A prestação do serviço de Odontologia dentro do ambiente hospitalar teve início devido aos benefícios observados com o trabalho de equipes multidisciplinares no cuidado com a saúde. De modo geral, os pacientes são atendidos pelos cirurgiõesdentistas dentro dos hospitais terciários porque sua condição de saúde impede a realização dos procedimentos em consultórios ou unidades de saúde, devido, entre outros, à dificuldade de locomoção ou falta de equipe treinada para atender portadores de enfermidades sistêmicas. Estudos que enfocam esse tema têm observado benefícios importantes na condição de saúde do paciente. Dessa forma, o presente trabalho teve como objetivos: Caracterizar o Serviço de Odontologia Hospitalar no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, nos seguintes aspectos: 1) assistencial: relacionar as atividades quanto ao número de atendimentos por tipo, procedência do paciente (internado ou ambulatorial), patologias de base e enfermaria específica; 2) financeiro: identificar a receita SUS dos procedimentos odontológicos realizados e identificar os custos do Serviço de Odontologia Hospitalar, e 3) percepção dos profissionais cirurgiõesdentistas e Chefes das especialidades médicas usuárias dos serviços de odontologia hospitalar, quanto aos serviços prestados, e a satisfação dos usuários pacientes. Foi realizada uma pesquisa exploratória descritiva com dados relativos ao ano de 2016, através de um estudo de caso. Para identificar a percepção dos profissionais e satisfação dos pacientes com os serviços odontológicos prestados pelo Hospital foram aplicados (em 2017) questionários específicos. Os resultados demonstraram prevalência de atendimentos ambulatoriais, sendo que os principais procedimentos realizados foram tratamentos periodontais, cirurgias e laserterapia. Quanto ao aspecto financeiro, observou-se que nem todos os procedimentos são reembolsados pelo SUS e seus custos ultrapassam o valor recebido. A receita media SUS e o custo por atendimentos foram R$ 59,91 e R$ 5,36 respectivamente. O estudo permitiu também concluir que a percepção / satisfação nas três esferas analisadas é positiva em relação do serviço prestado. Espera-se que as informações encontradas forneçam subsídios para a melhoria contínua do serviço existente dentro do hospital, bem como para outros gestores que desejam implantar a Odontologia Hospitalar em outros centros de referência. / The provision of Dentistry service within the hospital environment began due to the benefits observed with multidisciplinary healthcare providers working together. In general, patients are attended by dentists at tertiary referral hospitals because their health condition which prevents the procedures to be performed in the clinic or health units, due, among others, to the difficulty of locomotion or lack of trained personnel to attend patients with systemic diseases. Studies that focus on this theme have observed important benefits in patient\'s health condition. Thus, the present study aimed to characterize the activities and procedures performed by the team of dental surgeons at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP in 2016 under the following aspects: 1) assistential: to relate the activities regarding the number of attendances according to the patient origin (ambulatory or nursery) and base pathology; 2) financial: identify the oral care procedures SUS revenues obtained and the costs incurred providing the service, and 3) stakeholders perception / satisfaction: evaluate the perception / satisfaction regarding the contribution of the service in the three mains spheres that comprise it: the dentists who provides care, the physician who works together with the dentistry staff and the patient. To meet these objectives, the descriptive exploratory research was chosen through case reports. To measure the perception / satisfaction specific questionnaires were applied for each group in 2017. The results demonstrated the prevalence of ambulatory care and the main procedures performed were periodontal treatments, surgeries and laser therapy. As for the financial aspect, it was observed that the service is deficient, since not all procedures are reimbursed by SUS and the costs exceed the amount received. In average, SUS reimbursed R$5,36 per procedure while the calculated costs were R$ 59,91. The study also concluded that the perception / satisfaction in the three spheres analyzed are positive in relation to the service provided. It is expected the results obtained will provide subsidies for the continuous improvement of the existing service within the hospital, as well for other managers who wish to implement Oral Service Medicine in other referral hospitals.

