A presente dissertação busca aproximar o compliance penal ao cotidiano do profissional da medicina. Será analisada a possibilidade de o instituto, que tem por foco a pessoa jurídica, ser aplicado diretamente a pessoas físicas. As questões penais que envolvem a medicina também serão levantadas, com foco nos principais tipos penais que podem se apresentar no dia a dia do profissional. Será discutido se a adoção de normas de compliance consistiria uma assunção de culpa em caso de violação destas, e como esta implementação pode ser vista à luz da teoria da imputação objetiva. Estudaremos a teoria do erro de James Reason e os conceitos de Cultura Justa, ambos ferramentas que auxiliam na criação de normas preventivas. Forneceremos um delineamento geral dos elementos que devem, idealmente, compor o compliance para os profissionais da medicina. Analisaremos acórdãos do Tribunal de Justiça do Estado de São Paulo, com breve apontamentos acerca do atual panorama dos processos criminais que envolvem questões médicas. A conclusão busca responder se a adoção do compliance se justifica frente a todo o analisado, e se é benéfica para os profissionais. / This work tries to approximate the criminal compliance to the medical professional\'s daily life. It analyses the possibility of applying the institute, which is focused on corporations, directly to individuals. Criminal issues involving the field of medicine will also be raised, focusing on main crimes that can arise on daily activities. We will discuss if the adoption of standards of compliance would be seem as an assumption of guilt in case of violations of those, and how this implementation can be seen in light of the Theory of Objective Imputation. We will study the errors theory of James Reason and the concepts of Just Culture, both tools that assist in the creation of preventive standards. We provide a general outline of the elements that should ideally comprise the compliance program to medical professionals. We will analyze decisions of the Court of Justice of the State of São Paulo, with brief notes about the current situation of litigations involving medical issues. The conclusion seeks to answer whether the adoption of compliance methods can be justified at all, and if it is beneficial for the professionals.

