O cardioversor-desfibrilador implantável (CDI) é um dispositivo eletrônico utilizado no tratamento de pacientes com episódios ou risco de parada cardíaca. Tem a capacidade do monitoramento contínuo do ritmo cardíaco para o reconhecimento de arritmias fatais e o consequente disparo de choques para revertê-las. Esses choques elétricos são classificados como apropriados quando o disparo ocorre em decorrência de arritmia potencialmente fatal, ou inapropriados quando o CDI dispara o choque em função de interpretação incorreta dos batimentos cardíacos. Em geral, ocorrem com o paciente consciente provocando desconforto inesperado, geralmente de forte intensidade. A maneira como o paciente vivencia tais acontecimentos, suas reações e sua capacidade de enfrentamento diante de situações inesperadas influenciam de forma relevante sua adaptação à doença e ao CDI. Além disso, o dispositivo é um objeto estranho alojado dentro do corpo, que remete a falha no funcionamento cardíaco, podendo despertar sentimentos ambivalentes e dificuldade de elaboração. Assim, o principal objetivo desse estudo foi descrever e compreender como os pacientes entrevistados vivenciaram e se adaptaram ao implante do CDI a partir das quatro variáveis possíveis relacionadas ao funcionamento do dispositivo: ausência de choques, presença de choques apropriados, presença de choques inapropriados e presença de choques mistos (apropriados e inapropriados). Para tanto, foi utilizado o método clínico-qualitativo. Foram realizadas entrevistas semi-estruturadas com 4 pacientes submetidos ao implante de CDI que representam cada uma das variáveis. Os critérios de inclusão foram pacientes do sexo masculino, com cardiopatia isquêmica prévia, implante do CDI como prevenção primária ou secundária de morte súbita cardíaca (MSC), idade entre 50 e 70 anos e dispositivo implantado há, pelo menos, dois anos. Todos os pacientes foram selecionados no ambulatório da Unidade Clínica de Estimulação Cardíaca Artificial do Instituto do Coração HC-FMUSP (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo). Os dados foram analisados a partir do referencial Piscossomático e Psicanalítico Freudiano e categorizados posteriormente pela Escala Diagnóstica Adaptativa Operacionalizada Revisada (EDAO-R). Os resultados demonstraram que a adaptação, segundo o conceito utilizado, ao impacto do CDI e do choque está diretamente ligada ao impacto do IAM e do adoecimento como um todo, e as reações dos pacientes diante dos diferentes episódios parecem análogas evidenciando que só é possível compreender as repercussões psíquicas relativas ao CDI a partir da compreensão das repercussões causadas pela doença que levou o paciente a ter o dispositivo implantado. Um paciente demonstrou estar adaptado ao adoecimento e ao CDI, embora não tenha vivenciado episódios de choque, e os outros três pacientes demonstraram estar em processo de adaptação, vivenciando conflitos psíquicos que influenciam sua capacidade adaptativa. Existem evidências de que, se intervenções psicológicas e informativas forem adotadas, esse processo ocorrerá de maneira mais eficaz / The implantable cardioverter - defibrillator (ICD) is an electronic device used to treat patients with episodes or risk of cardiac arrest. It is able to continuously monitor of the patients heart rate for the recognition of fatal arrhythmias and the consequent triggering of shocks to reverse them. These electric shocks are classified as appropriate when the triggering occurs due to potentially fatal arrhythmias or inappropriate when the ICD fires the shock due to incorrect interpretation of the heart beat. In general, the shocks occur while patients are conscious, thus causing unexpected discomfort of strong intensity. The way the patient experiences such events, their reactions and their ability to cope with unexpected situations substantially influence their adaptation to the disease and to ICD. Furthermore, the device is a foreign object lodged inside the body, which refers to a malfunction of the heart and may arouse ambivalent feelings and difficulty of adaptation. Thus, the main objective of this study was to describe and understand how surveyed patients experienced and adapted to ICD implantation from the four variables related to operation of the device: the absence of shocks, the presence of appropriate shocks, the presence of inappropriate shocks and presence of (appropriate and inappropriate) mixed shocks. In order to carry out the study, the clinical-qualitative method was used. Semi-structured interviews were conducted with 4 patients undergoing ICD implantation that represent each variable. Inclusion criteria were male patients with previous ischemic heart disease, ICD implantation as primary or secondary prevention procedure of sudden cardiac death (SCD ), aged between 50 and 70 years who had the implanted device for at least two years. All patients were selected from the outpatient clinic of the Clinical Unit of Cardiac Pacing of the Heart Institute - HC - USP (Hospital das Clinicas, Medical School, University of São Paulo). Data were analyzed having the Psychosomatic and Freudian Psychoanalytic referential and subsequently categorized by the Revised Operational Adaptive Diagnostic Scale (ROADS). The results have shown that adaptation (according to the concept used) to the impact of ICD and shock is directly linked to the impact of AMI and to the disease as a whole and that the reactions of patients on the different episodes seem analogous, showing that you can only understand psychic repercussions on the ICD from the understanding of the effects caused by the disease that led the patient to have the device implanted. One of the patients proved to be adapted to the illness and the ICD, although he has not experienced episodes of shock while the other three patients demonstrated to be somewhere along the adaptation process, having experienced psychic conflicts that influence their adaptive capacity. There is evidence that if psychological interventions are adopted, this adaptation process will occur much more effectively

