Darbo tikslas - Įvertinti šeimos gydytojų požiūrį į farmacijos kompanijų medicinos atstovų teikiamą informaciją apie vaistus ir nustatyti, kaip ta informacija pasitelkiama, skiriant vaistus pacientams. Tyrimo metodika. 2008 m. balandžio – gruodžio mėnesiais, buvo apklausti Kauno mieso šeimos gydytojai dirbantys viešosiose ir privačiose įstaigose. Buvo išdalintos 229 anketos, atsakė – 133 respondentai (atsakas – 58, 1 proc.). Anketiniai duomenys analizuoti naudojant statistinę duomenų analizės programą SPSS 13.0. Statistinis duomenų reikšmingumas tikrintas pagal Chi kvadrato kriterijų, laisvės laipsnių skaičių ir statistinį reikšmingumą (p). Hipotezė apie dviejų nepriklausomų imčių vidurkių lygybę buvo tikrinama naudojant Mann – Whitney testą. Rezultatai. Dažniausiai šeimos gydytojai informaciją apie vaistus sužino medicinos atstovų individualių vizitų metu. Efektyviausi būdai informacijai apie vaistus sužinoti yra konferencijos, individualūs medicinos atstovų vizitai, bei specialisto vedamos apvalaus stalo prezentacijos. Lankančių šeimos gydytojus medicinos atstovų profesija dažniausiai yra gydytojai ir farmacininkai. Beveik trys ketvirtadaliai (72,2 proc.) šeimos gydytojų pastebi skirtingų profesijų medicinos atstovų kompetencijos skirtumus ir geriausiai vertina gydytojų bei farmacininkų kompetenciją pateikiant informaciją apie vaistus. Didžioji dalis (71,4 proc.) šeimos gydytojų bendravimą su medicinos atstovais vertina kaip dalykinį, jų nuomone, bendraujant su medicinos... [toliau žr. visą tekstą] / Aim of the study. To evaluate general practitioners view on how pharmaceutical companies present information about medicines and to determine how this information is used by doctors while prescribing them for patients. Methods. The general practitioners, who worked in private and public health centers in Kaunas city, were anonymously questioned from April to December in 2008. In total, 229 questionnaires were distributed, 133 of which were answered and returned back (the response rate was 58%). Statistical analysis of the obtained data was performed using the SPSS v. 13.0 software package. The associations between the variables were tested by Chi squared test. The hypothesis about the differences between means of two independent samples was evaluated using a criterion of Mann-Whitney test. Results. General practitioners most often get information about medicines from personal visits of medical representatives. The most effective ways of finding out the information about medicines are conferences, personal visits of medical representatives and round table meetings lead by specialists. General practitioners were most often visited by medical representatives who have doctor’s or pharmacist‘s qualifications. Almost three quaters (72.2%) of general practitioners have noticed different competence in qualification of medical representatives and those who had doctor‘s or pharmacist‘s qualification were evaluated best in providing the information about medicines. The greater part (71... [to full text]

Ce mémoire de maîtrise porte sur le concept d’identité organisationnelle, appliqué au milieu des organisations humanitaires. Le contexte mondial actuel dans lequel évoluent ces organisations leur impose de revoir certaines de leurs valeurs et façons de faire. En effet, les équipes des ONG sur le terrain sont confrontées à des conflits de plus en plus nombreux et complexes, qui remettent en question l’identité de leur organisation. Cette recherche vise à dresser un portrait du travail des employés de l’organisation Médecins Sans Frontières (MSF) lors de missions humanitaires, alors que ceux-ci doivent justifier et négocier la présence de l’organisation auprès de la population et des autorités locales. En nous basant sur le concept de sensemaking développé par Karl E. Weick, nous présentons une analyse narrative des récits de mission de cinq employés de MSF. Cette analyse permet d’étudier comment, au quotidien, les employés d’une ONG le terrain sont impliqués dans des négociations où l’identité organisationnelle est continuellement menacée et remise en question. / This thesis focuses on the concept of organizational identity, applied to humanitarian organizations. The actual international context is forcing these organizations to review some of their core values and procedures. Consequently, their teams on the field are confronted with more and more conflicts and complex situations where the organisation’s identity is at stake. The aim of this research is to produce a better understanding of the work that employees of Doctors Without Borders (MSF) do on the field during a mission, especially when they have to justify and negotiate the presence of their organisation with the local populations and authorities. Based on Karl E. Weick’s concept of sensemaking, we present a narrative analysis of fieldwork stories we collected by conducting interviews with five MSF employees. Not only does this analysis help us understand the roles employees have to play on the field, but it also provides insight into the different situations when organizational identity is being negotiated.

