute to a good training medical professional future

Atualmente, os profissionais da saúde não vêm sendo preparados para lidar com as dificuldades inerentes à morte e o morrer, no entanto, observa-se que, dentre eles, é o médico que vivencia mais negativamente essa realidade, em detrimento das intervenções psicossociais. A literatura aponta que, crenças e práticas religiosas são importantes na vida de muitos pacientes que procuram assistência, entretanto, muitos médicos e demais profissionais da equipe ainda estão incertos sobre a melhor maneira para abordar questões espirituais e religiosas. Esta pesquisa teve a intenção de compreender a vivência de religiosidade de médicos oncologistas no cuidado com o paciente oncológico. Optou-se pela modalidade de pesquisa qualitativa, na perspectiva da Fenomenologia Ontológica- Hermenêutica de Martin Heidegger, para a compreensão das situações vivenciadas. Foram realizadas entrevistas com oito médicos oncologistas, após a assinatura do consentimento livre e informado. As entrevistas foram gravadas e transcritas na íntegra, seguida de uma leitura ampla. Posteriormente, verificadas as convergências e divergências dos relatos, emergiram as categorias de análise. A análise interpretativa desvelou que os médicos têm uma abertura para a compreensão da dimensão religiosa do paciente, no entanto, a fazem com muita dificuldade e ambigüidade quanto às condutas a serem tomadas. Mostram-se sensíveis a uma nova postura médica que precisa de bases seguras para se solidificar, porém encontra-se em momento inicial, na construção de um novo paradigma, que transita entre o cuidar autêntico e o inautêntico. Revelaram a compreensão da importância de Deus, como facilitador ao enfrentamento da facticidade introduzida pelo adoecer e, paralelamente, relataram que, também buscam e confortam-se em sua relação com a espiritualidade e o transcendente. Diante do desamparo sentido pela angústia, na proximidade da fronteira vida-morte, emergem os modos de existir destes cuidadores, na medida em que deparam-se com a finitude humana. Alguns continuam agregados aos rituais religiosos, como missas, velórios e práticas de rezas como forma de elaboração do luto que vivenciam cotidianamente, assim, conservam a dimensão pública do evento morte. Outros mostram-se em uma postura mais contemplativa diante de um Deus interno, cultivando a religiosidade em seu mundo próprio, sem freqüentarem rituais. Acolheram a necessidade do paciente ser-com-o-divino, nos diversos momentos, ao longo do tratamento. Embora, alguns médicos não se sintam confortáveis, ponderando o valor científico das práticas, não há oposição. Tendo em vista que o cuidado permeia toda e qualquer ação humana, segundo a ontologia de Heidegger, podemos vislumbrar, a partir dos resultados desta pesquisa, filosofias educacionais que envolvam os modos de ser-com e suas implicações para o cuidado e o existir autêntico na relação do médico com a religiosidade. (CAPES). / Nowadays, the health professionals have not been prepared to deal with the difficulties inherent to death and dying, however, it is noticeable that, among them, it is the physician who experiences more negatively this reality, for he is the focus of the patients and their relatives. Literature points out that beliefs and religious practices are important the lives of many patients who look for assistance, however, many doctors and other professionals of the staff are still wrong about the best way of approaching spiritual and religious issues. This research had the aim of comprehending the experience of religiosity of oncologist physicians in the caring of the oncologic patient. We opted for the qualitative research, through the perspective of Martin Heideggers Ontological-Hermeneutic Phenomenology, to understand the situations experienced. We interviewed eight oncologist physicians, after the signature of the informed and free consent. The interviews were recorded and transcribed entirely, followed by a broad reading. After the convergences and divergences of the reports were verified, the categories of analysis emerged. The interpretative analysis unveiled that the physicians have an opening for the comprehension of the patients religious dimension, however, they do it with much difficulty and ambiguity in relation to the actions to be taken. It is a new medical posture that needs safe foundations to solidify, but it is in an initial moment, in the construction of a new paradigm that oscillates between the authentic and non-authentic treating. The Physicians revealed the importance of God as a facilitator to the coping with the adversity of sickening and alongside they reported that they also search for and comfort themselves with their relation with spirituality and the transcendental. In the situation of helplessness caused by anguish, in the proximity to death, these care takers existing forms emerge: some continue attached to religious rituals, such as masses, funerals and praying practices as a way of elaborating the grief that they experience daily, so as to keep the public dimension of the death event. Others show themselves in a more contemplative posture before an inner God, cultivating the religiosity in their own world, without attending rituals. The physicians incorporated the patients necessity of being-with-the-divine, in the various moments along the treatment. Although some physicians do not feel comfortable, considering the scientific value of the practices, there is no opposition. Seen that the care permeates all and every human action, according to Heideggers ontology, we can discern educational philosophies that involve the results of this research and the being-with ways and their implications for the caring and the authentic existing in the relationships between physicians and religiosity (CAPES).

This study examined women's health messages found on ten endometriosis websites. Qualitative research methods were used to investigate messages available via Internet media about causes and treatments of endometriosis, particularly as they relate to the suggestion that hysterectomy and pregnancy are effective treatments. Messages about infertility, physician-patient communication, and accessibility were also examined. Findings indicate that the websites provided similar messages regarding the symptoms, causes, and treatments of endometriosis; results pertaining to infertility were mixed. Little information was available on methods of improving physician-patient communication. Most websites provided additional low-cost information while requiring minimal technological competency or additional software of site patrons. The results of this study have implications for future research in medical science and communication and reflect the importance of research on women's health communication. A detailed discussion of findings and suggestions for further research are offered. The author's own experiences with endometriosis are incorporated into the analysis.

No description available.