"The purpose of this study is to analyze data collected from the records of those persons on the waiting list of the Family Consultation Service, Jacksonville, Florida, to ascertain if they reveal a pattern of association of certain social characteristics. Variables to be studied include: Presenting problem, age differences in marital partners, length of marriages, number of children, referral source, and person making application. The recent literature with regard to waiting lists has been reviewed and the findings incorporated in this study. The need for reexamining agency policies and procedures regarding applicants on the waiting list is recognized. It is believed that this study will provide a basis for such an evaluation"--Introduction. / Typescript. / "June, 1959." / "Submitted to the Graduate Council of Florida State University in partial fulfillment of the requirements for the degree of Master of Social Work." / Advisor: David L. Levine, Professor Directing Study. / Includes bibliographical references.

A Interconsulta Psiquiátrica é considerada uma área da Psiquiatria, que trabalha no Hospital Geral compondo uma equipe (Psiquiatria de Ligação) ou prestando seus serviços a uma equipe solicitante (Consultoria Psiquiátrica). O Serviço de Interconsulta em Psiquiatria (SIP) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP-USP) teve início em março de 1978 e a Terapia Ocupacional passou a integrar esta equipe em 1999. O cotidiano hospitalar tem uma marca própria com obrigações como usar vestimentas, ter horários previamente estabelecidos para se alimentar, para cuidar de sua higiene e para receber visitas, inclusive dos familiares. Os terapeutas ocupacionais, como profissionais que lidam com o cotidiano do indivíduo, têm sido inseridos nas equipes multiprofissionais do Hospital Geral, contribuindo com seus conhecimentos teóricos e técnicos específicos para cuidar de pessoas hospitalizadas. Apesar das várias funções que a Terapia Ocupacional (TO) pode exercer no Serviço de Interconsulta, existe escassez de estudos publicados sobre o perfil sócio-demográfico dos pacientes atendidos, o que prejudica o planejamento de ações e o levantamento da necessidade de recursos humanos para aquele Serviço. O objetivo deste trabalho foi realizar um estudo retrospectivo dos Pedidos de Interconsulta (PIs) para a TO do Serviço de Interconsulta em Saúde Mental (SISMen) do HCFMRP - USP no período de janeiro de 2000 a dezembro de 2005. Os sujeitos foram os indivíduos que estiveram internados nas enfermarias do campus do hospital universitário e para quem foi solicitada a assistência do Serviço de TO naquele período, perfazendo um total de 633 pacientes e 709 PIs. Os dados foram coletados mediante consulta dos PIs e dos prontuários dos pacientes. A maioria dos sujeitos consultados foi do sexo feminino, com ensino fundamental incompleto e houve distribuição equilibrada entre os solteiros e casados. Quanto à idade e à situação laboral, a média de idade dos pacientes foi de 39,2 anos e a maioria deles era autônoma ou aposentada, seguida de dona de casa. Verificou-se que a Clínica Médica foi a responsável por mais do que um terço dos Pedidos de Interconsulta feitos para o Serviço de TO, seguida das clínicas Unidade Metabólica e Psiquiatria respectivamente; o tempo médio de internação dos pacientes encaminhados para esse Serviço foi de 51 dias, sendo que a média de internação no HCFMRP-USP foi de 6,4 dias. Consequentemente, o gasto desses pacientes variou entre uma e 2,4 vezes mais do que os pacientes internados nesta instituição. A taxa média de encaminhamento para a TO do SISMen foi de 0,5%, sendo que o motivo de solicitação mais freqüente esteve relacionado aos aspectos emocionais do indivíduo, seguido por fatores referentes à hospitalização. Estes dados, de modo geral, estão de acordo com a literatura nacional e internacional dos SIPs. Concluiu-se que há necessidade de um instrumento padronizado para avaliar a população atendida pelo Serviço de Interconsulta de TO e que alguns pontos merecem estudos mais detalhados como a possibilidade de existência de associações entre dados sócio-demográficos e clínicos e o encaminhamento dos pacientes para esse Serviço. / Consultation Liaison Psychiatric is considered to be an area of Psychiatry which is part of a General Hospital, involving a team (Liaison Psychiatry) or providing services to a team that requests them (Psychiatric Consultation). The Consultation Liaison Psychiatric Service (CLPS) of the University Hospital, Faculty of Medicine of Ribeirão Preto (HCFMRPUSP) was started in March 1978 and Occupational Therapy became part of this team in 1999. The daily hospital routine has specific rules such as wearing specific clothing and taking meals, caring for ones hygiene and receiving visits, including those of relatives, at pre-established times. Occupational therapists, as professionals who deal with the daily routine of an individual, have been inserted into the multiprofessional teams of the General Hospital, contributing their specific theoretical and technical knowledge to the care of hospitalized persons. Despite the various functions Occupational Therapy (OT) can perform in the CLPS, there is a scarcity of published studies on the sociodemographic profile of attended patients, impairing the planning of actions and the determination of the human resources needed for that Service. The objective of the present investigation was to conduct a retrospective study of the Requests of Consultation Liaison (RCLs) sent to the OT of the Service of The Consultation Liaison in Mental Health (SCLMH) of HCFMRP-USP during the period from January 2000 to December 2005. The subjects involved were the individuals who had been admitted to the wards of the University Hospital and for whom the assistance of the OT Service had been requested during that period, for a total of 633 patients and 709 RCLs. The data were collected from the RCLs and the medical records of the patients. Most of the subjects involved were women with incomplete elementary schooling, with a balanced distribution of single and married subjects. Mean patient age was 39.2 years and most patients were self-employed or retired, followed by the housewife category. Internal Medicine was responsible for more than one third of the RCLs sent to the OT Service, followed by the Metabolic Unit and Psychiatric clinics. The mean time of hospitalization of the patients referred to this Service was 51 days, with the mean duration of hospitalization at HCFMRPUSP being 6.4 days. Consequently, the expenses with these patients ranged from one to 2.4 times more than those for the patients hospitalized in this institution. The mean rate of referral to the OT of the SCLMH was 0.5%, with the most frequent reason for the request being related to the emotional aspects of the individual, followed by factors related to hospitalization. These data, in general, agree with the Brazilian and international literature about the CLPS. We conclude that there is the need for a standardized instrument for the evaluation of the population attended at the Consultation Liaison Service of OT and that some points need more detailed studies regarding the possibility of the existence of an association between sociodemographic and clinical data and the referral of these patients to the OT Service.