Aim of the study: to survey pupils’ opinion regarding healthcare service organizing in boarding schools of Vilnius city. Objectives: to evaluate healthcare service organizing, to evaluate factors haveing influence in the relations between doctors and children; to compare health care service organizing between boarding schools of Vilnius city. Methods: a sample anonymous survey of 193 pupils aged between 10 and 18 was conducted. Results were compared between two surveyed boarding schools. SPSS statistics software (SPSS 10.0) was used to measure the statistical significance of the results. Results: School nurses play an important role in health care organizing within schools. Almost a half of pupils reported to have been registered with a doctor by school nurses. 84 % of younger pupils stated that nurses accompany them to the health centers. More than a half of pupils surveyed (53.9 %) indicated that average waiting time in health centre, prior to being admitted to the consulting-room, was between 10 to 20 minutes. The majority of pupils asserted that doctors have not provided them with accurate information regarding their health status; only 51 % of them believe that doctors would keep information about their health status in secret. Only 1 of ten children remarked, that doctor wasn’t attentive to him. Conclusions: Sufficient attention has been paid to the healthcare organization in Vilnius boarding schools, healthcare services have been provided in time, unfortunately... [to full text]

Problématique : La collaboration entre infirmières et médecins est un élément crucial lorsque la condition des patients est instable. Une bonne collaboration entre les professionnels permet d’améliorer la qualité des soins par l’identification des patients à risques et l’élaboration de priorités dans le but de travailler à un objectif commun. Selon la vision des patients et de leur famille, une bonne communication avec les professionnels de la santé est l’un des premiers critères d’évaluation de la qualité des soins. Objectif : Cette recherche qualitative a pour objectif la compréhension des mécanismes de collaboration interprofessionnelle entre médecins et infirmières aux soins intensifs. L’étude tente également de comprendre l’influence de cette collaboration sur la communication entre professionnels/ patients et famille lors d’un épisode de soins. Méthode : La collecte de données est réalisée par le biais de 18 entrevues, qui ont été enregistrées puis retranscrites. Parmi les entrevues effectuées deux gestionnaires, six médecins et infirmières, et enfin dix patients et proches ont été rencontrés. Ces entrevues ont été codifiées puis analysées à l’aide du modèle de collaboration interprofessionnelle de D’Amour (1997), afin de déterminer les tendances de collaboration. Pour terminer, l’impact des différentes dimensions de la collaboration sur la communication entre les professionnels/ patient et famille a été analysé. Résultats : Médecins et infirmières doivent travailler conjointement tant avec les autres professionnels, que les patients et leur famille afin de développer une relation de confiance et une communication efficace dans le but d’établir des objectifs communs. Les patients et les familles désirent rencontrer des professionnels ouverts qui possèdent des talents de communicateur ainsi que des qualités interpersonnelles. Les professionnels doivent faire preuve de transparence, prendre le temps de donner des explications vulgarisées, et proposer aux patients et aux familles de poser leurs questions. / Problem : The collaboration between nurses and physicians is a key element when the patient's condition is unstable. Good collaboration between these professionals allows improvement on the quality of care by identifying patients at risk and by establishing priorities so that we work towards the same goal. Patients and their families who experience the Intensive Care Unit improved when the messages provided are coherent, giving the sense of control and decision making back to the patient and their families. Objectif : The goal of this qualitative research is to better understand the mechanisms of collaboration between nurses and physicians during the daily interdisciplinary rounds the Intensive Care Units. It will also attempt to understand the influence of these behaviours on the communication between these professionals, the patients and their families. Method : The data collection is carried out via 18 interviews, which will first be recorded and then retranscribed. The interviews are done with 2 managers, six following with medical staffs and nurses and ten patients and close family members. These interviews have been coded and analyzed using the interprofessional collaboration model of D‟Amour (1997) in order to obtain the collaboration tendencies. Lastly, the impact of the different dimensions of collaboration on the communication between professionals/ patients and families have been analyzed. Results : In order to establish common objectives, all healthcare professionals must work together with the patients and their family to develop a trusting relationship and an effective communication. Patients and their family want to see professionals who are open, possessing communication and interpersonal skills. They must also be transparent, taking the time to provide popularized explanations and offer question periods to the patients and their family.