Le sujet principal de la Thèse est l’optimisation de la compliance des structures élastiques minces. Le problème consiste en déterminer la configuration la plus résistante, lorsqu'une quantité infinitésimale de matériau élastique est soumis à une force fixée et est confinée dans une région de volume infinitésimal.La résistance au chargement peut être mesurée en calculant une fonctionnelle de forme, la compliance, dans laquelle la forme représente le volume occupé par le matériau élastique. Donc nous sommes conduits à étudier un problème de minimisation d'une fonctionnelle de forme, sous une contrainte appropriée.Nous nous intéresserons plus particulièrement au cas où la région de design est un fil fin, représenté par un cylindre de section transverse infinitésimale. L'étude est motivée par des problèmes d'ingénierie: les structures minces sont très intéressantes d'un point de vue pratique.La stratégie utilisée tire son inspiration des travaux récents par I. Fragalà, G. Bouchitté et P. Seppecher, dans lesquels les auteurs considèrent des plaques élastiques [G. Bouchitté, I. Fragalà, P. Seppecher: Structural optimization of thin plates: the three dimensional approach., Arch. Rat. Mech. Anal. (2011)]. Cependant il faut souligner que le cas du cylindre est loin de se résumer à une variante technique du cas des plaques. Comme nous le verrons en effet, le modèle limite obtenu dans l'analyse asymptotique 3d-1d est plus riche et subtile que celui correspondant à une analyse asymptotique 3d-2d.L'étude des configurations optimales pour le modèle limite obtenu nous a conduit à une problématique nouvelle: l'existence de vraies forme optimales (donc sans apparition de structures composites) pour une barre en régime de pure torsion est liée à l'existence de solutions pour un problème non standard de frontière libre dans le plan. Ce problème représente un challenge et nous nous contenterons de donner quelques premiers résultats et perspectives.Par ailleurs, en liaison avec ce problème, nous développerons une stratégie nouvelle pour caractériser la dérivée de forme pour le minimum d'une fonction intégrale. La théorie de dérivées de forme est un sujet très largement étudié (voir e.g. la monographie de A. Henrot et M.Pierre Variations et Optimisation de Formes. Une Analyse Géométrique, Springer Berlin (2005), et les références qui y sont contenues), mais les techniques classiques qui y sont utilisées s'appuient sur des hypothèses de régularité non vérifiées dans notre cas. / The main topic of the Thesis is the optimization of the compliance of thin elastic structures.The problem consists in finding the most robust configurations, when an infinitesimal amount of elastic material is subjected to a fixed force, and contained within a region having infinitesimal volume.The resistance to a load can be measured by computing a shape functional, the compliance, in which the shape represents the volume occupied by the elastic material. Thus we are led to study a minimization problem of a shape functional, under suitable constraints.In particular, we treat the case in which the design region is a thin rod, represented by a cylinder with infinitesimal cross section. The study finds its motivation in engineering problems: thin structures are very convenient to be used in practical applications.The approach we adopt draws inspiration from some recent works by I. Fragalà, G. Bouchitté and P. Seppecher, in which the authors deal with the case of thin elastic plates [G. Bouchitté, I. Fragalà, P. Seppecher: Structural optimization of thin plates: the three dimensional approach., Arch. Rat. Mech. Anal. (2011)]. We point out that these two problems are not merely technical variants one of the other, due to the substantial difference between the limit passages 3d-1d and 3d-2d, namely from 3 to 1 and from 3 to 2 dimensions.The study of optimal configurations led us to face another interesting variational problem: actually to establish whether homogenization phenomena occur in bars in pure torsion regime turns out to be equivalent to solve a nonstandard free boundary problem in the plane. This new problem is very challenging and, besides the link with torsion rods, it has mathematical interest in itself. One of the tools which can be employed to attack the problem is shape derivative for minima of integral functionals. The theory of shape derivatives is a widely studied topic (see e.g. the monograph by A. Henrot and M.Pierre Variations et Optimisation de Formes. Une Analyse Géométrique, Springer Berlin (2005), and the references therein), but the approach we propose in new and relies on assumptions which are weaker that the classical ones.

This study investigated cultural differences, U.S.A. and Japan, in the selection of compliance-gaining strategies by lower status people as differentiated from a group leader in a short-term, task-oriented relationship. The subjects for this study consisted of 114 (59 male and 55 female) U.S. college students and 165 (65 male and 100 female} Japanese college students. All subjects lived in Oregon. After the subjects read the hypothetical scenario which involved changing a task for a classroom project, a 21 item questionnaire was administered. The questions were taken from Kipnis, Schmidt, and Wilkinson's (1980} study, and a six-point scale was used. The 21 questions were categorized into four compliance-gaining strategies: rationalization, exchange of benefits, ingratiation, and assertion. Rationalization and exchange of benefits were used to test hypotheses regarding culture as a whole. Hypothesis one was "Japanese lower status people who are in short-term, task-oriented relationships will use more rationalization compliance-gaining strategies than U.S. people who are in short-term, task-oriented relationships," while hypothesis two was "U.S. lower status people who are in short-term, task-oriented relationships will use more exchange of benefits compliance-gaining strategies than Japanese lower status people who are in short-term, task-oriented relationships." Ingratiation and assertion were used to test the hypotheses regarding gender in different cultures. Hypothesis three was "U.S. lower status females who are in short-term, task-oriented relationships will use more ingratiation compliance-gaining strategies than Japanese lower status females who are in short-term, task-oriented relationships," and hypothesis four was "U.S. lower status males who are in short-term, task-oriented relationships use more assertion compliance-gaining strategies than Japanese lower status males who are in short-term, task-oriented relationships."