Pesquisas demonstraram que a teleconsulta síncrona com vídeo interativo e compartilhamento remoto de aplicativos pode ser utilizada com sucesso na programação e verificação de aparelhos de amplificação sonora individuais (AASIs). Entretanto, esta consulta, mediada via tecnologia de informação e comunicação, pode dificultar a efetiva comunicação profissional/paciente, com consequente impacto negativo na compreensão e retenção da informação, adesão e bem-estar psicológico do paciente durante o tratamento. Este estudo comparou a comunicação nas consultas para adaptação do AASI realizadas face a face e a distância. Participaram do estudo 60 deficientes auditivos, com idades entre 50 e 89 anos (média=69), candidatos ao uso do AASI, divididos em dois grupos conforme a modalidade de atendimento: face a face (n=30) e teleconsulta (n=30). Estes participantes foram atendidos por cinco fonoaudiólogas com experiência na adaptação do AASI e, nas teleconsultas, por mais quatro facilitadores. O software TeamViewer 10© foi utilizado para a transmissão de áudio e vídeo e compartilhamento de dados (conexão via LAN USP, velocidade de 384 Kbps), entre o computador localizado no ambiente de teste, onde estavam o paciente e facilitador, e o ambiente remoto, onde estava a fonoaudióloga. Assim, a fonoaudióloga conduziu os procedimentos de programaçã e verificação do AASI à distância, com auxílio do facilitador. Todas as consultas foram gravadas em formato de vídeo. Dois avaliadores independentes analisaram os vídeos e atribuíram uma pontuação de 0 a 24 pontos para a comunicação ocorrida nas consultas, de acordo com a Escala Global de Pontuação de Consultas (Global Consultation Rating Scale GCRS). Pontuações maiores indicam resultados mais favoráveis. Em média, a duração das teleconsultas foi 10 minutos maior que a das consultas presenciais. Problemas técnicos ocorreram em 27% das teleconsultas, sendo necessário interrompê-las e reiniciá-las. A pontuação média da GCRS foi de 15,3 (presencial) e 12,6 (teleconsulta), sendo esta diferença significativa. Pontuações máximas ou próximas ao máximo não foram encontradas em nenhum dos casos. Para complementar os resultados, foi realizada análise qualitativa de 10 gravações das consultas, face a face (n=5) e a distância (n=5). A análise de conteúdo temático-categorial foi realizada utilizando o software NVivo 10. Nas duas modalidades de consulta, a análise da frequência de ocorrência das categorias indicou predominância da fala do profissional e, quando presente, do facilitador. O teor desta comunicação foi de caráter biomédico, sobressaindo o fornecimento de explicações sobre o uso e manuseio do AASI. A ocorrência de back channels, que podem indicar uma postura de escuta, foi mais frequente para os pacientes e acompanhantes. Concluiu-se que a comunicação nas consultas para adaptação do AASI não foi centrada no paciente, conforme atualmente preconizado. Além disto, esta comunicação sofreu a influência do uso das tecnologias de informação e comunicação. Sendo assim, é reforçada a recomendação da literatura quanto à necessidade de treinamento dos fonoaudiólogos para o uso de habilidades de comunicação efetivas, assim como de estratégias para contornar potenciais obstáculos advindos da interação via teleconsulta. / Researches have shown that the synchronous teleconsultation with interactive video and remote application sharing can be used successfully in programming and verification of hearing aids (HAs). However, this consultation, mediated via information and communication technology and communication, may difficult the effective communication professional/patient, with consequent negative impact on patients comprehension and retention of information, adherence and psychological welfare of the patient during the treatment. This study compared the communication in HA fitting consultations performed face-to-face and at distance. Participated in this study 60 hearing impaired, aged between 50 and 89 years (average=69), candidates to the HA use, divided into two groups according to the attendance modality: face to face (n=30) and teleconsultation (n=30). These participants were attended by five audiologists with expertise in hearing aid fitting and, in the teleconsultations, for another four facilitators. The TeamViewer software 10© was used to transmit audio and video and data sharing (connection via LAN USP, 384 Kbps speed), amongst the computer located in the test environment, where were the patient and the facilitator, and the remote environment, where was the audiologist. Thus, the audiologists conducted the programming procedures and examination of the hearing aid at the distance, with the facilitators assistance. All consultations were recorded in video format. Two independent examiners evaluated the videos and assigned a score of 0 to 24 points for communication occurred in the consultations, according to the Global Consultation Rating Scale GCRS. Higher scores indicate better results. On average, the duration of the teleconsultation was 10 minutes longer than the face to face consultations. Technical problems occurred in 27% of teleconsultation, being necessary to interrupt and restart them. The average score of the GCRS was 15.3 (in-person) and 12.6 (teleconsultation), and this is a significant difference. High scores or close to the maximum were not found in any of the cases. To complement the results, was performed qualitative analysis of 10 recordings of the consultations, face to face (n=5) and teleconsultation (n=5). The thematic categorical content analysis was performed using the NVivo software 10. In the two modalities of consultation, the categories\' occurrences frequency\'s analysis indicated a predominance of the professional speech and, when presence, of the facilitator. The contente of this communication was biomedical, protruding the providing explanations about the using and the HA handling. The occurrence of back channels, which can indicate a listening posture, was more common for patients and their companions. It was concluded that the communication in HA fitting consultations was not patient centered, as currently recommended. Furthermore, this communication has suffered the influence of the use of information and communication technologies. Thus, is strengthened the recommendation of literature regarding the need for training of audiologists to use effective communication abilities, as well as strategies to avoid potential obstacles arising from the interaction via teleconsultation.