The relationship between the Socialist Unity Party [SED] and the medical intelligentsia in the German Democratic Republic [GDR] has often been described as one of the most problem-atic for the Republic‟s political vanguard. This thesis discusses this relationship for the two dec-ades after the erection of the Berlin Wall in 1961. With the inability of East German workers to leave for West Germany after this event, the GDR was able to enforce their programme of so-cialist development in a new way. Doctors, despite being crucial for this socialist society and its legitimacy, were not excluded from the state‟s radical new policies. However, as files from the former state security apparatus, party and trade union make obvious, doctors were very success-ful in preventing both the ideological conditioning of their community and state interference in the composition of the medical elite. With the examination of the every-day life of the medical intelligentsia, especially in East German hospitals, this thesis contributes to the discussion about the difference between the claims of the socialist party and the realities faced in the healthcare sector. There were a variety of complex reasons for the increasing distance between the state‟s claim and reality, many of which will be analysed in the course of this work. This analysis is, em-bedded in a historical approach, outlined mainly by Mary Fulbrook, which sets the micro-level in the context of the macro-level, considering the correlation between the claim and ideology of the SED, their communication, mechanisms and policies reaching the boundaries of the social con-glomerate of doctors, as well as their reactions, career aspirations and pre-conditions. For the seventies, a whole section is dedicated to exploring the reasons that the medical intelligentsia was one of the main-clients of so-called „human trafficking gangs‟, enabling insight into their situa-tion and the attitude towards the socialist state, which led them to „vote with their feet‟. This the-sis demonstrates, especially for the sixties and seventies, that there is still much potential for fur-ther research, in to the case of the most ideologically unreliable social group in the GDR: the medical intelligentsia.

Due to the fact that the function of dispensing is not the exclusive practice of a single profession, there is much conflict surrounding the issue: it forms the crux of the pharmacy profession but it also forms part of doctors’ scope of practice. Separation of the acts of prescribing and dispensing would prevent the interest of the doctor, who has the potential to profit from selling medicines, being placed above the interest of the patient. It would, however, also affect the essential services that many dispensing doctors provide to pensioners, unemployed patients, those not covered by a medical scheme and those in rural areas. The implications of doctor dispensing are not clear as conflicting evidence suggests that dispensing doctors prescribe more medicine items, injections and antibiotics while preferring certain brand names on the one hand but on the other, evidence shows that dispensing doctors dispensed less expensive medicines compared to other health care providers. The main objective of this study was to analyse the prescribing patterns of dispensing doctors and other medicine providers in a section of the private health care sector of South Africa for 2005 to 2008 by using a medicine claims database. A retrospective drug utilisation review was conducted by extracting data from a medicine claims database for a four–year period, from 1 January 2005 to 31 December 2008. The results revealed that dispensing doctors had a lower cost per prescription compared to other health care providers (R112.66 ± R4.45 vs. R258.48 ± R23.93) and also had a lower cost per medicine item (R39.62 ± R2.18 vs. R112.43 ± R7.56) for the entire study period from 2005 to 2008. Dispensing doctors provided more items per prescription compared to other health care providers (2.85 ± 0.05 items vs. 2.30 ± 0.06 items) but other health care providers claimed more prescriptions per patient per year (7.50 ± 1.15 prescriptions vs. 3.29 ± 0.07 prescriptions). A higher percentage of generic medicine items were provided to patients visiting dispensing doctors. Dispensing doctors treated a majority of patients aged above 19 to 44 years of age while other health care providers treated a majority of patients above 59 years of age. Both dispensing doctors and other health care providers treated a majority of female patients and issued a majority of medicine items to treat acute conditions. The results also revealed that dispensing doctors