PURPORSE¡GThis purpose of the study is to investigate the effectiveness of diabetes shared care model (DSCM)and the factors associated with extent of glycemic control. METHOD¡GWe analyzed 212 patients who completed the five shared care visits and 739 patients who completed the second follow-up visit. Patients are recruited from a department of Endocrinology of medical center located in southern part of Taiwan. Data used in this study were collected from the patients¡¦ medical records. To evaluate effectiveness of diabetes shared care model¡]dietary compliance, exercise behavior compliance, clinical indicators¡^and to examine the factors associated with the hemoglobulin A1c is the purpose of the study. RESULT¡G In 212 patients completing the 5 visits, the compliance of carbohydrate consumption was significantly improved, however, there was no significant improvement in those of calories and fat consumption. Further analysis in 739 patients who completed the second follow-up visit, we found that the compliance of calories and fat consumption was significantly improved. The compliance of carbohydrate was improved, but not reaching significant difference. Although the compliance of 212 patients¡¦ exercise behavior was not significantly improved, the compliance of 739 patients¡¦ exercise behavior was significantly improved. The improvement of clinical indicators following participating the DCSM are as followed¡G 1.The hemoglobulin A1c¡]before¡G8.1% vs after¡G7.9%¡AP=0.04¡^¡Bfasting plasma glucose¡]before¡G164.1mg/dL vs after¡G136.8 mg/dL¡AP<0.01¡^¡Btotal cholesterol ¡]before¡G200.9mg/dL vs after¡G187.3 mg/dL¡AP<0.01¡^¡Blow density lipoprotein¡]LDL¡^¡]before¡G121.0mg/dL vs posttest¡G113.1 mg/dL¡AP<0.01¡^¡Bhigh density lipoprotein¡]HDL¡^¡]before¡G42.6mg/dL vs posttest¡G46.2 mg/dL¡AP<0.01¡^of 212 patients were significantly improved. On the other hand, the triglyceride¡]pretest¡G159.9mg/dL vs after¡G152.2 mg/dL¡AP=0.71¡^¡Bsystolic blood pressure¡]before¡G132.5mmHg vs after¡G137.3 mmHg¡AP=0.34¡^and diastolic blood pressure¡]before¡G79.5 mmHg vs after¡G78.4 mmHg¡AP=0.09¡^of 212 patients were not significantly improved. 2.In 739 patients who only completing the second follow-up visit, the hemoglobulin A1c¡Bfasting plasma glucose¡Bdiastolic blood pressure were significantly improved but the systolic blood pressure was remain unchanged. Finally, multivariate regression modeling was used to investigate the factors associated with extent of glycemic control improvement (first visit HbA1c-annual visit HbA1c) in 212 patients competing the annual visit. After adjusting for age and sex, patients¡¦ sex, level of first visit hemoglobulin A1c and level of first visit triglyceride was associated with the extent of glycemic control.

The importance of studying challenges in implementing information technology solutions in health care organizations is highlighted by the huge investments in health care information technology (HIT) which has been spurred by recent government mandates. Information technology can help improve health care delivery cost by facilitating the standardization of work processes or routines and reducing variations among them. Set in a premier 950+ bed hospital in the south eastern part of US, this dissertation consists of two studies examining the challenges involved in implementing HIT solutions. In the first study, we seek to gain deep insights into how the process of creating a patient’s chart evolves over time in a health care institution. The second study focuses on the users of Electronic Health Records (EHR) system, investigating the compliance behavior of various providers with respect to patient records in the system. In the first study, through the lens of Activity theory our results show that the charting routine is implicated by the following environmental factors: (1) Tools, (2) Rules, (3) Community, and (4) Roles, and by individual factors: (5) Computer Self-Efficacy and (6) Risk Propensity. In the second study, our results indicate that there is a substantial effect of subculture of the different occupational groups on IT security compliance intent and behavior in a health care institution.