There has been an increase of attention placed on the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), within South Africa. This has led to a number of controversies surrounding the legitimacy of ADHD diagnoses. And how effective the systems of categorising and diagnosing disorders are in aiding a number of practitioners in formulating a disorder. There is a substantial agreement within the literature that the understanding of ADHD is limited, the focus is mainly on the symptoms of disorders. This study explores the perceptions practitioners in the field, in identifying the effectiveness of the Diagnostic and Statistical Manual for Mental disorders (DSM) is for diagnosing ADHD. It became evident throughout this study that there is no consensus around the efficacy of the DSM. Furthermore, ADHD is not completely understood and therefore creates serious implications for the treatment and diagnosis of the disorder.

Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

Osteoarthritis (OA) is the leading cause of disability in North American and has major economic consequences for society. People with knee OA experience the worst quality of life, among musculoskeletal conditions, with function and mobility being influenced by symptoms such as pain and stiffness. However, the impact of OA symptoms varies due to intrinsic and extrinsic factors, leading many researchers to employ biopsychosocial and other population health frameworks to study the disease. These population health approaches have not been adopted when studying knee OA outcomes in bioarchaeology, where a limited biological lens prevails due to the sole reliance on skeletal remains. The purpose of this research was to explore methods for identifying the impairment potential of knee OA in archaeological populations using a clinical sample and population health approaches. Clinical studies have the advantage of assessing not only the biological implications of knee OA but also the functional outcomes. By creating a knee OA grading system applicable for both MRI and dry bone femora samples (Clinical Archaeological Osteoarthritis Score) a link between clinical and archaeological populations was proposed. Using this link to infer functional deficits onto archaeological populations using population health frameworks, a theoretical analysis was performed with two populations; the 17th century Huron and the 19th century Inuit from the Igloolik region of Nunavut. The results demonstrated the increased impairment potential of knee OA in the Inuit population versus the Huron population, produced by contrasting factors captured by the determinants of health, including social and physical environments.

No description available.

According to the National Drug Policy one of the health services objectives is to ensure the availability and accessibility of essential drugs to all citizens. An economic objective of the same policy is to promote the cost-effective and rational use of drugs (Department of Health, 1996). Currently, there is no system to scientifically determine the usage of medicines in the public sector and whether the current usage is satisfactory enough (John, 2004:2). The World Health Organization states that "good drug supply management is an essential component of effective and affordable health care services globally (World Health Organization, 1998:1). In the South African context, even though the Essential Drug List helps health care professionals to treat diseases in the public sector, it does not prescribe the minimum guidelines for medicine supply systems (Department of Health, 2006a). The general objective of this study was to develop a therapeutic medicine budget model in a district hospital in the public sector of the North-West Province to control medicine usage. This can be done after analysing the medicine usage patterns and then developing a framework for therapeutic budgeting by evaluating appropriate systems, i.e. the International Code for Disease (ICD-10) classification system, with the therapeutic budget model framework. Retrospective drug utilisation of six months (January 2007 until June 2007) was documented. A random sample population of 25% was selected (n = 1 494). After the data collection period of 9 weeks, the actual study population was only 18.67% (only 1 166 of the 1 494 patients files had a medicine history). All the medicine items prescribed were classified in the therapeutic budget model. Patient confidentially was assured by using a unique pin number on the survey form, so that no names of patients or other biographical details were collected from the patient files onto the survey form, which is in line with the requirements of the Ethics Committee approval conditions for the North-West University. The total number of medicine items dispensed during the study period was 11 768. The average cost per medicine item was R19.36 ± 86.79 for inpatients. The total number of consultations was 3 220. The average number of medicine items per consultation was 3.66 ± 1.98. The total cost of medicine items during the study period was R244 677.11. The average medicine cost per consultation for inpatients was R70.80 ± 177.72. The top three budget groups according to frequency represented 68.11% of all medicine used according to budget groups. The top three pharmacological groups according to total cost represented 61.68% of the total cost of pharmacological groups. The top three therapeutic codes according to frequency represented 18.75% of all therapeutic codes. The top three ICD-10 codes based on total cost represented 59.35% of all medical conditions diagnosed. The total hospital budget for 2007 was predicted at R3 276 750.00. Of this budget, 75% was for pharmaceuticals (R2 457 562.50). The total pharmaceutical medicine cost (excluding surgicals) from the study was R224 677.11 (this was for 18.67% of the total patient visits for six months) which can be calculated at R2 406 824.96 for all patients visits in a full year. The correlation between the actual budget and the projected budget showed a R50 737.54 surplus in the budget of the hospital. A therapeutic budget model can also help in achieving the following: • Proper preparation and planning of budgetary policies in a phased manner based on scientific evidence; • Evaluation of budgetary compliance, cost-efficiency of therapy and standard treatment guidelines (STG) / Essential Drug List (EDL) / formulary compliance; • Better procurement strategies based on demand, expenditure and inventory control; and • Better delivery and maintenance of quality health care by evaluating operational and clinical policies. The therapeutic budget model is a more appropriate manner to use in the projections of budgets and medicine usage. The scope of a therapeutic budget model to be implemented in the hospitals in the public sector of the North-West Province seems to be promising. / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

