Kronisk njursvikt ökar varje år och vid terminal njurinsufficiens ses njurtransplantation som förstaval av behandling. Behovet av donerade njurar är större än tillgången, vilket leder till en lång väntan för individen. Studiens syfte var att beskriva individers upplevelser i väntan på en njurtransplantation. Metoden var en litteraturstudien där tio vetenskapliga artiklar granskades och analyserades. I analysen framkom tre teman som utgjorde resultatet: behandling för att överleva där dialysbehandlingen sågs som en begränsning i livet och gjorde det svårt att leva som dem gjort tidigare, känna hopp där en transplantation var något att hoppas på, ett sätt att ta sig ur dialysen och få tillbaka sitt gamla liv, samt känna hopplöshet där rädsla för att njurtransplantationen aldrig skulle bli av och känslor av att vara på is i väntan uppkom. Slutsatsen är att behandlingen påverkade upplevelsen av väntan och ledde till att livet var på is, det centrala i livet var att få en transplantation som skulle förbättra livet. För att underlätta situationen för individer i väntan på transplantation finns det ett behov av att det forskas på hur sjuksköterskans bemötande kan stötta individer i väntan. / Chronic kidney failure is increasing every year and at end-stage renal disease kidney transplantation is seen as the first choice of treatment. The need for donated kidneys is greater than the supply, leading to a long wait for the individual. The study aimed to describe individuals' experiences while waiting for a kidney transplant. The method was a literature study where ten scientific articles were reviewed and analyzed. The analysis revealed three themes that formed the result: treatment in order to survive where the dialysis treatment was seen as a limitation in life and made ​​it difficult to live as they did before, feel hope where the transplantation was something to hope for, a way to get out of dialysis and regain the old life, and feel hopelessness where fear that the kidney transplant would never happen and feelings of being on hold while waiting arose. The conclusion is that the treatment affected the experience of waiting and it led to the feeling of being on hold, the central focus of life was the transplant that would improve their lives. To improve the situation of people waiting for a transplant, there is a need for research on how nurse's attitude can support individuals in anticipation.

Väntelistor till barnpsykiatrisk vård är vanligt förekommande och tiden på väntelista har visats vara påfrestande för familjerna som väntar. Denna studie har undersökt hur föräldrar upplever tiden på väntelista till Barn- och ungdomspsykiatrin (BUP), samt vilka behov av stöd de upplever sig ha under tiden de väntar. Sju föräldrar vars barn väntade på utredning inom BUP intervjuades. Data bearbetades genom tematisk analys. Resultatet visar att föräldrarna upplevde brist på kontroll och hopplöshet, delvis på grund av att de befann sig i ovisshet under väntetiden. Vidare visar resultatet att stödinsatser som innefattar information, konsultation, avlastning och behandling efterfrågades. Resultatet diskuteras med hjälp av teorin om Locus of Control (LOC) och begreppet ovisshetsdiskrepans. Vidare forskning behövs för att öka förståelsen för hur information gällande väntetiden påverkar upplevelsen av väntetiden. Därtill behövs forskning som undersöker om och hur upplevelsen av väntetiden påverkar kommande utredning eller behandling. / Waiting lists in child and adolescent psychiatry are common and waiting for mental health services has been shown to be challenging for the families involved. This study aimed to explore how parents of children on a waiting list for an assessment experienced the wait. The study also explored what kind of support the parents felt that they needed during this period. Interviews were conducted with seven parents of children on waiting lists and data was analyzed using thematic analysis. Results showed that the parents experienced a lack of control and hopelessness during the wait, partly because of the uncertainty that characterized the waiting time. Results concerning parental support showed that information, consultation, social support and treatment were requested. Results were discussed using the theoretical framework Locus of Control (LOC) and uncertainty discrepancy. Future studies exploring how information about the waiting time affects the waiting list experience are needed. In addition, future studies that explore if and how the waiting list experience affects the coming assessment or treatment are needed.