generally provided relatively inexpensive medicine items, including generic and innovator items, for female and male patients of all ages while other health care providers showed the opposite trend and issued relatively expensive medicine items to these patients. However, when analysing the top twelve pharmacological groups claimed, dispensing doctors had relatively higher costs compared to other health care providers for nine of the pharmacological groups (central nervous system, analgesic, cardio–vascular, ear, nose and throat, dermatological, urinary system, antimicrobial, endocrine system and cytostatic). The pharmacological groups contributing to the highest number of medicine items and highest medicine cost contribution were the antimicrobial group for dispensing doctors and cardio–vascular group for other health care providers. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

Due to the fact that the function of dispensing is not the exclusive practice of a single profession, there is much conflict surrounding the issue: it forms the crux of the pharmacy profession but it also forms part of doctors’ scope of practice. Separation of the acts of prescribing and dispensing would prevent the interest of the doctor, who has the potential to profit from selling medicines, being placed above the interest of the patient. It would, however, also affect the essential services that many dispensing doctors provide to pensioners, unemployed patients, those not covered by a medical scheme and those in rural areas. The implications of doctor dispensing are not clear as conflicting evidence suggests that dispensing doctors prescribe more medicine items, injections and antibiotics while preferring certain brand names on the one hand but on the other, evidence shows that dispensing doctors dispensed less expensive medicines compared to other health care providers. The main objective of this study was to analyse the prescribing patterns of dispensing doctors and other medicine providers in a section of the private health care sector of South Africa for 2005 to 2008 by using a medicine claims database. A retrospective drug utilisation review was conducted by extracting data from a medicine claims database for a four–year period, from 1 January 2005 to 31 December 2008. The results revealed that dispensing doctors had a lower cost per prescription compared to other health care providers (R112.66 ± R4.45 vs. R258.48 ± R23.93) and also had a lower cost per medicine item (R39.62 ± R2.18 vs. R112.43 ± R7.56) for the entire study period from 2005 to 2008. Dispensing doctors provided more items per prescription compared to other health care providers (2.85 ± 0.05 items vs. 2.30 ± 0.06 items) but other health care providers claimed more prescriptions per patient per year (7.50 ± 1.15 prescriptions vs. 3.29 ± 0.07 prescriptions). A higher percentage of generic medicine items were provided to patients visiting dispensing doctors. Dispensing doctors treated a majority of patients aged above 19 to 44 years of age while other health care providers treated a majority of patients above 59 years of age. Both dispensing doctors and other health care providers treated a majority of female patients and issued a majority of medicine items to treat acute conditions. The results also revealed that dispensing doctors generally provided relatively inexpensive medicine items, including generic and innovator items, for female and male patients of all ages while other health care providers showed the opposite trend and issued relatively expensive medicine items to these patients. However, when analysing the top twelve pharmacological groups claimed, dispensing doctors had relatively higher costs compared to other health care providers for nine of the pharmacological groups (central nervous system, analgesic, cardio–vascular, ear, nose and throat, dermatological, urinary system, antimicrobial, endocrine system and cytostatic). The pharmacological groups contributing to the highest number of medicine items and highest medicine cost contribution were the antimicrobial group for dispensing doctors and cardio–vascular group for other health care providers. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