BAGGRUND: Antibiotikaresistens udgørentrussel mod folkesundheden. Antibiotikabruger hoveddrivekraften bag resistensudviklingen.Restriktiv antibiotikabrugi overens-stemmelse med de gældende retningslinjerer derfornødvendig. Tarmfloraenpåvirkes af antibiotika oghar betydning for helbredet.Den salutogene teori er et veletableretkonceptindenfor Public Health. Oplevelse af sammenhæng (OAS)udgør et centralt koncept indenfor den salutogene teori, afspejler en persons syn på livet og kapacitet til at respondere på stressfyldte situationerog indeholder komponenterne begribelighed, håndterbarhed og meningsfuldhed.OASudgøret værdifuldt værktøj ved problemstillinger, hvor målet er ”compliant”adfærd.Det kunne tænkes,at hvis befolkningen og lægerne manglede OAS vedrestriktiv antibiotikabrug, kunne dette bidrage til at derescompliance til retningslinjerne, der anbefaler forsigtig antibiotikabrug ikke var optimal. FORMÅL: At formulere forslag til, hvordan forsigtig antibiotikabrug kunne fremmes ved at optimere OAS. Baggrundener litteratur, der belyser (i) befolkningens og lægernesholdninger overfor antibiotika og antibiotikaresistens i Norden og (ii) antibiotikas påvirkning af tarmfloraen og mulige helbredsmæssige konsekvenser.Det undersøges om der er grund til at ændre holdning overfor antibiotika,hvilke faktorerderfremmer og hæmmer forsigtig antibiotikabrug og hvordan OASkunne optimeres. METODE: Litteraturstudie efter struktureret litteratursøgning i PubMed og PsychINFO. RESULTATER: Antibiotika betragtes som noget beskyttende. Det kan ikke udelukkes, at antibiotika ved at påvirke tarmfloraen, kan have negative konsekvenser for helbredet.Viden, vaner og kommunikation har betydning for hvordan antibiotika bruges og hvorvidt forsigtig antibiotikabrug opleves begribelig og håndterbar.Læger kan ved ordination af antibiotika opleve en konflikt mellem patienten,der skal behandles bedst muligtog samfundet, hvor tiltagende antibiotikaresistens skal begrænses. Dette kan være én grund til at forsigtig antibiotikabrug ikke opleves meningsfuld. KONKLUSION: Forsigtig antibiotikabrug kunne fremmes ved atfremme velfungerende kommunikationog ved atbruge antibiotikas påvirkning af tarmfloraenog mulige helbredsmæssige konsekvenser som motivation. Hensigtsmæssige vaneri sammen-hæng med antibiotikabrug skal støttes og uhensigtsmæssige vaner om lægges. Her kunnelæger følges af en mikrobiolog for en dag / BACKGROUND:Drug resistance resulting from the overuse of antibiotics poses a threat to public health. Consequently, antibiotics must be used more cautiously.Intestinal flora is important to health and antibiotics can disrupt intestinal flora. Salutogenic theory is a well-established concept in public health. Sense of coherence (SOC), which is a key concept insalutogenic theory, reflects a person ́s lifeviewand capacity to respond to stressful situations, includes three components: comprehensibility, manageability and meaningfulness. SOC is a valuable tool for problems that target “compliant” behavior. Lack of SOC in both physicians and the general public may contribute to poor compliance to current guidelines that recommend restricting the use of antibiotics. AIM: The study aimed to formulate proposals for promoting the prudent use of antibiotics by optimizing SOCbased on literature that illustrates(i) the attitudes of the general public and doctors regarding antibiotics and antibiotic resistance in Scandinavia and (ii) the influence and possible health consequences of antibiotics on intestinal flora. It is discussed whether there are reasons for looking at antibiotics in a different way, which factors that facilitate or hinder prudent antibiotic use and how SOC could be optimized. METHODS: A literature study aftera structured search of the PubMed and Psych INFOdatabases. RESULTS: Although antibiotics are generally considered protective, their effect on intestinal flora may have adverse health consequences. Knowledge, habits and communication affect how antibiotics are used and whether prudent antibiotic use is experienced comprehensible and manageable. Doctors may experience conflict when prescribing antibiotics between treating the patient in the best possible manner and the need to limit such treatment to protect the community from increased resistance to antibiotics. Doctors ́wish to guarantee that their patients receive the best possible treatment might be one reason why they do not adhere to guidelines that recommend more restrictive use of antibiotics. Doctors do not consider the cautious use of antibiotics as meaningful. CONCLUSION: Careful antibiotic use could be promoted by using the influence of antibiotics on intestinal flora as motivational strategy;promoting effective communication and supporting appropriate and unlearn undesirable habits related to antibiotic use. A possible approach would be teaming physicians with a microbiologist for a day / <p>ISBN 978-91-982282-8-1</p>

