Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2007. / LICL has E-Thesis 0023 ; please contact computer services.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2008. / LICL has E-Thesis 0038 ; please contact computer services.

Thesis (D. Min.)--Boston University, 2000. / Abstract. Includes bibliographical references (leaves 170-205).

Thesis (D. Min.)--Boston University, 2000. / Abstract. Includes bibliographical references (leaves 170-205).

Thesis (D. Min.)--Boston University, 2000. / Abstract. Includes bibliographical references (leaves 170-205).

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2016-09-14T17:09:11Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação_Juliano_Biblioteca.pdf: 11130689 bytes, checksum: a577f73fe7d8e20644a19bcc4ba15002 (MD5) / Made available in DSpace on 2016-09-14T17:09:11Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação_Juliano_Biblioteca.pdf: 11130689 bytes, checksum: a577f73fe7d8e20644a19bcc4ba15002 (MD5) Previous issue date: 2016-07-12 / A história da psiquiatria, em sua maior parte, confunde-se com a história dos asilos. Os Hospitais Gerais desenvolveram-se, ao longo da história da medicina, como ambientes em que não havia espaço para os loucos. A partir do século XX, começa a ocorrer uma mudança nesse paradigma, sobretudo nos EUA e na Europa, com a criação das UPHGs em diversos serviços por lá, e a consolidação da Interconsulta psiquiátrica como área de atuação da psiquiatria, que passa a estreitar o contato com o restante da medicina. Foi um movimento que rendeu diversos avanços tanto à psiquiatria quanto às outras áreas médicas. No Brasil, esse percurso começou na década de 1950 e ocorre de forma mais tímida. Apenas 1,1% dos Hospitais gerais contam com suporte da psiquiatria em nosso país atualmente. Contudo, houve espaço no Brasil para o desenvolvimento de projetos pioneiros nesse campo, cuja história não está registrada. A psiquiatria pernambucana foi protagonista na empreitada, inaugurando inclusive a integração da psiquiatria ao hospital geral no Brasil. Pernambuco também foi um dos pioneiros na introdução da clínica psicanalítica em hospitais gerais do serviço público. O presente trabalho pretende registrar a história dessas experiências. Para tanto, escolhemos os serviços da UFPE e do Hospital Barão de Lucena, sedes dos primeiros serviços de saúde mental em hospital geral de Pernambuco. Fez-se uma ampla pesquisa documental, além de serem entrevistados alguns dos principais atores da construção desses serviços. Apesar de difícil, a integração dos cuidados de saúde mental ao hospital geral na UFPE e no HBL conseguiu efetivar-se, a partir da psiquiatria na UFPE e da psicanálise no HBL. Foram espaços configurados e sustentados dentro de uma perspectiva de formação, para além da assistência, e acreditamos que sua longevidade tenha relação com isso. / The history of psychiatry, for the most part, is intertwined with the history of asylums. General Hospitals have developed mostly as environments in which there was no room for the insane. Since the early twentieth century, a paradigm shift takes place, specially in the US and Europe, with the creation of psychiatryc units in several General Hospitals there. It led to the consolidation of Consultation Liaison Psychiatry as an official sub-specialty of Psychiatry. Integration of Psychiatry and other medical specialties was a movement that yielded many advances in both psychiatry as other medical areas. In Brazil, this journey began in the 1950s and is more . Only 1.1% of brazilian general hospitals have psychiatric support nowadays. However, there was room in Brazil for the development of pioneering experiments in this field, whose history is not recorded. Pernambuco’s psychiatry had a key role in these experiments, inaugurating the integration of psychiatry to the general hospital in Brazil. Pernambuco was also one of the first places to have a psychoanalytic couch in public service facilities. This work aims to record the history of these pioneering experiences in the state of Pernambuco. Therefore, we chose the services of UFPE and the Hospital Barão de Lucena, headquarters of general Hospital Psychiatry in Pernambuco. An extensive literature research was done, along with statements collection from some of the major players in the construction of these services. Although difficult, the integration of mental health care to the general hospital at UFPE and HBL was sucessful, arising from psychiatry at UFPE and psychoanalysis at in HBL. They were configured spaces and sustained in a training perspective, and we believe that it explains their longevity.