Osteoarthritis (OA) is the leading cause of disability in North American and has major economic consequences for society. People with knee OA experience the worst quality of life, among musculoskeletal conditions, with function and mobility being influenced by symptoms such as pain and stiffness. However, the impact of OA symptoms varies due to intrinsic and extrinsic factors, leading many researchers to employ biopsychosocial and other population health frameworks to study the disease. These population health approaches have not been adopted when studying knee OA outcomes in bioarchaeology, where a limited biological lens prevails due to the sole reliance on skeletal remains. The purpose of this research was to explore methods for identifying the impairment potential of knee OA in archaeological populations using a clinical sample and population health approaches. Clinical studies have the advantage of assessing not only the biological implications of knee OA but also the functional outcomes. By creating a knee OA grading system applicable for both MRI and dry bone femora samples (Clinical Archaeological Osteoarthritis Score) a link between clinical and archaeological populations was proposed. Using this link to infer functional deficits onto archaeological populations using population health frameworks, a theoretical analysis was performed with two populations; the 17th century Huron and the 19th century Inuit from the Igloolik region of Nunavut. The results demonstrated the increased impairment potential of knee OA in the Inuit population versus the Huron population, produced by contrasting factors captured by the determinants of health, including social and physical environments.

According to the National Drug Policy one of the health services objectives is to ensure the availability and accessibility of essential drugs to all citizens. An economic objective of the same policy is to promote the cost-effective and rational use of drugs (Department of Health, 1996). Currently, there is no system to scientifically determine the usage of medicines in the public sector and whether the current usage is satisfactory enough (John, 2004:2). The World Health Organization states that "good drug supply management is an essential component of effective and affordable health care services globally (World Health Organization, 1998:1). In the South African context, even though the Essential Drug List helps health care professionals to treat diseases in the public sector, it does not prescribe the minimum guidelines for medicine supply systems (Department of Health, 2006a). The general objective of this study was to develop a therapeutic medicine budget model in a district hospital in the public sector of the North-West Province to control medicine usage. This can be done after analysing the medicine usage patterns and then developing a framework for therapeutic budgeting by evaluating appropriate systems, i.e. the International Code for Disease (ICD-10) classification system, with the therapeutic budget model framework. Retrospective drug utilisation of six months (January 2007 until June 2007) was documented. A random sample population of 25% was selected (n = 1 494). After the data collection period of 9 weeks, the actual study population was only 18.67% (only 1 166 of the 1 494 patients files had a medicine history). All the medicine items prescribed were classified in the therapeutic budget model. Patient confidentially was assured by using a unique pin number on the survey form, so that no names of patients or other biographical details were collected from the patient files onto the survey form, which is in line with the requirements of the Ethics Committee approval conditions for the North-West University. The total number of medicine items dispensed during the study period was 11 768. The average cost per medicine item was R19.36 ± 86.79 for inpatients. The total number of consultations was 3 220. The average number of medicine items per consultation was 3.66 ± 1.98. The total cost of medicine items during the study period was R244 677.11. The average medicine cost per consultation for inpatients was R70.80 ± 177.72. The top three budget groups according to frequency represented 68.11% of all medicine used according to budget groups. The top three pharmacological groups according to total cost represented 61.68% of the total cost of pharmacological groups. The top three therapeutic codes according to frequency represented 18.75% of all therapeutic codes. The top three ICD-10 codes based on total cost represented 59.35% of all medical conditions diagnosed. The total hospital budget for 2007 was predicted at R3 276 750.00. Of this budget, 75% was for pharmaceuticals (R2 457 562.50). The total pharmaceutical medicine cost (excluding surgicals) from the study was R224 677.11 (this was for 18.67% of the total patient visits for six months) which can be calculated at R2 406 824.96 for all patients visits in a full year. The correlation between the actual budget and the projected budget showed a R50 737.54 surplus in the budget of the hospital. A therapeutic budget model can also help in achieving the following: • Proper preparation and planning of budgetary policies in a phased manner based on scientific evidence; • Evaluation of budgetary compliance, cost-efficiency of therapy and standard treatment guidelines (STG) / Essential Drug List (EDL) / formulary compliance; • Better procurement strategies based on demand, expenditure and inventory control; and • Better delivery and maintenance of quality health care by evaluating operational and clinical policies. The therapeutic budget model is a more appropriate manner to use in the projections of budgets and medicine usage. The scope of a therapeutic budget model to be implemented in the hospitals in the public sector of the North-West Province seems to be promising. / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.