Bakgrund: Fysisk aktivitet på recept (FaR) är en ny behandlingsform som idag används för att öka den fysiska aktiviteten hos patienter som antingen redan är sjuka i olika livsstilsrelaterade sjukdomar, eller i riskzonen för att insjukna. Idag består behandling i hög grad av läkemedel, men FaR kan fungera som ett alternativ som minimerar användandet av traditionell medicin samtidigt som det ökar patientens självkänsla samt motiverar dem till en förändrad livsstil. Sjukvårdspersonalen måste vara kunnig i hur de kan bidra till att öka patientens compliance. Syfte: Syftet med denna studie är att undersöka vilka faktorer som kan påverka en patients compliance till FaR.  Metod: Metoden som användes för denna studie var en konvergent mixad metod, som kombinerade både en kvalitativ och kvantitativ analys av totalt 17 artiklar. Av dessa var 10 kvantitativa och 7 var kvalitativa. Resultat: Analysen av framkommen data resulterade i tre övergripande teman; mänskliga relationer och livsförhållanden, sjukvårdspersonalens arbete och deras inställning, patientens fysiska samt psykiska hälsa. Dessa kan påverka patientens compliance antingen på ett positivt eller negativt sätt. Slutsats: Compliance kan delas in i tre huvudteman, socioekonomisk status och livsförhållanden, sjukvårdspersonalens arbete och deras inställning och slutligen patientens psykiska samt fysiska hälsa. Klinisk betydelse: FaR kan ses som en fortsättning av sjuksköterskans hälsofrämjande arbetsuppgifter. Uppsatsen kan bidra till en ökad kunskap om hur sjuksköterskor i synnerlighet men även annan vårdpersonal kan bidra till att patientens compliance når upp till en så hög nivå som möjligt. / Background: Exercise on Prescription (EoP) is a new way of treating patients, and is being used today to initiate physical activity among patients with lifestyle related diseases, or patients at risk of such diseases. Today the normal treatment is to use medication, but EoP can be an alternative that minimize the need for traditional medication as well as empower and motivate the patients to change their lifestyle. Healthcare staff must know how to increase patient compliance. Purpose: The purpose of this study was to examine factors that can affect patient compliance to FaR. Method: The method used was a convergent mixed method, which combines qualitative and quantitative text analysis of 17 articles, 10 of which were quantitative and 7 qualitative.  Results: The data analysis resulted in the conclusion that the patient compliance in relation to EoP was mainly influenced by three themes; social relations and living conditions, the healthcare professionals the patient interact with and their attitude towards EoP, and the patient's physical and mental health. These themes can affect the patient compliance to a either negative or positive outcome. Conclusion: Compliance can be subdivided into three major themes: Socioeconomic status and living conditions, the work done by healthcare staff and their attitude and finally the physical and psychological health of the patients. Clinical significance: FaR is a logical progression on the health-promoting work done by nurses. This work aims to further the knowledge on how nurses in particular, but also other health care professions, can contribute to helping the patient reach the best compliance possible.

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

Thesis (M.S.)--University of Michigan, 1991. / eContent provider-neutral record in process. Description based on print version record.

Thesis (M.S.)--University of Michigan, 1991. / eContent provider-neutral record in process. Description based on print version record.