Submitted by Rafael Santana (rafael.silvasantana@ufpe.br) on 2017-05-12T19:01:29Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação_Juliano_Biblioteca.pdf: 11109168 bytes, checksum: 1032a08c27aa11c40a06a7024ebe6551 (MD5) / Made available in DSpace on 2017-05-12T19:01:29Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação_Juliano_Biblioteca.pdf: 11109168 bytes, checksum: 1032a08c27aa11c40a06a7024ebe6551 (MD5) Previous issue date: 2016-07-12 / A história da psiquiatria, em sua maior parte, confunde-se com a história dos asilos. Os Hospitais Gerais desenvolveram-se, ao longo da história da medicina, como ambientes em que não havia espaço para os loucos. A partir do século XX, começa a ocorrer uma mudança nesse paradigma, sobretudo nos EUA e na Europa, com a criação das UPHGs em diversos serviços por lá, e a consolidação da Interconsulta psiquiátrica como área de atuação da psiquiatria, que passa a estreitar o contato com o restante da medicina. Foi um movimento que rendeu diversos avanços tanto à psiquiatria quanto às outras áreas médicas. No Brasil, esse percurso começou na década de 1950 e ocorre de forma mais tímida. Apenas 1,1% dos Hospitais gerais contam com suporte da psiquiatria em nosso país atualmente. Contudo, houve espaço no Brasil para o desenvolvimento de projetos pioneiros nesse campo, cuja história não está registrada. A psiquiatria pernambucana foi protagonista na empreitada, inaugurando inclusive a integração da psiquiatria ao hospital geral no Brasil. Pernambuco também foi um dos pioneiros na introdução da clínica psicanalítica em hospitais gerais do serviço público. O presente trabalho pretende registrar a história dessas experiências. Para tanto, escolhemos os serviços da UFPE e do Hospital Barão de Lucena, sedes dos primeiros serviços de saúde mental em hospital geral de Pernambuco. Fez-se uma ampla pesquisa documental, além de serem entrevistados alguns dos principais atores da construção desses serviços. Apesar de difícil, a integração dos cuidados de saúde mental ao hospital geral na UFPE e no HBL conseguiu efetivar-se, a partir da psiquiatria na UFPE e da psicanálise no HBL. Foram espaços configurados e sustentados dentro de uma perspectiva de formação, para além da assistência, e acreditamos que sua longevidade tenha relação com isso. / The history of psychiatry, for the most part, is intertwined with the history of asylums. General Hospitals have developed mostly as environments in which there was no room for the insane. Since the early twentieth century, a paradigm shift takes place, specially in the US and Europe, with the creation of psychiatryc units in several General Hospitals there. It led to the consolidation of Consultation Liaison Psychiatry as an official sub-specialty of Psychiatry. Integration of Psychiatry and other medical specialties was a movement that yielded many advances in both psychiatry as other medical areas. In Brazil, this journey began in the 1950s and is more . Only 1.1% of brazilian general hospitals have psychiatric support nowadays. However, there was room in Brazil for the development of pioneering experiments in this field, whose history is not recorded. Pernambuco’s psychiatry had a key role in these experiments, inaugurating the integration of psychiatry to the general hospital in Brazil. Pernambuco was also one of the first places to have a psychoanalytic couch in public service facilities. This work aims to record the history of these pioneering experiences in the state of Pernambuco. Therefore, we chose the services of UFPE and the Hospital Barão de Lucena, headquarters of general Hospital Psychiatry in Pernambuco. An extensive literature research was done, along with statements collection from some of the major players in the construction of these services. Although difficult, the integration of mental health care to the general hospital at UFPE and HBL was sucessful, arising from psychiatry at UFPE and psychoanalysis at in HBL. They were configured spaces and sustained in a training perspective, and we believe that it explains their longevity.

Pain is underdetected and undertreated in people with dementia. We aimed to investigate the prevalence of pain in people with dementia admitted to general hospitals and explore the association between pain and behavioural and psychiatric symptoms of dementia (BPSD). We conducted a longitudinal cohort study of 230 people, aged above 70, with dementia and unplanned medical admissions to 2 UK hospitals. Participants were assessed at baseline and every 4 days for self-reported pain (yes/no question and FACES scale) and observed pain (Pain Assessment in Advanced Dementia scale [PAINAD]) at movement and at rest, for agitation (Cohen–Mansfield Agitating Inventory [CMAI]) and BPSD (Behavioural Pathology in Alzheimer Disease Scale [BEHAVE-AD]). On admission, 27% of participants self-reported pain rising to 39% on at least 1 occasion during admission. Half of them were able to complete the FACES scale, this proportion decreasing with more severe dementia. Using the PAINAD, 19% had pain at rest and 57% had pain on movement on at least 1 occasion (in 16%, this was persistent throughout the admission). In controlled analyses, pain was not associated with CMAI scores but was strongly associated with total BEHAVE-AD scores, both when pain was assessed on movement (b 5 0.20, 95% confidence interval [CI] 5 0.07- 0.32, P 5 0.002) and at rest (b 5 0.41, 95% CI 5 0.14-0.69, P 5 0.003). The association was the strongest for aggression and anxiety. Pain was common in people with dementia admitted to the acute hospital and associated with BPSD. Improved pain management may reduce distressing behaviours and improve the quality of hospital care for people with dementia.