As medidas com microfone sonda constituem o método preferencial para a verificação do Aparelho de Amplificação Sonora Individual in situ. No Brasil apenas uma pequena parcela dos fonoaudiólogos que atuam em serviços públicos realiza esse procedimento devido, principalmente, à fragilidade de treinamento profissional. O treinamento profissional continuado, aliado a um processo de preceptorado, tem potencial para modificar esta realidade. O uso da teleconsulta como forma de preceptorado clínico vem sendo sugerido na literatura e pode representar uma oportunidade importante de integração entre ensino e serviço. O objetivo do estudo foi avaliar a eficácia de um treinamento online e da teleconsulta síncrona para preceptorado clínico na realização de procedimentos de verificação do aparelho de amplificação sonora individual in situ. Participaram do estudo 50 fonoaudiólogos que atuavam no processo de seleção e verificação do AASI nos serviços públicos de Reabilitação Auditiva sendo divididos de maneira aleatória em grupos controle (n=25) e experimental (n=25). Todos os participantes tiveram acesso a um material educacional online (plataforma Moodle) sobre as medidas com microfone e sonda. No decorrer do curso realizaram procedimentos de avaliação formativa e somativa. Posteriormente, o grupo experimental participou de teleconsultas síncronas. A inabilidade para interpretação de resultados, manuseio dos equipamentos e fragilidade do treinamento profissional foram fatores que interferiram na adoção ou dificultaram o uso das MMS na prática clínica, anteriormente ao treinamento. Não foram observadas diferenças estaticamente significativas (teste U de Mann-Whitney) entre os grupos no acesso aos conteúdos do curso, nas reações ao desempenho do instrutor, a interface gráfica e ao treinamento e no benefício do treinamento online. Ocorreu diferença significativa (teste de Friedman) para análise dos acessos intragrupo. Houve correlação (Spearman) significativa e positiva entre os resultados de reação e o instrutor e com a interface gráfica. A teleconsulta foi mais utilizada com o propósito de equiparar as respostas obtidas com AASI ao target de prescrição e, ao longo do tempo, a frequência de solicitação de teleconsultas para o grupo experimental foi sendo reduzida. Concluiu-se de um modo geral que o treinamento online foi bem avaliado em todos os quesitos pelos participantes, assim como as teleconsultas e que houve benefício do treinamento nas habilidades dos participantes em interpretar os resultados das medidas com microfone sonda e tomar condutas clinicas compatíveis. Ambos os grupos apresentaram melhora para resoluções de casos clínicos após o treinamento realizado. Combinar a teleconsulta ao treinamento online não impactou estes resultados do benefício. / The microphone probe measurements are the preferred method for the verification of individual sound amplification device in situ. In Brazil only a small portion of the audiologists who work in public services does so mainly due to the fragility of professional training. Continued professional training, coupled with a preceptorship process, has the potential to change this reality. The use of teleconsultation as a form of clinical preceptorship has been suggested in the literature and may represent an important opportunity for integration between teaching and service. The objective of the study was to evaluate the effectiveness of an online training and synchronous teleconsultation for clinical preceptorship in procedures for verification of individual hearing aid in situ. The study included 50 audiologists who worked in the selection and verification of hearing aids in public service of Auditory Rehabilitation, divided randomly into control group (n=25) and experimental group (n=25). All participants had access to an online educational material (Moodle platform) on measures with microphone and probe. During the course they conducted formative and summative assessment procedures. Subsequently, the experimental group participated in synchronous teleconsultation. The inability to interpretation of results, handling equipment and fragility of professional training were factors that interfered in the adoption or hindered the use of MMS in clinical practice, prior to the training. Statically significant differences weren\'t observed (Mann-Whitney U test) between groups in access to course content, in response to instructor performance, the graphics and the training and efficiency of online training interface. Significant differences (Friedman test) occured for analysis of intra-group access. There was a significant and positive correlation (Spearman) between results of the reaction and the instructor and with the graphical interface. The teleconsultation was more used in order to match the responses obtained with HA to target prescription and over time, the frequency of teleconsultation request to the experimental group was reduced. It was concluded, in general, that online training was well rated in all aspects by the participants, as well as telconsultas and that the training was beneficial on the skills of the participants in interpreting the microphone probe measurements and take compatible clinical behavior. Both groups showed improvement in clinical cases resolutions after the training conducted. Combining teleconsultation with the online training did not affect these results the benefit.