Introdução: As doenças respiratórias ocupacionais constituem um grave problema de saúde pública na realidade brasileira. A silicose é a pneumoconiose mais prevalente, considerada a principal causa de invalidez entre as doenças respiratórias ocupacionais e pode desenvolver uma forma grave de pneumopatia fibrosante levando a insuficiência respiratória crônica onde apenas o transplante pulmonar é a terapia capaz de re-estabelecer a qualidade de vida e assim prolongar a sobrevida destes indivíduos. Objetivo: Fazer uma revisão sistemalizada da literatura sobre o tema “transplante pulmonar” e “silicose” e “sobrevida”, além de avaliar o resultado do transplante pulmonar realizado em pacientes com silicose em estágio terminal, comparando as alterações de função pulmonar entre aqueles submetidos à cirurgia com aqueles que não foram operados, além de detectar os fatores prognósticos que podem influenciar a sobrevida dos pacientes submetidos a este procedimento. Métodos: Após uma busca sistematizada na literatura sobre o tema, 40 artigos foram analisados, sendo que 13 destes descorriam sobre o tema, e cinco tratavam exclusivamente de transplante de pulmão em silicose avançada. Posteriormente, foram retrospectivamente estudados os prontuários de 26 pacientes listados para tranplante pulmonar por silicose pulmonar em estágio terminal, no período entre janeiro de 1989 até junho de 2015 pelo grupo de Transplante Pulmonar da Santa Casa de Porto Alegre – RS. As características epidemiológicas, as medidas de função pulmonar analisadas através de espirometria, teste de caminhada de 6 minutos, teste de difusão do monóxido de carbono, medidas de pressões da artéria pulmonar, foram comparadas entre os grupos transplante versus não transplante. As variáveis categóricas são apresentadas em números absolutos e/ou porcentagem. O pequeno número da amostra não foi suficiente para garantir a normalidade e os dados foram analisados através dos testes não paramétricos do qui-quadrado (x2), teste de Mann Whitnney e teste de Friedman. Para as análises pareadas, foi utilizado o teste de Wilcoxon. Para amostra menor que 5, o teste de exato de Fisher. As variáveis analisadas em relação aos eventos relacionados com mortalidade, foram estudadas através da correlação de Spearman. O sobrevida até o desfecho, estabelecida através da curva de Kaplan-Mayer. Foram assumidos valores de p < 0,005 como os de significância estatística. Resultados: Todos eram homens, com idade de 45,4 + 11 anos, sendo o extrativismo mineral responsável por 44,0% das ocupações. O padrão restritivo observado em 65,4 % dos casos onde 82,3% destes tinham CVF < 40,0% do previsto (CVF de 27,07 + 16,0%) com DLCO 39 + 6,2%, demostrando limitação funcional importante, marcada por uma distância percorrida no TC6M muito curta, 267,4 + 104,5 metros com dessaturação de 10,7 + 5,4%. A história de tabagismo foi observada em 46,2% e de tuberculose em 34,6%. A sobrevida global dos pacientes listados foi de 693,5 (46 – 5.250) dias, todavia no subgrupo dos pacientes transplantados foi de 1.226 (60 – 5.250) dias contra 288 (46 – 1.333) dias nos não transplantados (p= 0,002). A sobrevida após o transplante foi 889 (3 – 5.176) dias, sendo de 85,7% no 1o mês, 69% no 1o ano, 44,0% em três anos e 25,0% em cinco. Apenas o tempo de isquemia foi significamente maior no grupo que faleceu (p= 0,042), entretanto, na análise multivariada, pôde-se perceber que o tempo de isquemia (p= 000, Ro= - 0,842), o tempo de ventilação mecânica (p= 0,045, Ro= - 0,507) e o tempo de permanência dos drenos (p= 0,025, Ro= - 0,558), tiveram impacto negativo sobre a sobrevida. Conclusão: Embora ainda não sejam claros os critérios de indicação de transplante em silicose avançada, observamos que os pacientes mais emagrecidos e possivelmente desnutridos, assim como aqueles com pior função pulmonar, tendem a morrer mais precocemente sem o procedimento. Por outro lado, no grupo de pacientes operados, um tempo de isquemia prolongado, o sangramento transoperatório (desde o ato cirúrgico até a retirada dos drenos) visto através da permanência dos drenos de tórax e a duraçao da ventilação mecânica invasiva, estiveram relacionados com óbito. Ainda que esta série seja a maior encontrada de transplante pulmonar por silicose realizada em um único centro, um número maior de pacientes deve ser estudado e acompanhados para que estas e outras questões possam ser elucidadas. / Background: Occupational respiratory diseases are a serious public health problem in Brazil. Silicosis is the most prevalent pneumoconiosis, considered the leading cause of disability among occupational respiratory diseases. It may develop a severe form of lung fibrosis, leading to chronic respiratory failure, where only therapy that can re-establish the quality of life, and thus prolong the survival of these individuals is lung