A demanda crescente de usuários de implante coclear (IC) e a distribuição irregular de profissionais especializados no país, tornam necessário o deslocamento de pacientes por longas distâncias para os atendimentos, com consequente aumento dos custos diretos e indiretos do tratamento. A teleconsulta pode ser vista como uma alternativa em potencial para o acesso desta população a estes serviços. O presente ensaio clínico, randomizado, controlado, avaliou a eficácia da teleconsulta síncrona na programação dos sistemas de IC em usuários acompanhados em um Programa de Implante Coclear credenciado pelo Sistema Único de Saúde. Participaram do estudo 79 indivíduos com idades entre nove e 68 anos (média de 21,6), 41 do sexo masculino e 38 do sexo feminino, usuários de IC por um período de 0,58 a 24,75 anos. Estes indivíduos foram divididos em dois grupos, de acordo com o modo de programação do IC: controle (n=40), que realizou o procedimento face a face e experimental (n=39) que realizou a teleconsulta síncrona. Treze fonoaudiólogos sem experiência na programação do dispositivo atuaram como facilitadores das teleconsultas. Os procedimentos de programação do IC englobaram a telemetria de impedância, definição dos níveis de estimulação elétrica, varredura e balanceamento dos eletrodos e ajuste fino da programação. Como medidas de avaliação de resultados foram utilizados o tempo dispendido na consulta, a audiometria em campo livre, o percentual de reconhecimento de sentenças no silêncio e no ruído, o limiar de reconhecimento de sentenças no silêncio e ruído (HINT-Brasil), a avaliação da satisfação com a consulta (escala MISS-21) e de aspectos pertinentes à teleconsulta. Os facilitadores responderam as questões abertas referentes à suas impressões dos atendimentos. Os dados foram analisados por meio de estatística inferencial (testes t de Student, Wilcoxon, Mann-Whitney e correlação de Spearman). Os resultados mostraram que após a programação do IC, em média, os participantes apresentaram limiares audiométricos abaixo de 30 dB NA. O reconhecimento da fala pós atendimento, respectivamente para os grupos experimental e controle, foram de 81,3% e 83,8% (silêncio) e 57,9% e 58,1% (ruído). No HINT-Brasil os resultados foram, respectivamente, para os grupos experimental e controle 61,4 dB NA e 61,8 dB NA (silêncio) e relação S/R de 9,5 dB NA e 10,4 dB NA (ruído). Os participantes estiveram satisfeitos com a consulta. Não houve diferença estatisticamente significativa entre os grupos em nenhuma das medidas de resultado. Todos os participantes relataram que teleconsulta pode ser vista como uma alternativa viável ao atendimento face a face e sua aplicação clínica facilitaria a rotina de pacientes usuários de IC. Os facilitadores destacaram a sua importância para o aprendizado e como ferramenta de formação continuada. A teleconsulta síncrona foi eficaz na programação dos sistemas de IC e amplamente aceita pelos usuários e profissionais. / The growing number of cochlear implant (CI) users and the uneven distribution of specialized professionals in the country makes necessary patients traveling over long distances to receive care, with consequent increase in direct and indirect costs of treatment. The telehealth can be viewed as an alternative for this population to access such services. This clinical randomized, controlled clinical trial evaluated the efficacy of synchronous teleconsultation in the programming of CI systems in a Cochlear Implant Program accredited by the National Health System in Brazil. Participate in this study 79 subjects aged between nine and 68 years (average 21.6), 41 males and 38 females, CI users for a period from 0.58 to 24.75 years. The participants were divided into two groups, according to the nature of consultation: control group (n = 40), who performed the CI programming face-to-face and experimental group (n = 39) who performed the CI programming through the synchronous teleconsultation. Thirteen audiologists without experience in CI programming acted as facilitators of teleconsultation. The CI programming procedures encompassed the impedance telemetry, setting of electrical stimulation levels, sweeping and balancing of the electrodes and programming evaluation in live speech mode. The outcome measures were the time spent in consultation, free field audiometry, the percentage of sentence recognition in quiet and in noise, the sentence recognition threshold in silence and noise (HINT-Brazil), satisfaction with the consultation (MISS-21 scale) and aspects related to teleconsultation. The facilitators responded open questions regarding their impressions of the teleconsultations. Data were analyzed using inferential statistics (Student t test, Wilcoxon, Mann-Whitney and Spearman correlation). The results showed that after CI programming, on average, the participants had audiometric thresholds below 30 dB HL. The speech perception for the experimental and control groups post CI programming were respectively, 81.3% and 83.8% (in silence) and 57.9% and 58.1% (in noise). In HINT-Brazil the results were, respectively, for the experimental and control groups 61.4 and 61.8 dB (silence) and S/N ratio of 9.5 dB and 10.4 dB (in noise). Participants were satisfied with the teleconsultation. There were no statistically significant difference between the groups in any of the outcome measures. All participants reported that teleconsultation could be a viable alternative to facilitate CI users follow up routine. Facilitators emphasized the importance of teleconsultation for learning and for continuing education. The teleconsultation was effective in programming the CI systems and accepted by users and professionals.