by Chong Yu Hoi. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 166-172). / Chapter 1. --- Introduction --- p.1 / Chapter 2. --- Background --- p.5 / Chapter 2.1. --- Evolution of Primary Health Care in Last TwoDecades 226}0ؤ An Overview --- p.5 / Chapter 2.2. --- Role of Primary Health Care --- p.11 / Chapter 2.3. --- Significance of Referral Between Primary and Secondary Health Care --- p.12 / Chapter 2.4. --- Attributes of Referral --- p.14 / Chapter 2.4.1. --- Referral Rate --- p.14 / Chapter 2.4.2. --- Referral Pattern --- p.19 / Chapter 2.4.3. --- Reason of Referral --- p.20 / Chapter 2.4.4. --- Appropriateness of Referral --- p.24 / Chapter 2.4.5. --- Referral Letter --- p.30 / Chapter 3. --- Situation in Hong Kong --- p.34 / Chapter 3.1. --- Health of the Society --- p.34 / Chapter 3.2. --- History of GOPC Service in Hong Kong --- p.35 / Chapter 3.3. --- Present Situation of GOPC Services --- p.37 / Chapter 3.4. --- Previous Surveys on Private Practice in Hong Kong --- p.38 / Chapter 3.5. --- Previous Surveys on GOPC Services in Hong Kong --- p.39 / Chapter 3.6. --- A Review of Data from 12 GOPCs --- p.44 / Chapter 4. --- The Study: Objectives and Method --- p.48 / Chapter 4.1. --- Objectives --- p.48 / Chapter 4.2. --- Materials & Method - The Framework of the Study --- p.51 / Chapter 4.3. --- Phase One --- p.52 / Chapter 4.3.1. --- Study Population --- p.53 / Chapter 4.3.2. --- Sampling Method --- p.53 / Chapter 4.3.3. --- Survey Method --- p.53 / Chapter 4.3.4. --- Data Analysis --- p.54 / Chapter 4.4. --- Phase Two --- p.55 / Chapter 4.4.1. --- Study population --- p.56 / Chapter 4.4.2. --- Sampling Method --- p.57 / Chapter 4.4.3. --- Survey Method --- p.57 / Chapter 4.4.4. --- Data Analysis --- p.58 / Chapter 4.5. --- Phase Three --- p.59 / Chapter 4.5.1. --- Study Population --- p.59 / Chapter 4.5.2. --- Sampling Method --- p.60 / Chapter 4.5.3. --- Survey Method --- p.60 / Chapter 4.5.4. --- Data Analysis --- p.60 / Chapter 5. --- Study Result: Phase One --- p.62 / Chapter 5.1. --- The Response Rate --- p.62 / Chapter 5.2. --- Profile of Patients --- p.63 / Chapter 5.3. --- Referral Rate --- p.64 / Chapter 5.3.1. --- The Spectrum In Hong Kong --- p.64 / Chapter 5.3.2. --- Relationship with Individual GOPC --- p.65 / Chapter 5.3.3. --- Relationship with Practice Size --- p.66 / Chapter 5.3.4. --- Relationship with the Day of the Week --- p.67 / Chapter 5.3.5. --- Relationship with Workload of the Day --- p.69 / Chapter 5.3.6. --- Relationship with Workload of Doctor --- p.70 / Chapter 5.3.7. --- Relationship with Basic Medical Training --- p.72 / Chapter 5.3.8. --- Relationship with Year of Experience --- p.73 / Chapter 5.3.9. --- Relationship with Higher Qualification --- p.73 / Chapter 5.4. --- Referral Pattern --- p.74 / Chapter 5.5. --- Reason of Referral --- p.75 / Chapter 5.6. --- Prescription Rate --- p.77 / Chapter 5.7. --- Investigation Rate --- p.78 / Chapter 5.8. --- Duration of Disease before Referral --- p.78 / Chapter 5.9. --- Number of GOPC consultation before Referral --- p.79 / Chapter 6. --- Study Result: Phase Two --- p.82 / Chapter 6.1. --- Response Rate --- p.82 / Chapter 6.2. --- Background of the Referral --- p.83 / Chapter 6.2.1. --- GOPCs of Referral --- p.83 / Chapter 6.2.2. --- Waiting Time for SOPC Appointment --- p.85 / Chapter 6.2.3. --- The patients --- p.86 / Chapter 6.3. --- Present Complaint --- p.87 / Chapter 6.3.1. --- Duration of Disease before Referral --- p.87 / Chapter 6.3.2. --- Number of GOPC Consultation before Referral --- p.89 / Chapter 6.4. --- Assessment of Referral --- p.90 / Chapter 6.4.1. --- Management of Referring Doctor --- p.90 / Chapter 6.5. --- Referrals with Inappropriate Necessity --- p.91 / Chapter 6.5.1. --- The Patients --- p.91 / Chapter 6.5.2. --- Referring GOPCs --- p.93 / Chapter 6.5.3. --- The Specialties --- p.94 / Chapter 6.5.4. --- "Diagnosis, Investigation & Treatment" --- p.95 / Chapter 6.5.5. --- Timing of Referral --- p.97 / Chapter 6.5.6. --- Duration of Present Attack --- p.97 / Chapter 6.5.7. --- Outcome of Referral --- p.97 / Chapter 6.6. --- Referrals with Inappropriate Timing --- p.98 / Chapter 6.6.1. --- The Patients --- p.98 / Chapter 6.6.2. --- The Referring GOPCs --- p.98 / Chapter 6.6.3. --- The Specialties --- p.100 / Chapter 