transplantation. Purpose: To evaluate the outcome of lung transplantation performed in patients with silicosis in terminal stage, comparing the changes in lung function among those undergoing surgery with those who did not undergo surgery, and detect prognostic factors that may influence the survival of patients undergoing this procedure. Methods: We performed a systematic literature review for key words “lung transplantation”, “silicosis”, “survival”, and found 40 articles, wherin 13 adressed this specific theme, and only five exclusivelly to lung transplantation due advanced (end-stage) silicosis. Then, we retrospectively studied the medical records of 26 patients listed for lung tranplante by pulmonary silicosis in terminal stage, in the period from January 1989 to June 2015 by the Lung Transplant group of Santa Casa de Porto Alegre - RS. Epidemiological characteristics, lung function measurements analyzed by spirometry, 6-minute walk test, carbon monoxide diffusion test, pressure measurements of the pulmonary artery, were compared between the transplant versus not transplantation groups. Categorical variables expressed as absolute numbers and/or percentage. The small sample size was not sufficient to ensure the normality, and data were analyzed using non-parametric tests of the chi-square (x2), Mann Whitnney, test and Friedman test. For paired analysis, the Wilcoxon test was used. Sample less than 5, Fisher's exact test was used. The variables analyzed related to mortality were studied by Spearman correlation. The survival rate until the outcome, established by Kaplan- Mayer curve. Values os p <0.005 assumed as statistical significance. Results: All were men, aged 45.4 + 11 years, the mineral extraction accounted for 44.0% of occupation. The restrictive pattern observed in 65.4% of cases where 82.3% of them had FVC <40.0% of predicted (FVC 27.1+ 16,0%) with DLCO 39 + 6.2%, showing significant functional limitation, marked by a very short distance in the 6MWT, 267.4 + 104.5 meters with desaturation 10.7 + 5.4%. A history of smoking was observed in 46.2% and tuberculosis in 34.6%. The overall survival of patients was found 693.5 (46 - 5,250) days, however the subgroup of transplant patients was 1.226 (60 - 5,250) against 288 days (46 - 1,333) in the non-transplanted days (p = 0.002). The survival after transplantation was 889 (3 - 5.176) days, and 85.7% were alive at the first month, 69.0% at 1st year, 44.0% at three years, and 25.0% at five. Only the ischemic time was significantly higher in patients who died (p = 0.042), however, in the multivariate analysis, it was possible to realize that the ischemic time (p = 000, rs = - 0.842), the duration of mechanical ventilation ( p = 0.045, rs = - 0.507) and the drains length of stay (p = 0.025, rs = - 0.558), had a negative impact on survival. Conclusion: Although advanced silicosis in transplant indication criteria are still unclear, we found that the most emaciated and possibly malnourished patients, and those with poor lung function, tend to die earlier without the procedure. On the other hand, those that were operated, a prolonged ischemic time, intraoperative bleeding (from the surgery to the removal of drains) seen through the permanence of thoracic drains, and the duration of mechanical ventilation, were related to death. Although this series is the largest found related to lung transplantation due end stage silicosis performed at a single center, a larger number of patients should be studied and monitored for these and other questions can be clarified.

Introdução: As doenças respiratórias ocupacionais constituem um grave problema de saúde pública na realidade brasileira. A silicose é a pneumoconiose mais prevalente, considerada a principal causa de invalidez entre as doenças respiratórias ocupacionais e pode desenvolver uma forma grave de pneumopatia fibrosante levando a insuficiência respiratória crônica onde apenas o transplante pulmonar é a terapia capaz de re-estabelecer a qualidade de vida e assim prolongar a sobrevida destes indivíduos. Objetivo: Fazer uma revisão sistemalizada da literatura sobre o tema “transplante pulmonar” e “silicose” e “sobrevida”, além de avaliar o resultado do transplante pulmonar realizado em pacientes com silicose em estágio terminal, comparando as alterações de função pulmonar entre aqueles submetidos à cirurgia com aqueles que não foram operados, além de detectar os fatores prognósticos que podem influenciar a sobrevida dos pacientes submetidos a este procedimento. Métodos: Após uma busca sistematizada na literatura sobre o tema, 40 artigos foram analisados, sendo que 13 destes descorriam sobre o tema, e cinco tratavam exclusivamente de transplante de pulmão em silicose avançada. Posteriormente, foram retrospectivamente estudados os prontuários de 26 pacientes listados para tranplante