Made available in DSpace on 2016-05-02T13:54:45Z (GMT). No. of bitstreams: 1 LudimilaBarbosabandeiraRodrigues-dissert-completa.pdf: 288096 bytes, checksum: 9306115bdeaa37c9c411d939fd697852 (MD5) Previous issue date: 2009-12-11 / Since the creation of the Unified Health System, through the promulgation of Brazilian Federal Constitution in 1988, the building process of regionalization and prioritization of health states needs to create mechanisms to ensure coordination between health services in order to establish it as a flow of users in a flexible and dynamic process, called the reference and counter reference. This study aimed to evaluate the implementation of the reference and counter-reference in specialized clinics of the Municipal Health System at Alfenas-MG, from the experience of the practice. This is a qualitative and quantitative descriptive study of the epidemiological type of cross-design. Initially, a review was conducted on the historical process of building the Unified Health System - SUS and the meaning of the reference system and counter-reference in this context. Next step was performed to collect data which used the chips to the routing specialist appointments used by the Municipal Health Department of Alfenas MG and the questionnaires to medical professionals. The results allowed to infer that, although under the organizing principles of SUS, the system of reference and counter reference, is still immature. However, the majority of the medical professionals agree to the necessity of its implantation by means of a computerized system for the information socialization of the attendance given to the user on different attention points and to speed the flow and reverse-flow of the user in the health attention net. / Desde a criação do Sistema Único de Saúde (SUS) através da promulgação da Constituição Federal de 1988, o processo de construção da regionalização e da hierarquização da saúde estabelece a necessidade de se criarem mecanismos que garantam a articulação entre os serviços de saúde, visando a estabelecer nele um fluxo de usuários, num processo dinâmico e flexível, denominado de referência e de contrarreferência. Este estudo teve como objetivo avaliar a implantação de um mecanismo formal da referência e de contrarreferência em consultas especializadas no Sistema Municipal de Saúde de Alfenas- MG, a partir da experiência vivenciada na prática. Trata-se de um estudo quali-quantitativo, descritivo e exploratório, do tipo epidemiológico de delineamento transversal. Num primeiro momento, foi realizada uma revisão histórica sobre o processo de construção do Sistema Único de Saúde SUS - e o significado do sistema de referência e de contrarreferência nesse contexto. Em seguida, foi realizada a etapa de coleta de dados, em que se utilizou a ficha de encaminhamento para consultas especializadas proposta pela Secretaria Municipal de Saúde de Alfenas MG e a aplicação de questionários aos profissionais médicos. Os resultados obtidos permitem inferir que, sob os princípios organizativos do SUS, o sistema de referência e de contrarreferência de consultas especializadas é ainda incipiente. Entretanto, a maioria dos profissionais médicos concorda com a necessidade de sua implantação por meio de um sistema informatizado para a socialização das informações sobre o atendimento prestado ao usuário nos diferentes pontos de atenção e para agilizar o fluxo e contrafluxo do usuário na rede de atenção à saúde.