Rural and remote areas of Australia remain the last bastion of health disadvantage in a developed nation with an enviable health score-card. During the last ten years, rural and remote health has emerged as a significant issue in the media and the political arena. This thesis examines print media, policy documents and interviews from selected informants to ascertain how they represent medical practitioners and health services in rural and remote areas of Australia, why they do so, and the consequences of such positions. In many of these representations, rural and remote medical practitioners are aligned with national and cultural mythologies, while health services are characterised as dysfunctional and at crisis point. Ostensibly, the representations and identity formulations are aimed at redressing the health inequities in remote rural and Australia. They define and elaborate debates and contestations about needs and claims and how they should be addressed; a process that is crucial in the development of professional identity and power (Fraser; 1989). The research involves an analysis and critical reading of the entwined discourses of culture, power, and the politics of need. Following Wodak and others (1999), these dynamics are explored by examining documents that are part of the discursive constitution of the field. In particular, the research examines how prevailing cultural concepts are used to configure the Australian rural and remote medical practitioner in ways that reflect and advance socio-cultural hegemony. The conceptual tools used to explore these dynamics are drawn from critical and post-structural theory, and draw upon the work of Nancy Fraser (1989; 1997) and Ruth Wodak (1999). Both theorists developed approaches that enable investigation into the effects of language use in order to understand how the cultural framing of particular work can influence power relations in a professional field. The research follows a cultural studies approach, focussing on texts as objects of research and acknowledging the importance of discourse in the development of cultural meaning (Nightingale, 1993). The methodological approach employs Critical Discourse Analysis, specifically the Discourse Historical Method (Wodak, 1999). It is used to explore the linguistic hallmarks of social and cultural processes and structures, and to identify the ways in which political control and dominance are advanced through language-based strategies. An analytical tool developed by Ruth Wodak, Rudolf de Cillia, Martin Reisigl and Karin Leibhart (1999) was adapted and used to identify nationalistic identity formulations and related linguistic manoeuvres in the texts. The dissertation argues that the textual linguistic manoeuvres and identity formulations produce and privilege a particular identity for rural and remote medical practitioners, and that cultural myth is used to popularise, shore up and advance the goals of rural doctors during a period of crisis and change. Important in this process is the differentiation of rural and remote medicine from other disciplines in order to define and advance its political needs and claims (Fraser, 1989). This activity has unexpected legacies for the rural and remote health sector. In developing a strong identity for rural doctors, discursive rules have been established by the discipline regarding roles, personal and professional characteristics, and practice style; rules which hold confounding factors for the sustainability of remote and rural medical practice and health care generally. These factors include: the professional fragmentation of the discipline of primary medical care into general practice and rural medicine; and identity formulations that do not accommodate an ageing workforce characterised by cultural diversity, decreasing engagement in full time work, and a higher proportion of women participants. Both of these factors have repercussions for the recruitment and retention of rural and remote health professionals and the maintenance of a sustainable health workforce. The dissertation argues that the formulated identities of rural and remote medical practitioners in the texts maintain and reproduce relationships of cultural, political and social power. They have also influenced the ways in which rural and remote health services have been developed and funded. They selectively represent and value particular roles and approaches to health care. In doing so, they misrepresent the breadth and complexities of rural and remote health issues, and reinforce a reputational economy built on differential professional and cultural respect, and political and economic advantage. This disadvantages the community, professions and interest groups of lower value and esteem, and other groups whose voices are often not heard. Thus, regardless of their altruistic motivations, the politics of identity and differentiation employed in the formulated identities in the texts are based on an approach that undermines the redistributive goals of justice and equity (Fraser 1997), and works primarily to develop and advantage the discipline of rural medicine.

