Global ETD Search

1	Does Patient Input Influence Psychologists' Treatment Recommendations? Braunstein, Abraham 09 October 2015 (has links) No description available. Psychology
2	Hiv-positiva kvinnor och deras barn : PM granskning från samtliga Svenska förlossningskliniker Wallgren, Kim, Ström, Frida January 2013 (has links) Under år 2011 levde ca 5800 personer i Sverige med diagnosen hiv (humant immunbristvirus) och 18 nya fall upptäcktes via MHV:s screening av gravida kvinnor. Risken att ett barn smittas under graviditet och förlossning är 15-25 % om kvinnan inte behandlas med antiretrovirala läkemedel. Riskerna ökar med ytterligare 10-15 % om kvinnan sedan väljer att amma sitt barn. Barn till kvinnor som behandlas med antiretrovirala läkemedel och har icke mätbara virusnivåer i blodet löper en risk på 0,4-1 % att smittas. RAV (referensgruppen för antivirala medel) uppdaterade 2010 sina behandlingsrekommendationer för hiv-1 positiva kvinnor under graviditet och förlossning. Detta till följd av att WHO ändrade sina riktlinjer samma år. En stor skillnad i rekommendationerna är att kvinnan får möjlighet till en vaginal förlossning om virusmängden och den obstetriska anamnesen tillåter. Syftet med studien var att granska PM för handhavandet av den hiv-1 positiva kvinnan och hennes barn under förlossning och puerperium på förlossningskliniker i Sverige. En kartläggningsstudie valdes med beskrivande och jämförande design. Metoden var att samla in samtliga förlossningsklinikers PM och/eller strategi för omhändertagande av patientgruppen. De insamlade PM:en granskades enligt RAV:s behandlingsrekommendationer och enligt AGREE som är ett validitetssäkrat instrument för granskning av kliniska riktlinjer. Resultatet visar på stor variation i både uppbyggnad av PM och följsamhet till behandlingsrekommendationer. Förlossningsklinikernas behandlingsstrategier skiljer sig också åt beroende på antal förlossningar/år och huruvida de tog emot eller skickade vidare patientgruppen. Vissa förlossningskliniker saknade helt PM och några av dessa tog ändå emot patientgruppen. Generellt sett var PM:ens utformning undermålig gällande uppbyggnad och uppdatering, samt att flera förlossningskliniker ej hade anammat de nya behandlingsrekommendationerna från RAV. / In 2011, approximately 5800 people in Sweden were living with an hiv (human immunodeficiency virus) diagnosis and 18 new cases were detected during antenatal screenings of pregnant women. The risk of a child being infected during pregnancy and delivery is 15-25 % if the woman hasn’t been treated with antiretroviral drugs. The risk will increase a further 10-15 % if the woman choses to breastfeed the child. The children of women that are treated with antiretroviral drugs and has non-measureable levels of virus in the blood runs a risk of 0.4-1 % of being infected. In consequence of WHO changing their guidelines in 2010, RAV (a reference group for antiviral treatment) updated their treatment recommendations for hiv-1 positive women during pregnancy and delivery. A major difference in the recommendation is that the woman is given an option of vaginal delivery, if allowed by the viral levels and obstetrical history.The purpose of this study was to review PM for the handling of the hiv-1 positive woman and her child during delivery and puerperium on maternity clinics in Sweden. A survey study was chosen with descriptive and comparative design. The method was to gather PM and/or strategy for care of the patient group from all clinics. The gathered PMs were reviewed according to RAV’s treatment recommendations and according to AGREE, an instrument for examination of clinical guidelines. The result displayed a great variation in both PM structure and adherence to the treatment recommendations. The care strategy of a maternity clinic was dependent of deliveries per year and also whether the patient group was admitted or referred. Some maternity clinics lacked PMs entirely and some of these would nevertheless admit the patient group. In general, the form of the PMs were substandard regarding structure and maintenance and several of the maternity clinics had not embraced the new treatment recommendations from RAV. Hiv delivery treatment recommendations clinical guidelines RAV Hiv förlossning behandlingsrekommendationer kliniska riktlinjer RAV
3	Savoirs et soin. L'interaction patient-médecin dans le cadre du traitement du cancer de la prostate. / On care and knowledge. Doctor-patient interaction in prostate cancer therapy Cléau, Hélène 17 February 2012 (has links) Les traitements du cancer de la prostate permettent d’analyser les savoirs tels qu’ils sont élaborés actuellement en cancérologie. Les propositions de traitement découlent des savoirs scientifiques. La participation du patient au choix du soin s’en trouve questionnée. Le patient est une figure socialement construite et médicalement produite qui n’a de sens qu’au regard du rôle professionnel du médecin. La relation entre ces deux acteurs s’inscrit dans une structure de soin. Cette situation sociale est instituée autour de la nécessité du soin, entendue comme réponse à la souffrance de l’autre. Notre analyse montre les tensions qui traversent le groupe professionnel des médecins sur la question des recommandations thérapeutiques. Les questions de légitimité et d’expertise permettent de mettre à jour la concurrence entre les urologues et les oncologues-radiothérapeutes. Cette concurrence se joue à travers les traitements proposés. Les savoirs mobilisés pour justifier de la légitimité ne sont pas les mêmes et ne sont pas uniquement scientifiques. Ils s’organisent selon une priorité accordée à la sur-vie. En outre, ces savoirs médicaux retentissent de façon différente chez les patients, eux aussi détenteurs d’un savoir sur le soin. En