pulmonar por silicose pulmonar em estágio terminal, no período entre janeiro de 1989 até junho de 2015 pelo grupo de Transplante Pulmonar da Santa Casa de Porto Alegre – RS. As características epidemiológicas, as medidas de função pulmonar analisadas através de espirometria, teste de caminhada de 6 minutos, teste de difusão do monóxido de carbono, medidas de pressões da artéria pulmonar, foram comparadas entre os grupos transplante versus não transplante. As variáveis categóricas são apresentadas em números absolutos e/ou porcentagem. O pequeno número da amostra não foi suficiente para garantir a normalidade e os dados foram analisados através dos testes não paramétricos do qui-quadrado (x2), teste de Mann Whitnney e teste de Friedman. Para as análises pareadas, foi utilizado o teste de Wilcoxon. Para amostra menor que 5, o teste de exato de Fisher. As variáveis analisadas em relação aos eventos relacionados com mortalidade, foram estudadas através da correlação de Spearman. O sobrevida até o desfecho, estabelecida através da curva de Kaplan-Mayer. Foram assumidos valores de p < 0,005 como os de significância estatística. Resultados: Todos eram homens, com idade de 45,4 + 11 anos, sendo o extrativismo mineral responsável por 44,0% das ocupações. O padrão restritivo observado em 65,4 % dos casos onde 82,3% destes tinham CVF < 40,0% do previsto (CVF de 27,07 + 16,0%) com DLCO 39 + 6,2%, demostrando limitação funcional importante, marcada por uma distância percorrida no TC6M muito curta, 267,4 + 104,5 metros com dessaturação de 10,7 + 5,4%. A história de tabagismo foi observada em 46,2% e de tuberculose em 34,6%. A sobrevida global dos pacientes listados foi de 693,5 (46 – 5.250) dias, todavia no subgrupo dos pacientes transplantados foi de 1.226 (60 – 5.250) dias contra 288 (46 – 1.333) dias nos não transplantados (p= 0,002). A sobrevida após o transplante foi 889 (3 – 5.176) dias, sendo de 85,7% no 1o mês, 69% no 1o ano, 44,0% em três anos e 25,0% em cinco. Apenas o tempo de isquemia foi significamente maior no grupo que faleceu (p= 0,042), entretanto, na análise multivariada, pôde-se perceber que o tempo de isquemia (p= 000, Ro= - 0,842), o tempo de ventilação mecânica (p= 0,045, Ro= - 0,507) e o tempo de permanência dos drenos (p= 0,025, Ro= - 0,558), tiveram impacto negativo sobre a sobrevida. Conclusão: Embora ainda não sejam claros os critérios de indicação de transplante em silicose avançada, observamos que os pacientes mais emagrecidos e possivelmente desnutridos, assim como aqueles com pior função pulmonar, tendem a morrer mais precocemente sem o procedimento. Por outro lado, no grupo de pacientes operados, um tempo de isquemia prolongado, o sangramento transoperatório (desde o ato cirúrgico até a retirada dos drenos) visto através da permanência dos drenos de tórax e a duraçao da ventilação mecânica invasiva, estiveram relacionados com óbito. Ainda que esta série seja a maior encontrada de transplante pulmonar por silicose realizada em um único centro, um número maior de pacientes deve ser estudado e acompanhados para que estas e outras questões possam ser elucidadas. / Background: Occupational respiratory diseases are a serious public health problem in Brazil. Silicosis is the most prevalent pneumoconiosis, considered the leading cause of disability among occupational respiratory diseases. It may develop a severe form of lung fibrosis, leading to chronic respiratory failure, where only therapy that can re-establish the quality of life, and thus prolong the survival of these individuals is lung transplantation. Purpose: To evaluate the outcome of lung transplantation performed in patients with silicosis in terminal stage, comparing the changes in lung function among those undergoing surgery with those who did not undergo surgery, and detect prognostic factors that may influence the survival of patients undergoing this procedure. Methods: We performed a systematic literature review for key words “lung transplantation”, “silicosis”, “survival”, and found 40 articles, wherin 13 adressed this specific theme, and only five exclusivelly to lung transplantation due advanced (end-stage) silicosis. Then, we retrospectively studied the medical records of 26 patients listed for lung tranplante by pulmonary silicosis in terminal stage, in the period from January 1989 to June 2015 by the Lung Transplant group of Santa Casa de Porto Alegre - RS. Epidemiological characteristics, lung function measurements analyzed by spirometry, 6-minute walk test, carbon monoxide diffusion test, pressure measurements of the pulmonary artery, were compared between the transplant versus not transplantation groups. Categorical variables expressed as absolute numbers and/or percentage. The small sample size was not sufficient to ensure the normality, and data were analyzed using non-parametric tests of