Tillgänglighet till ortodontisk vård behövde förbättras. Förbättringsarbetet fokuserade på processen för ortodontisk diagnostik och behandling i allmäntandvården. Syftet med förbättringsarbetet var att på ett mer resurseffektivt sätt identifiera och behandla patienter med ett ortodontiskt behandlingsbehov för att öka tillgänglighet och erbjuda patienterna optimal behandling. Studiens syfte var att utifrån berörda tandläkares erfarenheter utvärdera vad som har betydelse för att insatser för bättre ortodontisk vård fungerar som de gör. Förbättringsarbetet utgick från strukturen i förbättringsrampen. I fallstudien användes data från enkäter, intervjuer och förbättringsarbetet. Gemensam tolkning genomfördes med triangulering. Riktlinjer och förändrade ortodontikonsultationer infördes. Tiden för konsultationer för ortodontisten minskade trots bibehållen mängd patienter. I fallstudien identifierades stödjande och hindrande faktorer av betydelse för utfallet av förbättringsinsatserna.  Förändringar i processen för ortodontisk diagnostik och behandling i allmäntandvården bidrog till att frigöra tid för ortodontisten och därmed förbättrad tillgänglighet till specialisttandvård för patienterna. Stödjande och hindrande faktorer av betydelse för insatser för bättre ortodontisk vård kan komma till nytta vid spridning av arbetssättet. / Access to orthodontic care needed to be improved. The improvement project focused on the process for orthodontic diagnosis and treatment in general practice. The aim of the improvement project was to make the process for orthodontic diagnosis and treatment planning more efficient, to improve accessibility and offer patients optimal treatment. The study aimed to explore the experience of dentists in general practice related to the impact of changes on orthodontic care. The improvement project followed the steps of the improvement ramp. In the case study data from questionnaires, interviews and the improvement project were used. Triangulation was used for interpretation. Guidelines and alterations in orthodontic consultations were introduced. Scheduled time for consultations was reduced, despite no change in the number of patients. The case study identified constraining and enabling factors to be considered in relation to the improvement project. Changes in the process contributed to making consultations less time consuming and thereby useful to improve accessibility to care. The impact of constraining and enabling factors in relation to the improvement efforts can promote transfer of learning to other caregivers in adopting improvement activities.

No description available.

Syftet med studien har varit att undersöka vad några specialpedagoger verksamma inom grundskolan berättar om handledning och konsultation i skolan. Studien har genomförts utifrån kvalitativa semistrukturerade intervjuer med syfte att fånga informanternas berättelser, i enlighet med narrativ teori. Efter genomförandet av intervjuerna transkriberades, kodades och tematiserades dem, vilket utmynnade i olika teman och subteman i relation till syfte och frågeställningar. Resultatet visar att rollen som specialpedagog formas olika utifrån faktorer som styrdokument, utbildning, förväntningar, erfarenheter, personliga intressen och förutsättningar som ges i den egna verksamheten. Det kvalificerade samtalet skrivs fram som ett paraplybegrepp för studien och berättelserna kring detta samtalsbegrepp och begreppen handledning och konsultation, som rör avgränsningen för densamma, skiljer sig åt mellan informanterna. Det framkommer en tvetydig bild av definitionen av det kvalificerade samtalet likväl som uppfattningen och tolkningen av begreppen handledning och konsultation. Det är tydligt att specialpedagogens otydliga roll har en stark inverkan på vad informanterna berättar om handledning och konsultation då rollen formas, enligt studien, mycket efter personen som innehar rollen. För att vidareutveckla det kvalificerade samtalet som kraftfullt verktyg i praktiken skulle den pedagogiska handledningen med fokus på pedagogisk utveckling behöva diskuteras vidare. Vi ser också behovet av att säkerställa rektorers kunskap kring uppdraget, som ett led i att bereda plats för samtalsuppdraget i praktiken. / The purpose of the study has been to investigate what some Special Educational Needs Coordinators working in elementary school have to say about supervision and consultation at school. The study has been conducted on the basis of qualitative, semi-structured interviews with the purpose of capturing the informants' stories according to narrative theory. After undertaking the interviews, they were transcribed, encoded and thematized, which resulted in different themes and subthemes in relation to the purpose of the study as well as to our research- questions. The results show that the role of a Special Educational Needs Coordinator is formed differently, depending on factors such as; governing documents, education, expectations, experiences, personal interests and the current conditions in their individual workplaces. The qualified conversation is written as an umbrella term for the study and the stories about this concept of conversation and the concepts of supervision and consultation, concerning the boundaries, differ between the informants. There is an unclear picture of the definition of the qualified conversation, as well as the perception and interpretation of the concepts of supervision and consultation. It is evident that the Special Educational Needs Coordinator's unclear role has a strong impact on what the informants tell us about supervision and consultation as the role is formed, according to the study, mostly based on the person holding the role. In order to further develop the qualified conversation as a powerful tool in practice, pedagogical guidance focusing on educational development needs to be further discussed. We can also identify a need to ensure the headteacher's knowledge of the assignment, as part of preparing a place for the communication assignment in practice.