somme, les savoirs sur le soin apparaissent comme une recherche de sens, une mise en cohérence de la pathologie, inhérente à des mondes sociaux différents, mais qui se nourrissent les uns des autres. / Treatments for prostate cancer have led us to analyze how knowledge can be produced in cancer research. The different treatment options offered to the patient directly originate from scientific knowledge. At that point already, one can question the patient’s participation to the choice of his treatment. The patient is a figure who is socially constructed and medically produced. This figure only becomes significant in regard to the doctor’s professional role. The relation between those two actors – doctor and patient – has to be replaced in its context of a social structure of care. Social situation instituted from the necessary of care, as an answer to human suffering, the analysis shows the tensions that arise within the professional group of doctors. Issues of legitimacy and expertise have revealed the rivalry between urologists and oncologists. That rivalry shows mostly through the treatments which are offered. The knowledge used to legitimate one option or the other varies and is not exclusively scientific. Different bodies of knowledge take priority according to the survival (goal). Moreover those medical bodies of knowledge are not understood in the same way for each patient, as they themselves hold particular knowledge about care/cure. In the end, it appears the pieces of knowledge about cure/care inherently belong to different social worlds that feed from each other, and those different bodies of knowledge seek to make sense of illness. Savoirs profanes / Savoirs savants Soins Interaction patient-médecin Cancérologie Groupe professionnel de médecins Recommandations thérapeutiques Common knowledge / Formal knowledge Cure/Care Patient-doctor interaction Oncology Profesional group of doctors Treatment recommendations 306
4	Clients' Service Expectations and Practitioners' Treatment Recommendations in Veterinary Oncology Stoewen, Debbie Lynn 18 May 2012 (has links) Service provision in veterinary oncology in Ontario was examined using a mixed methods approach. First, an interview-based qualitative study explored the service expectations of oncology clients at a tertiary referral centre. Next, a survey-based quantitative study established an understanding of oncology service in primary care practice and investigated the treatment recommendations of practitioners for dogs diagnosed with cancer. The first study, which involved 30 individual and dyadic interviews, identified “uncertainty” (attributable to the unpredictable nature of cancer and its treatment) as an overarching psychological feature of clients’ experience. Consequently, “the communication of information” (both content and process) was the foremost service expectation. For clients, it enabled confidence in the service, the ability to make informed patient care decisions, and preparedness for the potential outcomes of those decisions; it also contributed to creating a humanistic environment, which enhanced client resiliency. Findings suggest that services can support client efforts to manage uncertainty through strategic design and delivery of service, and incorporate intentional communication strategies to support clients’ psychological fortitude in managing the cancer journey. The second study, a vignette-based survey of primary care practitioners across Ontario (N=1071) which investigated veterinarian decision-making in relation to oncology care, determined that 56% of practitioners recommended referral as their first choice of intervention, while 28% recommended palliative care, 13% in-clinic treatment, and 3% euthanasia. Recommendations were associated with patient, client and veterinarian factors. Specifically, referral and treatment were recommended for younger dogs, healthier dogs, and dogs with lymphoma versus osteosarcoma; for strongly bonded clients, and financially secure clients; and by veterinarians who graduated from a North American college, had experience with treating cancer, felt confident in the referral centre, and believed treatment was worthwhile, with variation in relation to practitioner gender and the type of medicine practiced. The human-animal bond appeared to be the primary factor associated with practitioners’ advocacy for quality of medical care for patients. Through a blend of qualitative and quantitative methodologies, this thesis contributes to the evidence upon which best practices may be built so as to enhance the quality of patient and client care in veterinary oncology. / Ontario Veterinary College Pet Trust Fund 049406 and 049854 client expectations treatment recommendations veterinary oncology practitioner service expectations qualitative research quantitative research thematic analysis vignette-based vignette-based inquiry full factorial experiment vignette-based research specialty oncology service primary care practice veterinary client logistic regression analysis uncertainty client uncertainty interview cancer cancer care canine cancer lymphoma osteosarcoma veterinary communication communication communication skills information content and process veterinary cancer care Ontario survey questionnaire referral euthanasia in-clinic treatment palliative care quality of care quality of medical care illness uncertainty service provision oncology epidemiology tertiary referral centre social epidemilogy veterinary epidemiology client well-being human-animal bond practitioner attitude best practice information preferences preparatory information cancer journey communication process continuity of care clinical decision making decision making practice variation adaptation

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