the chi-square (x2), Mann Whitnney, test and Friedman test. For paired analysis, the Wilcoxon test was used. Sample less than 5, Fisher's exact test was used. The variables analyzed related to mortality were studied by Spearman correlation. The survival rate until the outcome, established by Kaplan- Mayer curve. Values os p <0.005 assumed as statistical significance. Results: All were men, aged 45.4 + 11 years, the mineral extraction accounted for 44.0% of occupation. The restrictive pattern observed in 65.4% of cases where 82.3% of them had FVC <40.0% of predicted (FVC 27.1+ 16,0%) with DLCO 39 + 6.2%, showing significant functional limitation, marked by a very short distance in the 6MWT, 267.4 + 104.5 meters with desaturation 10.7 + 5.4%. A history of smoking was observed in 46.2% and tuberculosis in 34.6%. The overall survival of patients was found 693.5 (46 - 5,250) days, however the subgroup of transplant patients was 1.226 (60 - 5,250) against 288 days (46 - 1,333) in the non-transplanted days (p = 0.002). The survival after transplantation was 889 (3 - 5.176) days, and 85.7% were alive at the first month, 69.0% at 1st year, 44.0% at three years, and 25.0% at five. Only the ischemic time was significantly higher in patients who died (p = 0.042), however, in the multivariate analysis, it was possible to realize that the ischemic time (p = 000, rs = - 0.842), the duration of mechanical ventilation ( p = 0.045, rs = - 0.507) and the drains length of stay (p = 0.025, rs = - 0.558), had a negative impact on survival. Conclusion: Although advanced silicosis in transplant indication criteria are still unclear, we found that the most emaciated and possibly malnourished patients, and those with poor lung function, tend to die earlier without the procedure. On the other hand, those that were operated, a prolonged ischemic time, intraoperative bleeding (from the surgery to the removal of drains) seen through the permanence of thoracic drains, and the duration of mechanical ventilation, were related to death. Although this series is the largest found related to lung transplantation due end stage silicosis performed at a single center, a larger number of patients should be studied and monitored for these and other questions can be clarified.

Bakgrund: När ett organs förmåga att tillgodose kroppens behov avtar medför detta en påverkan på patientens dagliga liv vilket kräver kontakt med hälso- och sjukvården. Sjukdomsbilden är komplex och organsviktens behandling blir i slutändan en organtransplantation. Transplantationsprocessen är lång och utgörs av behandlingar och undersökningar som påverkar kroppen både fysiskt och psykiskt. Dock är efterfrågan på organ större än tillgången vilket medför väntan på obestämd tid för patienten. Syfte: Att beskriva patienters erfarenheter av att vänta på organtransplantation. Metod: Litteraturöversikt baserad på elva vetenskapliga artiklar med kvalitativ ansats och en artikel med kvantitativ ansats och en med mixad metod. Resultat: Ur analysen framkom tre kategorier; Livet känns ständigt osäkert, uthållig kamp, support av nära nätverk med nio underkategorier. Diskussion: Livet i väntan på organtransplantation innebär ett stort lidande och begräsningar i vardagen. Begränsningarna i vardagen skapar ett behov av stöd från patientens omgivning däribland sjuksköterskan. För att sjuksköterskan ska kunna stötta patienten under transplantation processen är det av stor vikt att förstå hur patienter upplever vardagen i väntan på organtransplantation. / Background: When an organ's ability to meet the body's needs decreases, this has an impact on the patient's daily life, which requires contact with the health service. The disease picture is complex and the treatment of organ failure eventually becomes an organ transplant. The transplant process is long and consists of treatments and screening that affect the body both physically and mentally. However, the demand of organs is bigger than the supply, which means waiting indefinitely for the patient. Aim: To describe patients' experiences of waiting for an organ transplant. Method: Literature-based study based on eleven scientific articles with a qualitative approach and one article with a quantitative approach and one with a mixed method. Results: The analysis revealed three categories; Life feels constantly insecure, enduring struggle, support from close networks with nine sub-categories. Discussion: Life while waiting for an organ transplant involves massive suffering and limitations in everyday life. The limitations of everyday life create a need of support from the patient's environment, including the nurse. In order for the nurse to be able to support the patient during the transplant process, it’s of big importance to understand how patients experience everyday life while waiting for an organ transplant.