The diploma thesis is a business proposal for the establishment of a business in the field of psychological-career testing. These are services that will help predominantly the last years of primary school pupils to determine which career paths to go further The business plan includes the process of establishing the company, defining the market environment, competition, marketing and promotional strategy along with the sales concept. The financial plan evaluates the economic success of the proposed business. Subsequently, the results of the work are useful as a basis for the company executives as well as for product and service creators.

Introduction: The field of implementation science provides the variables adoption and reach, which can be used to evaluate aspects to access, a primary incitement for integrated care. This study compared two integrated models: In Year 1, behavioral health consultants worked collaboratively with pediatricians to provide brief on-the-spot consultations to patients with behavioral concerns, and in Year 2, a structured, evidence-based treatment (EBT), the Family Check-Up, was developed to be delivered in conjunction with the existing collaborative model. Method: A chart review revealed the number of children who (a) attended a 4- to 5-year-old well-visit, (B) were screened, (c) were identified as having behavior problems, (d) were referred, and (e) accessed the services. Outcomes were calculated as percentages of children with behavioral concerns who were referred to (adoption) and received (reach) the services in each year. Results: Key findings were that (a) physician referrals increased when an EBT was added, but (b) patients had better first-session contact with the brief approach than the EBT, which few patients completed. Discussion: Results underscore the utility of measuring adoption and reach as partial indicators of access to services. These are accessible variables, collected in every practice that can be measured routinely in the context of quality improvement and, ideally, reported in studies as a way to disseminate knowledge about how to build behavioral health technology into primary care. Future research should strive for more rigor in measuring adoption and reach, and consider including a number of other implementation outcomes.

Multilingualism in classrooms is currently prompting debate and has significantly impacted on schooling in South Africa over the last decade. At present South African educators face the challenge of coping with and finding solutions to culturally and linguistically diverse urban school contexts that did not exist before. In many South African communities young learners, without any prior knowledge of English, are placed in English preschools. Preschool teachers have the demanding task of preparing these multilingual preschoolers for formal schooling in English, and, in addition, are pressurised by parents or caregivers who expect their children to be fluent in English by the time they enter primary school. A group of preschool teachers in a specific urban, multilingual preschool context expressed concern about multilingual preschool learners’ academic performances and their future, and requested advice and support. Consequently a need was identified for speech-language therapists to make their expertise available to multilingual preschool learners, as well as to their preschool teachers. To address this need, an exploratory, descriptive, contextual research design, incorporating the quantitative perspective, was selected to describe the specific educational context of multilingual preschools in the Pretoria Central Business District (CBD) and Sunnyside area. A descriptive survey was conducted and two survey techniques were employed to collect the data, namely a questionnaire and a test battery. The questionnaire was used to collect information from 32 teacher participants to investigate the needs and strengths of preschool teachers and multilingual preschool learners. The test battery was utilised to collect data on the language and communication proficiency in English of 30 learner participants. Results indicated that the teacher participants perceived certain personal challenges while supporting the preschool learners acquiring English as Language of Learning and Teaching (ELoLT). These teachers expressed a need for knowledge and support. They also reported that the multilingual preschool learners in the research context had to communicate in ELoLT despite it being an unfamiliar language. Some of the multilingual preschool learners displayed behaviours that could be indicative of negative influences on their self-esteem. The language and communication assessment revealed that many learner participants’ comprehension and expression in ELoLT were insufficient for learning and that they required support for academic success. In addition, the results support the claim that an integrated view of the multilingual learners’ communication abilities need to be established across contexts, by combining assessment strategies, such as naturalistic and structured assessment, as well as interdisciplinary perspectives. The results of the empirical research was used to propose a service delivery model for the acquisition of ELoLT in the research context. This proposed model may be an effective approach to provide supportive intervention to multilingual preschool learners with linguistic barriers to learning. In addition, initial stage intervention guidelines for the basic level ELoLT learner were offered in response to the needs of the specific community. These guidelines may provide a basis for the planning of intervention strategies to preschool teachers who were concerned about the education and future of multilingual preschool learners. / Thesis (DPhil (Communication Pathology))--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / Unrestricted