6.6.4. --- Necessity of Referral --- p.101 / Chapter 6.6.5. --- Number of GOPC Visit before Referral --- p.101 / Chapter 6.6.6. --- Number of GOPC Visit with Specialty --- p.102 / Chapter 6.6.7. --- Duration of Disease --- p.103 / Chapter 6.6.8. --- Duration of Disease with Specialty --- p.104 / Chapter 6.6.9. --- "The Diagnosis, Number of GOPC Visit and Duration of Illness" --- p.105 / Chapter 6.6.10. --- Investigation & Treatment Prescribed --- p.107 / Chapter 6.6.11. --- Prognosis of the Referred Cases --- p.109 / Chapter 6.7. --- Referrals with Inappropriate Investigation --- p.110 / Chapter 6.7.1. --- The Patients --- p.110 / Chapter 6.7.2. --- The Referring GOPCs --- p.110 / Chapter 6.7.3. --- The Specialties --- p.112 / Chapter 6.7.4. --- The Diagnosis & Investigation --- p.113 / Chapter 6.7.5. --- Prognosis of Referral --- p.115 / Chapter 6.8. --- Referrals with Inappropriate Treatment --- p.115 / Chapter 6.8.1. --- The Patients --- p.115 / Chapter 6.8.2. --- Referring GOPC --- p.115 / Chapter 6.8.3. --- The Specialties --- p.117 / Chapter 6.8.4. --- The Diagnosis & Treatment --- p.118 / Chapter 6.8.5. --- Prognosis of the Referred Cases --- p.119 / Chapter 6.9. --- Assessment of the Referral Letter --- p.120 / Chapter 7. --- Study Result: Phase Three --- p.122 / Chapter 7.1. --- The Response Rate --- p.122 / Chapter 7.1.1. --- The GOPC Doctors --- p.122 / Chapter 7.1.2. --- The Specialists --- p.123 / Chapter 7.2. --- Profile of GOPC Doctors --- p.123 / Chapter 7.2.1. --- Years of Clinical Practice --- p.123 / Chapter 7.2.2. --- Qualification Obtained --- p.124 / Chapter 7.3. --- Profile of Specialists --- p.125 / Chapter 7.3.1. --- Years of Clinical Practice --- p.125 / Chapter 7.3.2. --- Qualification Obtained --- p.126 / Chapter 7.4. --- Workload of the Participating Doctors --- p.126 / Chapter 7.4.1. --- Number of outpatient Seen by GOPC Doctors --- p.126 / Chapter 7.4.2. --- Number of outpatient Seen by Specialists --- p.126 / Chapter 7.5. --- Referrals from GOPCs to Specialist Clinics --- p.127 / Chapter 7.5.1. --- Percentage of GOPC Cases Referred to Specialist Clinics --- p.127 / Chapter 7.5.2. --- Percentage of Specialist Cases Referred from GOPCs --- p.127 / Chapter 7.6. --- Communication between GOPC and Specialist Clinic --- p.128 / Chapter 7.6.1. --- Opinion of GOPC Doctors on Referral Letters --- p.128 / Chapter 7.6.2. --- Opinion of GOPC Doctors on Feedback from Specialists --- p.130 / Chapter 7.6.3. --- Opinion of Specialist on Referral Letters --- p.131 / Chapter 7.6.4. --- Opinion of Specialists on Their Feedback --- p.135 / Chapter 7.7. --- The Form of Feedback from Specialists --- p.136 / Chapter 7.8. --- Suggestions on Improving the Communication --- p.137 / Chapter 7.9. --- In Service Training for GOPC Doctors --- p.138 / Chapter 8 --- _ Discussion and Recommendation --- p.141 / Chapter 8.1. --- Limitations and Comments --- p.141 / Chapter 8.1.1. --- Representativeness of The Sample --- p.141 / Chapter 8.1.2. --- Response Rate --- p.141 / Chapter 8.1.3. --- Size of The Sample --- p.142 / Chapter 8.1.4. --- Short Duration of the Study --- p.142 / Chapter 8.1.5. --- Discontinuity of Phase One and Phase Two --- p.143 / Chapter 8.2. --- Discussion --- p.144 / Chapter 8.2.1. --- Referral Rate in Hong Kong --- p.145 / Chapter 8.2.2. --- Referral Pattern and Reason of Referral --- p.147 / Chapter 8.2.3. --- Appropriateness of Referrals --- p.149 / Chapter 8.2.4. --- Communication between GOPCs & SOPCs --- p.149 / Chapter 8.2.5. --- In Service Training for GOPC Doctors --- p.150 / Chapter 8.2.6. --- Waiting Time for SOPCs Appointment --- p.151 / Chapter 8.2.7. --- Prescription Rate --- p.152 / Chapter 8.2.8. --- Common Investigations Requested by Specialists --- p.153 / Chapter 8.2.9. --- Factors Associated with Referral Rates --- p.155 / Chapter 8.2.10. --- Factors Associated with Appropriateness of Referrals --- p.157 / Chapter 8.2.11. --- Factors Associated with Timing of Referrals --- p.158 / Chapter 8.3. --- Recommendation --- p.161 / Chapter 8.3.1. --- Further Study in Private Sector --- p.161 / Chapter 8.3.2. --- Further Study in Other Regions --- p.161 / Chapter 8.3.3. --- Further Study on the Appropriateness of those Non-referrals --- p.161 / Chapter 8.3.4. --- Improve Record in Specialist Clinics --- p.162 / Chapter 8.3.5. --- Upgrade of GOPC Drug Formulary --- p.162 / Chapter 8.3.6. --- Standard Referral & Feedback Form --- p.163 / Chapter 8.3.7. --- Shared Care Program between SOPCs & GOPCs --- p.163 / Chapter 8.3.8. --- Medical Record System in GOPCs --- p.163 / Chapter 8.3.9. --- Further Training for GOPC Doctors --- p.164 / Chapter 8.3.10. --- Principal Medical Officer for GOPC Service --- p.164 / Chapter 9. --- Reference --- p.166 / Chapter 10. --- Appendix --- p.173