Bakgrund: Njurtransplantation ses som den främsta behandlingsmetoden vid terminal njursvikt, då den ökar både livskvalitet och livslängd för patienten jämfört med dialys. Prevalensen av njursvikt ökar i hela världen och efterfrågan av njurar möter inte behovet. Syfte: Syftet med studien var att belysa patientens upplevelse i väntan på en njurtransplantation. Metod: Studien genomfördes som en litteraturstudie med induktiv ansats, för att bilda en uppfattning om hur forskningsläget ser ut inom valt område. Resultat: Resultatet baseras på nio kvalitativa vetenskapliga artiklar från sju olika länder, där fyra kategorier framkom, Ett liv som begränsar, Förväntningar, Glädje och sorg samt Behov och betydelse av stöd. Gemensamt för samtliga artiklar var att livet begränsades i väntan på en njurtransplantation, vilket påverkade patienterna både emotionellt och fysiologiskt. Ju längre tid som patienterna befann sig på väntelistan minskade hoppet om en ny njure, och känslan av frustration samt oro ökade. Konklusion: Litteraturstudien visar på att behovet av information från sjuksköterskan till patienter som väntade på en njurtransplantation var stort. Information skapade en känsla av delaktighet i vården som i sin tur bevarade patientens hopp, samt minskade upplevelsen av oro. / Background: Kidney transplantation is seen as the main treatment method for terminal kidney failure as it increases both quality of life and longevity of the patient compared to dialysis. The prevalence of kidney failure is increasing worldwide and the demand for kidneys is not meeting the need. Aim: The aim of the study was to highlight the patient's experience while waiting for a kidney transplant. Method: The study was conducted as a literature study with an inductive approach to form an idea of what the research situation looks like in the chosen area. Result: The result is based on nine qualitative articles from seven different countries where four categories emerged: A life that limits, Expectations, Joy and sorrow and Need and importance of support. Common to all articles was that life was limited while waiting for a kidney transplant, which affected the patients both emotionally and physiologically. The longer the patients were on the waiting list, the less hope for a new kidney diminished and the feeling of frustration and anxiety increased. Conclusion: The literature study shows that the need for information from the nurse to patients waiting for a kidney transplant was great. Information created a sense of participation in care which in turn preserved the patient's hope and reduced the experience of anxiety.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The objectives of this study were to explore patients’ experiences about long waiting time at the Vanguard Community Health Care Centre in the Western Cape and to explore possible solutions for this problem from the patients’ perspective. A qualitative research approach was applied. A sample size of (n=12) was drawn from a total population of 2829 (N=2829) using a non-random convenient sampling technique. A semi-structured interview guide was designed based on the objectives of the study and validated by experts in the field before data collection took place. Approval for the study was obtained from the Ethics Committee at the faculty of Health Sciences, Stellenbosch University and from the facility manager of health centre where the study was to be undertaken. The presentation of the results was categorised into themes and sub-themes that emerged from the data analysis. According to the findings in chapter 4 the themes that emerged were: Causes of long waiting time Areas of concern where waiting occurs most Emotions experienced when waiting long for service Possible solutions to waiting long for service The findings support the conceptual framework developed for the purpose of this study which includes the Patient’s Bill of Rights, the Principles of Batho Pele, Quality Care, Patients’ Representation and Patient satisfaction. The results of the study suggests that the conceptual framework needs to be implemented as a guideline to address the problems of long waiting time with the input from the participants’ opinions about possible solutions to be incorporated to the problem of long waiting time at the community health centre. / AFRIKAANSE OPSOMMING: Die doelwitte van die studie was om pasiente se gevoelens oor lang wagtye by Vanguard Gemeenskapsgesondheidsentrum in die Wes-Kaap te ondersoek en om moontlike oplossings vir hierdie probleem vanaf die pasient se perspektief te bepaal ‘n Kwalitatiewe navorsingsbenadering is gebruik. ‘n Steekproefgrootte van (n=12) is verkry vanaf ‘n totale bevolking van 2829 (N= 2829) deur die gebruik van ‘n nie-ewekansige gerieflike steekproefneming tegniek. ‘n Semi-gestruktureerde onderhoudgids is ontwerp gebaseer op die doelwitte van die studie. Die onderhoudgids is geldig bevind deur spesialiste in die gebied voor data insameling plaasgevind het. Goedkeuring vir die studie is verkry van die Etiese Komitee by die Fakulteit Gesondheidswetenskappe, Stellenbosch Universiteit en van die bestuurder van die gesondheidsentrum waar die studie uitgevoer sou word. Resultate is rangskik in temas en subtemas wat afgelei is van die data analise. Die volgende temas is bepaal vanuit Hoofstuk 4 se bevindinge: Redes vir lang wagtye Areas waar lang wagtye voorkom Emosies ondervind wanneer lank gewag moet word vir diens Moontlike oplossings vir lang wagtye Die bevindinge ondersteun die konseptuele raamwerk ontwikkel vir die doel van die studie wat die Handves van Regte vir pasiente, die beginsels van Batho Pele, Kwaliteitsorg, Pasient verteenwoordiging en Pasienttevredenheid insluit. Die bevindinge van die studie dui aan dat die konseptuele raamwerk geimplementeer moet word as riglyn om die probleme wat ervaar word met lang wagtye aan te spreek. Die deelnemers se menings oor moontlike oplossings moet deel moet wees van die aanspreek van die probleem van lang wagtye in die gemeenskapsgesondheidsentrum.