The New South Wales Medical Board established a Health Programme for the assessment and rehabilitation of doctors whose clinical performance was impaired by alcohol or psychoactive substance use, mental or physical illness. This programme was developed to be individualized to the needs of each registrant. The present study has three aims: 1. To describe those doctors who participated in the Board???s Health Programme. 2. To chart the duration of involvement of these doctors through the programme. 3. To examine the outcomes associated with this programme. The study is based on the prospective cohort of all 181 impaired doctors who participated in the Health Programme between July 1st 1993 and April 30th 2001. Information on each registrant was collected at the time of the initial assessment and at each review conducted as part of the programme. Additional qualitative data was also collected and supplemented by a file audit conducted in August and September 2001. One hundred and eighty-one doctors were prospectively monitored as part of this study. The largest source of impairment was psychiatric illness (45.3%), 77% of the doctors were male. The average age of the cohort was 41.6 (sd 11.1) years. Impaired doctors were more likely to be working in emergency medicine or psychiatry and be based in a rural area. Of those who had finished their involvement in the programme, successful graduates participated for a mean of 38.2 (sd 22.3) months. In general outcomes of involvement were positive, 64 of 113 (56.6%) of doctors successfully graduated from the programme. One hundred and ten of 168 (65.5%) improved during the period of their involvement and 111 of 126 (88.1%) were working in medicine. Five, 2.8% of the participants died during the period of this study. Measures of registrant insight and support tended to increase during the period of involvement with the Health Programme. Future studies will need to establish evidence for the most appropriate interventions with impaired doctors. This process would be strengthened by the collection of standardized data across intervention programmes, supplemented with functional assessments and the collection of qualitative data.

Orientador: Rosa Lúcia Sverzut Baroni / Banca: Sérgio Nobre / Banca: Hygino H. Domingues / Banca: Marcos Vieira Teixeira / Banca: Luiz Jean Lauand / Resumo: Esta pesquisa teve por objetivo o estudo documentado da evolução histórica do Doutorado em Matemática no Brasil, no período de 1842, quando foi instituído o Doutorado na Escola Militar, até 1937 na então Escola Politécnica. Foi articulado a partir de quatro bases: as origens do ensino da Matemática; o ambiente acadêmico em que o doutorado se firmou; a documentação da época (Decretos e Teses) e a biografia dos autores, sendo permeado por dados históricos do Brasil. O trabalho divide-se em duas partes. A primeira parte focaliza a temática proposta. A evolução do trabalho contou com a interferência marcante de documentos originais - fontes primárias, além de fontes secundárias e obras de referência. A segunda parte denominou-se Documental. Esta foi produzida por intensa pesquisa de campo em instituições como a "Biblioteca Nacional - R.J."; "Biblioteca de Obras Raras do Centro Tecnológico - UFRJ."; "Biblioteca do Clube de Engenharia - R.J."; "Bibliotecas da UNESP", além de pesquisas "on-line". Ressaltamos que esse trabalho produziu com exclusividade uma tabela que relaciona as Teses apresentadas, seus Autores e informa a localização atual delas. Trata-se de uma referência aos que pretenderem aprofundar seus estudos em relação à História da Pesquisa Matemática no Brasil. / Abstract: This research aims at investigating the PhD historical development in Mathematics in Brazil, from 1842, when the first PhD course was created in the Militar School, to 1937 when it was created in the Politechnical School. Four bases were used to articulate this study: the origins of Mathematics teaching; the academic environment in which the PhD course was consolidated; historical documentation (Decrees and Thesis) and the autors' biographies, being permeated by Brazilian historical data. The study is divided in two parts. The first one focuses on the theme that was proposed. The evolution of this study counted on the remarking interference of original documents - primary sources, besides the secondary sources and the references. The second part of the study was called Documental. It was carried out with intense fieldwork in institutions like the "National Library in Rio de Janeiro"; "The Library of Rare Works of the Technological Center - UFRJ"; "The Library of the Engeneering Club in Rio de Janeiro"; "The Sao Paulo State University Libraries", besides online research. It is important to highlight that this study has produced with exclusivisity a table that shows the theses presented, their authors and their present location. It is a reference for those who intend to improve their knowledge concerning the History of Mathematics Research in Brazil. / Mestre