by Lam Ho Cheung, Andrew. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1993. / Includes bibliographical references (leaves 1-5 (3rd gp.)). / ABSTRACT --- p.I1-3 / ACKNOWLEDGEMENTS --- p.II / TABLE OF CONTENTS --- p.III1-2 / Chapter CHAPTER ONE - --- INTRODUCTION / Chapter 1.1 --- The Problem --- p.1 / Chapter 1.2 --- The purpose of the thesis --- p.5 / Chapter CHAPTER TWO - --- PSYCHIATRIC OUTPATIENT SERVICE PROVISION / Chapter 2.1 --- Provision of psychiatric outpatient provision --- p.6 / Chapter 2.2 --- The problem of pattern of consultation --- p.13 / Chapter CHAPTER THREE- --- OBJECTIVES AND HYPOTHESIS SETTING / Chapter 3.1 --- Objectives --- p.30 / Chapter 3.2 --- Definition of essential terms --- p.30 / Chapter 3.3 --- Hypothesis setting --- p.32 / Chapter CHAPTER FOUR - --- METHOD / Chapter 4.1 --- Research design and Data collection method --- p.36 / Chapter 4.2 --- Recording schedule design --- p.37 / Chapter 4.3 --- Setting --- p.39 / Chapter 4.4 --- Subjects --- p.40 / Chapter 4.5 --- Data Collection and Processing --- p.40 / Chapter 4.6 --- Data analysis --- p.43 / Chapter CHAPTER FIVE - --- DESCRIPTIVE FINDINGS / Chapter 5.1 --- The overall pattern of consultations --- p.45 / Chapter 5.2 --- Diagnostic group of sex and age group --- p.53 / Chapter CHAPTER SIX - --- FACTORS ASSOCIATED WITH DROP-OUTS OF PATIENTS / Chapter 6.1 --- Background of the drop-outs and the non-drop-outs group --- p.55 / Chapter 6.2 --- Univariate analysis of relationship between various variables and drop-outs --- p.55 / Chapter 6.3 --- Multiple logistic regression model of relationship between drop-outs and various variables --- p.58 / Chapter CHAPTER SEVEN - --- FACTORS ASSOCIATED WITH PROLONGED & CONTINUED ATTENDANCE / Chapter 7.1 --- Background of the treated & discharged group and prolonged & continued attendance group --- p.62 / Chapter 7.2 --- Univariate analysis of relationship between various variables and prolonged & continued attendance --- p.62 / Chapter 7.3 --- Multiple logistic regression model of relationship between prolonged & continued attendance and various variables --- p.65 / Chapter CHAPTER EIGHT - --- DISCUSSION / Chapter 8.1 --- The overall pattern of consultations --- p.69 / Chapter 8.2 --- Factors associated with the risk of drop-outs --- p.76 / Chapter 8.3 --- Factors associated with the prolonged & continued attendance --- p.80 / Chapter 8.4 --- Implications to service delivery --- p.85 / Chapter 8.5 --- Limitations of this thesis --- p.86 / Chapter CHAPTER NINE - --- CONCLUSION AND RECOMMENDATIONS / Chapter 9.1 --- Conclusion --- p.90 / Chapter 9.2 --- Recommendations --- p.92 / Chapter 9.3 --- Suggestion for future work --- p.93 / BIBLIOGRAPHY / APPENDIX I - TABLE / APPENDIX II- SAMPLE RECORDING SCHEDULE

The thesis focuses on the impact of the EU Directive (2002/14/EC), which was incorporated into UK employment law, with its phased implementation starting on 6th April 2005. The empirical evidence is based on a survey and predominantly on case-study research that involved interviews with: managers, employees and trade union representatives, together with the collection of relevant documentary evidence. The empirical findings, especially for the non-unionised sector, indicate that the reflexive nature of the Information and Consultation of Employees (ICE) Regulations has mainly stimulated the development of organisation-specific or tailor-made information and consultation arrangements, which minimally comply with the legislative provisions. Moreover, the development of such arrangements is primarily based on the ad hoc momentum that is generated by business pressures (i.e. collective redundancies, transfer of undertakings etc) and can be viewed as reflecting the conceptual framework of legislatively prompted voluntarism. The ICE