ABSTRACT The purpose of the study is to evaluate the housing process of Witzenberg Local Municipality and determine the involvement of the community and their perception regarding the whole process. The researcher is using a qualitative method to obtain the views, perspectives and feelings of the participants. For the purpose of the study is data collection limited to the sample population of people on the waiting list and those already in possession of low-cost house of the seven townships in the Witzenberg Local Municipality to. The researcher made use of questionnaires and interviews to collect data to make a profound finding and recommendation. In Witzenberg, 41% of households earn less than R30000 per annum (Witzenberg Local Municipality 2012: Online) which indicate that the Witzenberg Local Municipality has a high need for subsidized housing. The waiting list for low-cost housing in the Witzenberg Local Municipality currently stands at 6278 of which 1478 are a blocked housing project and a backlog of 4800 houses. The inhabitants of the Municipality received low-cost housing 8 years ago (Witzenberg Local Municipality 2012: Online). Witzenberg Local Municipality does has a housing problem, which stems from finance, affordability, insufficient land to erect housing projects, overcrowding, and quality of housing, staff shortage, unemployment, uncontrolled farm evictions and community involvement (Witzenberg Local Municipality 2007a:Online). Low-cost housing is in demand to address the challenges. Farm evictions, influx into the Witzenberg Local Municipality and forming of informal dwellings and increasing of squatter camps hold a serious threat to build sustainable, quality low-cost housing in the Witzenberg Local Municipality and with limit staff is in-flux control very hard to manage. Although the homeowners of the Witzenberg Local Municipality are happy to have received houses, they expressed much concern about the poor construction work, overall quality of the materials used as well as the housing process adopted by the Witzenberg Local Municipality. / Public Administration / M. Admin.

Das zunehmende Durschnittsalter unserer Gesellschaft und der Mangel an Spenderorganen stellen bedeutende Herausforderungen für die Organtransplantation dar. Organe, die früher als "marginal" galten, werden heute routinemässig transplantiert. Gleichzeitig mit der Zunahme älterer Patienten auf der Warteliste steigt das Interesse an der Entwicklung von speziellen Allokations-Strategien. Basierend auf dem Konzept der Abstimmung des metabolischen Bedarfs des älteren Empfängers und der Kapazität der älteren Spenderniere entwickelte Eurotransplant daher das Eurotransplant Senior Program (ESP), welches im Januar 1999 gestartet wurde. Im Rahmen dieses Programms werden Nieren von über 65 Jahre alten Spendern lokal auf eine selektierte Gruppe über 65 Jahre alter, nicht immunisierter Empfänger übertragen. Das Ziel dieser 5-Jahres Analyse war es herauszufinden, ob das ESP erfolgreich seine Ziele erreicht hat, Organe von älteren Spendern optimal zu nutzen und die Zeit auf der Warteliste für ältere Empfänger zu verkürzen. Als Basis dienten Daten des Eurotransplant Information Systems (ENIS). Zusätzliche Informationen wurden für die ESP Patienten und zwei Kontrollgruppen mit entweder annähernd vergleichbarem Alter des Spenders (Kontrolle 1) oder des Empfängers (Kontrolle 2) erfasst. Insgesamt zeigt diese Auswertung, dass die Ziele des ESP erreicht wurden. Die Verfügbarkeit von älteren Spenderorganen wurde von 162 (10%) im Jahre 1998 auf 239 (fast 15%) im Jahre 2004 gesteigert. Die Wartezeit für ältere Empfänger verkürzte sich signifikant im Vergleich zu vor der Einführung des ESP und weiter im Verlauf der ersten 5 Jahre auf deutlich unter 4 Jahre, während sich die Wartezeit für Patienten in den Kontrollen die über ETKAS transplantiert wurden um bis zu einem Jahr verlängerte. Die kalte Ischämiezeit für ESP Patienten war signifikant kürzer mit etwa 12 im Vergleich zu ca. 17 Stunden für beide Kontrollen.Das Patienten- und Transplantatüberleben der Empfänger von Organen von über 65-jähriger Spendern wurde durch die ESP-Allokation, trotz 5-10% höherer Abstossungraten, nich negativ beeinflusst. Die Analyse der unabhängigen Risikofaktoren für akute Abstoßungsreaktionen weist darauf hin, dass ein verbessertes HLA matching unter Beibehaltung kurzer Ischämiezeiten möglicherweise von Vorteil wäre. / The aging society and the shortage of organs impose significant challenges to organ transplantation. As a result, organs previously considered marginal are now routinely used. At the same time, an increase in the number of elderly patients on renal transplant waiting lists has heightened interest in the development of special allocation strategies for these patients. As a result, Eurotransplant started the Eurotransplant Senior Program (ESP) in January 1999, an allocation scheme based on the concept of matching the metabolic demand of the recipient and the excretory capacity of the donor. The program obtaines kidneys from donors over 65 years and locally allocates them to a selected group of non-immunized patients in the same age group. The main objective of this evaluation was to find out if the allocation scheme is effective in using kidneys from elderly donors and if it shortens the waiting time for elderly patients. The Eurotransplant database was used as a starting point, and data added to the database by collecting additional information on the ESP patients, and on two control groups. The controls were observed over the same time period as the ESP patients, and matched them for either donor age (Control 1) or recipient age (Control 2). Overall, this 5-year analysis of the ESP shows that the objectives of the program have been met. The availability of elderly donors increased from 169 (10%) in 1998 to 239 (almost 15%) in 2004. The waiting time for elderly recipients transplanted within the ESP was successfully reduced compared to the waiting time before introduction of ESP and is now below 4 years, while waiting time in both control groups has increased by up to one year. The cold ischemia time for ESP patients was significantly shorter, with a mean of approximately 12 hours compared with over 17 hours in both control groups. Graft and patient survival in recipients of organs from donors age over 65 were not negatively impacted by the ESP allocation despite 5-10% higher acute rejection rates.Based on an analysis of independent risk factors the use of HLA matching instead of waiting time should be considered as an allocation criterion while maintaining a short cold ischemia time.