Thesis (M.B.A.)--Massachusetts Institute of Technology, Sloan School of Management; and, (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division; in conjunction with the Leaders for Global Operations Program at MIT, 2011. / Cataloged from PDF version of thesis. / Includes bibliographical references (p. 41-42). / The widely held assumption is that to improve access and quality of health care, we need to spend more. In fact, that is not necessarily true. The results of this project, performed at Massachusetts General Hospital (MGH), demonstrate that more sophisticated management of health care processes will lead to greater capacity and higher quality at lower cost. This work includes system-level analysis of surgical patient flow and reveals several opportunities for performance improvement. The results show that management of variability, both intrinsic to and generated by the perioperative department', will result in lower patient wait times, less crowding, and ultimately higher throughput for surgical patients throughout the hospital. The solution developed here is an "open block" scheduling policy for the operating rooms at MGH. It was designed with the aid of a discrete event simulation model, which was used to refine the policy and predict the impact of the change. By more effectively characterizing and managing the stochastic demand of non-elective surgical cases, this policy will dramatically reduce delays and open capacity for higher case volume. Specifically, it will reduce the number of non-elective surgical patients exceeding maximum recommended wait time from 30% to 2%; it will free up an average of seven inpatient beds per day; and it will lay the foundation for increased operating room utilization - by up to the equivalent of five operating rooms. Indeed, this is merely one example demonstrating that by focusing our efforts on creative healthcare system design and management, we can meet the needs of society and spend less doing so. / by Devon J. Price. / S.M. / M.B.A.

Bakgrund: Patienter med psykisk sjukdom har en ökad risk för somatiska sjukdomar, något som gör att de ofta är tvungna att söka sig till akutmottagningar där de ofta upplever att de inte blir sedda och inte heller trodda på. Tidigare studier visar på att stigmatisering av patienter med psykisk sjukdom förekommer såväl i samhället som hos vårdpersonal. Miljön på akutmottagningar är ofta stökig och sjuksköterskorna har ofta ont om tid. Syfte: Syftet var att undersöka hur sjuksköterskor i den somatiska akutsjukvården upplever att det är att vårda patienter med psykisk sjukdom. Metod: Forskningsdesignen som valdes var intervjustudie med kvalitativ ansats. Nio sjuksköterskor som jobbat på en akutmottagning i minst ett år intervjuades. Intervjuerna genomfördes på två akutmottagningar. Tematisk analys med induktiv ansats valdes som kvalitativ analysmetod. Resultat: Huvudresultaten av studien sammanfattades i två övergripande teman; den kännande sjuksköterskan och den professionella sjuksköterskan. Följande kategorier kunde placeras in i de två nämnda teman: känslor, fördomar, tid och miljö, bemötande och empati, kunskapsbrist och utbildning samt ansvar. Resultatet visade att sjuksköterskorna på akutmottagningar ofta upplevde känslor som frustration och hopplöshet då de vårdar patienter med psykisk sjukdom. Sjuksköterskorna upplevde att tidsbrist, kunskapsbrist och vårdmiljön på akutmottagningarna var faktorer som försämrade möjligheten till ett bra bemötande och god omvårdnad av patienter med psykisk sjukdom. Slutsats: Studiens resultat visar att sjuksköterskor på akutmottagningar stod inför många utmaningar och vården av patienter med psykisk sjukdom försvårades på grund utav flera faktorer. Dessa faktorer var kunskapsbrist, tidsbrist, stress, fördomar, ansvar samt vårdmiljön. Känslor som sjuksköterskorna ofta upplevde vid vårdandet av patienter med psykisk sjukdom var frustration och hopplöshet. / Background: Patients with mental illness have an increased risk of somatic diseases, which means that they are often forced to turn to emergency departments where they often feel unseen nor believed in. Previous studies show that stigmatization of patients with mental illness is present both in the society and among health professionals. The environment in emergency rooms are often messy and nurses often have little time. Aim: The aim was to examine how nurses in an emergency care experience about caring for patients with mental illness. Method: The research design that were chosen was an interview study with a qualitative approach. Nine nurses who worked in an emergency department for at least a year were interviewed. The interviews were conducted in two emergency departments. Thematic analysis with inductive approach was chosen as qualitative analysis. Results: The main results of the study were summarized in to two main themes; the sentient nurse and the professional nurse. The following categories could be placed into the two mentioned themes; feelings, prejudices, time and environment, attitudes and empathy, lack of knowledge and education, and responsibility. The results showed that nurses in emergency departments often experience feelings of frustration and hopelessness as they care for patients with mental illness. The nurses felt that the lack of time, lack of knowledge and the un-adapted environment in emergency departments were factors that worsened the possibility of good treatment and good nursing care of patients with mental illness. Conclusion: The results of the study show that nurses in emergency departments were facing many challenges and that the care of patients with mental illness was complicated because out of several factors. These factors were such as lack of knowledge, lack of time, stress, responsibility, preconception and the un-adapted environment. Feelings that nurses often experienced in the care of patients with mental illness was frustration and hopelessness.