The Telemedical Assistance Service (TMAS) plays a vital role in medical care at sea by linking the medically responsible officers (MROs) on board with onshore physicians. This project aims to investigate telemedical providers’ perceptions of maritime health care quality today, as well as future potential improvements in this field. A qualitative methodology was chosen as its strength lies in focus on the processes – the people, situation and events that lead to certain outcomes. Semi-structured interviews with TMAS professional staff focused on current communication limitations, perceptions of overall care quality, and what developments, technological or otherwise, might improve healthcare at sea. Following interview transcription and coding against the aims, results with a good degree of consensus were as follows. Poor communication is clearly an issue. High speed data transmission would allow TMAS medical staff to directly observe and evaluate injured crew, and to direct MROs with greater certainty. A touchpad-based system to codify onboard pharmaceuticals was recommended. Standardised initial communication templates would save time and uncertainty and are congruent with how ship’s officers deal with many other situations. Given the difficulty MROs have with IV placement, a shift to intraosseous delivery was recommended. A smaller, more focused and integrated TMAS physician cohort in Sweden was suggested. Pulse oximeters, glucometers and defibrillators were seen as ‘must have’ items on board. Developments in point of care blood analysis, especially for detection of inflammation and infection, were seen as important to evaluate. As a general conclusion, progress could be made in improving onboard medical care via a collaboration between TMAS personnel, MROs, and maritime training staff. This would allow for dialogue on what changes to training and onboard equipment might be agreed now; what should be further evaluated; and a mechanism by which developments in communication, techniques, and portable analytic devices might be effectively implemented in the future. / Telemedical Assistance Service (TMAS) spelar en viktig roll i sjukvård till sjöss genom att sammanföra sjukvårdsansvariga sjöbefäl (MROs) med sjukvårdspersonal iland. Denna rapport syftar till att undersöka uppfattningar hos landbaserad personal i TMAS-funktionen angående dagens vårdkvalitet inom sjöfarten, samt potentiella förbättringar inom området. En kvalitativ metod valdes då denna lämpar sig väl med hänsyn till att den fokuserar på processerna, vilka inbegriper individer, situationer, och händelser som leder till vissa utfall. Semistrukturerade intervjuer med TMAS-personal inriktades på rådande begränsningar inom kommunikation, vårdkvalitet ombord, samt hur framtidens teknik kan förbättra sjukvård till sjöss. Efter intervjutranskribering och kodning mot tre huvudfrågor har resultat med en hög grad av samstämmighet utkristalliserats. Bristfällig kommunikation är ett uppenbart problem. Dataöverföring med hög hastighet skulle tillåta konsulterande läkare att själv observera och utvärdera skadade besättningsmedlemmar, samt att instruera MROs med högre noggrannhet. Ett system baserat på pekplattor för effektiviserad hantering av mediciner ombord rekommenderades. Standardiserade mallar som stöd för initial patientrapportering skulle spara tid och förebygga osäkerhet, och skulle ligga väl i linje med hur fartygsbefäl hanterar många andra situationer ombord. Mot bakgrund av ombordanställdas besvär med att sätta intravenösa infarter, rekommenderades en övergång från intravenös till intraosseös läkemedelsadministrering. En mindre och mer integrerad arbetsgrupp på TMAS-avdelningen i Sverige föreslogs. Syremättnadsmätare, glukosmätare, och defibrillatorer ansågs vara oumbärliga tillbehör ombord. Utrustning för patientnära blodanalys, i synnerhet för att upptäcka inflammation och infektion sågs som viktigt att utvärdera vidare. Sammanfattningsvis pekar resultaten mot att framsteg inom sjukvård till sjöss kan främjas genom samarbete mellan TMAS-personal, sjukvårdsansvariga ombord, och kursansvariga för sjöfartsutbildningar. Ett sådant samarbete skulle möjliggöra en dialog om vilka förändringar avseende utbildning och utrustning ombord som kan implementeras i dagsläget, och vilka som kräver vidare granskning. Det hade även utgjort ett forum för vad som kan realiseras i framtiden beträffande kommunikation, tillvägagångssätt, och portabla analysverktyg.

The thesis named Quality forms of family and kindergarten cooperation deals with the effectiveness leadership of tripartite meetings at a given kindergarten. The theoretical part summarizes subjects such as cooperation, communication, representation of coopration with the family in Framework Education Programme for pre-school and primary education or the portfolio. The practical part consists of the research carried out at a particular school that describes the tripartite leadership, mapping the effectiveness of tripartite meeting with the participation of the child and its portfolio, and at the very end offers further opportunities to engage the activities in tripartite meetings with the support of the portfolio.