Submitted by Mariana Granado Barbosa (mgranadobarbosa@gmail.com) on 2018-06-15T03:38:39Z No. of bitstreams: 1 TA MarianaGB v.final 12062018.pdf: 802684 bytes, checksum: 999853e56c5ed01ebb9085705e158cdd (MD5) / Approved for entry into archive by Simone de Andrade Lopes Pires (simone.lopes@fgv.br) on 2018-06-15T16:58:24Z (GMT) No. of bitstreams: 1 TA MarianaGB v.final 12062018.pdf: 802684 bytes, checksum: 999853e56c5ed01ebb9085705e158cdd (MD5) / Approved for entry into archive by Isabele Garcia (isabele.garcia@fgv.br) on 2018-06-15T20:24:22Z (GMT) No. of bitstreams: 1 TA MarianaGB v.final 12062018.pdf: 802684 bytes, checksum: 999853e56c5ed01ebb9085705e158cdd (MD5) / Made available in DSpace on 2018-06-15T20:24:22Z (GMT). No. of bitstreams: 1 TA MarianaGB v.final 12062018.pdf: 802684 bytes, checksum: 999853e56c5ed01ebb9085705e158cdd (MD5) Previous issue date: 2018 / Filas de espera constituem um problema crônico nos países que optaram por sistemas universais. Entretanto, no Brasil há poucos estudos sobre filas de espera nos serviços de saúde. Este é um estudo de caso que pretende contribuir acrescentando métrica nessa discussão e fundamentando-a em torno da viabilidade econômico-financeira das decisões em saúde e da regulação, de modo mais amplo. Partindo do contexto de um hospital municipal da zona sul da cidade de São Paulo, analisamos dois cenários diferentes, a demanda proveniente da atenção básica para consulta com especialista, que nem sempre termina na indicação de cirurgia, e as filas de espera internas ao hospital para cirurgia ginecológica, de pacientes já avaliadas e com cirurgia indicada, aguardando seu agendamento. Da análise desses dados, traçamos um novo modelo de gerenciamento da fila de espera para cirurgia ginecológica eletiva nesse hospital. Nossa proposta não tem o objetivo de atingir espera zero. Tampouco é fundamentada em estratégia única. Nossa principal conclusão é que a estratégia mais eficiente para o gerenciamento das filas de espera envolve o fortalecimento das ações de integração com a rede de atenção. No Sistema Único de Saúde, o olhar de linha de cuidado, pode viabilizar efetivamente a entrega de maior valor na assistência prestada e pode ser feita através de iniciativas locais. / Waiting lists are a chronic problem in countries that opted for universal health systems. However, there are few studies on waiting lists in health services in Brazil. This case study aims to contribute by adding metrics to this discussion and grounding it around the economic-financial viability of health care decisions and access regulation in a broader way. Starting from the context of a municipal hospital in the south of the city of São Paulo, we analyzed two different scenarios: the demand for primary care for consultation with a specialist, which does not always end with the recommendation of surgery, and inpatient waiting lists, which have patients that were already evaluated and are waiting for the surgery. From this data analysis, we draw a new management model of gynaecologic elective surgery waiting list in this hospital. Our proposal does not aim to achieve zero wait, nor is it based on a single strategy. Our main conclusion is that the most efficient strategy for the waiting lists management involves the strengthening of health care networks’ integration actions. In the Unified Health System it can effectively enable the delivery of greater value in the assistance provided and can be done through local initiatives.