Directive is aimed at bringing a consistency to the establishment of basic and standard information and consultation arrangements across the workplaces in Great Britain. Subsequently, it should promote the harmonisation of employee participation practices amongst the UK and other EU countries, as it has the goal of ensuring that there is a minimum floor of rights in relation to information sharing and consultation with employees. Nevertheless, the Europeanisation of British industrial relations cannot instantly take place through the adoption of such EU directives. With regard to this research endeavour, it emerges that the extant national idiosyncrasies cannot be substantially altered, whilst business pressures and employers’ goodwill continue to be key drivers in the development of employee participation and consultation arrangements in Great Britain, albeit within the newly adopted legislative and statutory framework.

Aims. The aim of this study was to explore the effects of the health consultation experience for people with learning disabilities, particularly in terms of their self-concept Background. Annual health checks have been introduced as a reasonable adjustment for health providers to make in meeting the needs of people with learning disabilities, who experience significantly poorer health outcomes than the general population. Evaluation of the health consultation from the service user perspective can inform this service provision. Design. A constructivist grounded theory approach, based on symbolic interactionism, was used to explore the meaning of the health consultation experience for the person with learning disabilities, and its effects on their sense of self. Methods. Purposive and snowballing sampling was used to recruit 25 participants with learning disabilities through a GP practice, self-advocacy groups and a health facilitator. Nine individual interviews, three interviews with two participants, three focus groups (n=7, n=5 and n=3), and an audio-recorded health check consultation were carried out (with two participants interviewed twice and four attending two focus groups), as well as a member check used to assess the resonance of the findings. Data collection was undertaken in different primary care trusts across the north west of England. Data were subjected to constant comparative analysis, using a symbolic interactionist approach, to explore all aspects of the health consultation experience and its effects on the self. Findings. Current expectations, attitudes and feelings about health consultations were strongly influenced by previous experience. Participants negotiated their own reality within the consultation, which affected their self-concept and engagement with their health care. Respectful and secure health professional – service user relationships, developed over time, were central to an effective consultation. Perspectives on the consultation, and engagement within it, were co-constructed with a companion, who could help to promote the personhood of the service user with support from the health professional. Anxiety, embarrassment and felt stigma were identified as significant barriers to communication and engagement within the consultation. Conclusions. People with learning disabilities have similar health consultation needs and expectations to other people, but may have more difficulties in engaging with the process and building trusting relationships with the health professional, due to previous negative experiences, anticipated stigma and loss of self within health settings leading to a fear of disclosure. This, combined with difficulties in communication and cognitive processing, results in less satisfactory outcomes persisting over time. The effects of triadic consultations are generally positive, particularly where relatives or health facilitators are involved. However, continuity of companion as well as health professional is needed, and more service user engagement should be supported. Fundamental attitude change by health professionals, supported by specific educational initiatives to enhance their understanding of the service user perspective, is needed to reduce health inequalities. Participatory research by people with learning disabilities should inform future health care practice.

Orientador: Carmen Maria Casquel Monti Juliani / Resumo: INTRODUÇÃO: A regulação de acesso é compreendida como importante ferramenta de gestão do sistema de saúde. OBJETIVO: Conhecer o perfil e demanda de urgência e emer-gência encaminhadas a um serviço de alta complexidade antes e após um sistema de regulação. MÉTODO: Estudo transversal, avaliando, por meio de análise estatística, dois períodos o primeiro de março de 2015 a setembro de 2016 e o segundo de outubro de 2016 a abril de 2018. RESULTADOS: Houve predominância dos moradores de Botucatu sendo 82% adultos e as especialidades mais buscadas foram oftalmologia, clínica médica e ortopedia. 10450 casos foram regulados pela Central de Regulação de Ofertas de Serviços de Saúde, em análise comparativa do período anterior e posterior da implantação da plataforma notou-se aumento na demanda de atendimento dos municípios e na distribuição das especialidades solicitadas. Das solicitações aceitas e encaminhadas ao Hospital das Clínicas prevaleceu o público mascu-lino e as principais hipóteses diagnósticas foram relacionadas à fratura, trauma, afecções car-díacas e acidente vascular cerebral. Após realizou-se um cálculo amostral que evidenciou 12,5% a realização de contrarreferência, analisando a amostra a maioria eram homens com média de idade de 40 anos e o tempo médio de regulação dos casos foi de 1 hora, 43 minutos e 48 segundos com as principais queixas relacionadas à fratura, dor abdominal, infarto agudo do miocárdio e dispneia. CONCLUSÃO: Houve diferença significativa comparando o... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: BACKGROUND: Access regulation is understood as an important health system manage-ment tool. AIM: To know the profile and demand of urgency and emergency sent to a high complexity service before and after a regulation system. METHOD: Cross-sectional study, evaluating, through statistical analysis, two periods from March 2015 to September 2016 and the second from October 2016 to April 2018. RESULTS: Population of Botucatu was predo-minantly 82% and specialties most sought were ophthalmology, medical clinic and orthope-dics. 10450 cases were regulated by the Central of Regulation of Health Service Offerings, in a comparative analysis of the period before and after the implementation of the platform, there was an increase in the demand for care of the municipalities and in the distribution of the spe-cialties requested. Of the requests accepted and sent to Hospital das Clínicas, the male public prevailed and the main diagnostic hypotheses were related to fracture, trauma, cardiac affecti-ons and stroke. After a sample calculation that showed a 12.5% counterreference, the sample was mostly men with a mean age of 40 years and mean time to regulate the cases was 1 hour, 43 minutes and 48 seconds with the main complaints related to fracture, abdominal pain, acute myocardial infarction and dyspnea. CONCLUSION: There was a significant difference comparing the two periods, evidencing the increase after the insertion of the platform, contri-buting to the regulation and flow of the patien... (Complete abstract click electronic access below) / Mestre

Este trabalho de Dissertação de Mestrado objetivou investigar as entrevistas iniciais realizadas com as famílias que buscavam atendimento para um dos filhos, no período de julho de 1997 a junho de 2001, na Clínica Psicológica Dr Durval Marcondes, do Departamento de Psicologia Clínica do IPUSP e em consultório particular. Fundamenta-se na leitura da obra de D. W. Winnicott, que traz importantes contribuições para a psicanálise contemporânea. Realiza uma crítica aos modelos de triagens existentes nas Clínicas-Escola e em outras instituições, destacando o caráter de exclusão dessa prática. Discute, também, aspectos da dinâmica e função da família do ponto de vista de D.W. Winnicott. A metodologia que embasou o trabalho utiliza-se do método psicanalítico para fundamentar a pesquisa de práticas clínicas diferenciadas e inovadoras. Recorre, ainda, às idéias de Walter Benjamim sobre o valor da narrativa como forma de partilhar experiências inter-humanas. Há o relato de cinco casos que ilustram a prática de consultas psicoterapêuticas com famílias. Na discussão dos casos não se pretende esgotar as compreensões destes, mas apontar possíveis sentidos. Discute-se, também, o modelo de intervenções usadas nesse trabalho, que se baseiam na idéia de o analista ser capaz de sustentar sua prática clínica (dar holding). Destaca-se, enfim, o valor deste trabalho para os pacientes e para as instituições públicas. / This master\'s dissertation aims at investigating the initial interviews carried out with the families that, between July, 1997, and June, 2001, sought help for one of their children at the Dr. Durval Marcondes Psychological Clinic, of the Department of Clinical Psychology at the University of São Paulo\'s Institute of Psychology, and at a private office. The dissertation is based on the writings of D. W. Winnicott, who has contributed much to contemporary psychoanalysis. A criticism is presented in regard to the screening models currently used in school-clinics and other institutions, especially the character of exclusion of this practice. Aspects of the dynamics and function of the family are also discussed from Winnicott\'s point of view, with the psychoanalytic method being used as the basis for studying innovative alternative clinical practices. Reference is also made to Walter Benjamin\'s ideas regarding the importance of narration as a way of sharing inter-human experiences. Five clinical cases are described to demonstrate the practice of therapeutic consultation work with families, although the discussion of these cases merely brings up possible meanings, and makes no pretense at providing any type of full understanding. Also discussed is the model of intervention used in this work, which is based on the idea of the analyst as someone able to give holding in his or her clinical practice. Finally, the value of this work for patients and for public institutions is also highlighted.