The World Health Organization recommends exclusive breastfeeding (EBF) until six months of age, and breastfeeding along with other foods up to two years of age or even longer. The importance of EBF until six months of age is well established, mainly because of the benefits for the child and for the mother such as a reduction in children's morbidity and mortality and also hospital admissions. Despite of the fact that breastfeeding is an effective and inexpensive way to improve child s health, unfortunately this practice is stopped long before the recommended period. Due to that, this study aimed at knowing EBF prevalence among children born at the University Hospital of Santa Maria as well as the reasons for the early weaning. Besides, it assessed the effect of a multiprofessional intervention to promote breastfeeding in the Hospital. The prevalence of EBF was assessed at four and six months postpartum in two groups: control group (whose mothers received the information usually provided by the staff) and intervention group (whose mothers received additional information about breastfeeding by a multiprofessional team). For this, a randomized trial was carried out, enrolling 379 dyads (mother-baby): 194 in the control group and 185 in the intervention group. The intervention consisted of meetings (as group dynamic) with the mothers. The results showed that EBF prevalence in the control group were 42.8% at four months, and 13.4% at six months age. On the other hand, in the intervention group the EBF prevalence was significantly higher: 57.8% at four months and 26.5% at six months age. In addition, the number of days of EBF in the intervention group was also significantly higher (median 150 days) compared to controls (median 113 days). The assessment of data at four and six months showed negative association with the variables "did not participate in the intervention" and "use of pacifiers" with the variable "duration of EBF". At six months it was further observed negative association between "duration of EBF" with mother coming back to work . The results of this study allowed us to prove the effectiveness of a multidisciplinary intervention carried out in the post-partum time in increasing EBF rates in children at the ages of four and six months. / A Organização Mundial de Saúde recomenda o aleitamento materno exclusivo (AME) até seis meses de idade e, após, que seja continuado com outros alimentos até dois anos ou mais. Apesar de já consagrada a importância do AME até os seis meses de idade, dos inúmeros benefícios comprovados para a criança e para a mãe, principalmente na redução significativa da morbimortalidade e hospitalizações infantis, essa prática é interrompida muito antes do período recomendado. A ciência de que o investimento na promoção do aleitamento materno é uma medida efetiva e de baixo custo para melhoria da saúde infantil motivou conhecer a prevalência do AME em crianças nascidas no Hospital Universitário de Santa Maria, os motivos que levam ao desmame precoce nessa população e avaliar o efeito de uma estratégia de intervenção multiprofissional, com vistas à promoção do aleitamento materno. Foram avaliadas as prevalências do AME aos quatro e seis meses pós-parto em dois grupos: grupo intervenção, cujas mães receberam, além das orientações da rotina do serviço, uma intervenção adicional, realizada por equipe multiprofissional; e grupo controle, cujas mães receberam apenas as orientações da rotina do serviço. Foi realizado um estudo analítico experimental, tipo ensaio de campo randomizado, no qual participaram 379 díades (mãe-bebê), sendo 194 no grupo controle e 185 no grupo intervenção. A intervenção constituiu-se de encontros em forma de dinâmica em grupo com as mães selecionadas. Os resultados demonstraram que as prevalências de AME no grupo controle foram de 42,8% aos quatro meses e de 13,4% aos seis meses. No grupo intervenção, as prevalências foram significativamente maiores: 57,8% aos 4 meses e de 26,5% aos 6 meses. Além disso, o número de dias de AME no grupo intervenção também foi significativamente maior (mediana de 150 dias) quando comparado ao controle (mediana de 113 dias). Aos quatro e seis meses foram observadas associações negativas entre as variáveis não participar da intervenção e uso de bico ou chupeta com a variável tempo de AME . Aos seis meses também foi observada associação negativa entre tempo de AME com o fato de a mãe trabalhar fora. Os resultados do presente estudo permitem comprovar a efetividade de uma intervenção multiprofissional realizada no pós-parto, em nível hospitalar, no aumento das taxas de AME em crianças tanto aos quatro como aos seis meses.

This research covers the story of four persons from different backgrounds brought together by their faith in God, fellowship in the same church, residing in the same community and sharing the experience of living with HIV and AIDS: either as infected and/or affected individually. I am one of these persons due to the fact that I lost my sister to HIV and AIDS, thus I am affected. Though I only appear in the story as the researcher, it is my own loss that made it possible for me to empathise with my co-researchers. While one co-researcher was affected due to the fact that her husband was infected, became ill and died of HIV and AIDS-related sicknesses, the other two women were both infected by their husbands and at the same time were affected because they had to nurse the same husband who infected them. This was one of the cruelest moments in their lives but they forgave their husbands and cared for them to the end. In order for my research to reach the holistic insight into these women’s stories, I used the postfoundationalist practical theology approach. The reason for this is that this approach is contextual and relevant to people’s everyday life. One does not have to import knowledge to try to solve problems emanating from a particular context, but one needs to engage the locals and from that engagement, people start to reflect positively on their problems. Other lessons learnt is that one needs more than just a religious experience to play a role in solving the problem of HIV and AIDS; one needs more of the other disciplines to work together. In places like Mozambique, HIV and AIDS is not regarded as one of the health problems, but is classified as an interdepartmental or multi-sectoral problem. This means that HIV and AIDS do not affect only the Health Department, but all the departments. As such, each department is expected to have its own HIV and AIDS budget. It is here that I propose the Multi Disciplinary Team (MDT) composed of professionals from different disciplines working together to help solve the problem at hand. HIV and AIDS also help us to revisit our own understanding of God. While some people see the pandemic as the punishment from God for promiscuity, the truth is that we are all created in His image and this loving God does not destroy His own creation through HIV and AIDS. In His loving care, He reaches out to the unreached and cares for all His people: whether they are infected with HIV and AIDS, cancer or just are as healthy as they could be. The process of this research has empowered and enabled me to contribute to those who are infected and affected to be resilient and to stand, having hope in the goodness of God, working with others to bring a lasting solution to those infected and affected. Being resilient helps one to reclaim the marred Image of God in oneself and to reflect that image to impact onto our communities. / Thesis (PhD)--University of Pretoria, 2011. / Practical Theology / unrestricted

The diploma thesis is focused on the one hand on the ways of the coordination of the multidisciplinary teams and the interdisciplinary cooperation of the professionals helping people with eating disorders (EDs) and on the other hand on the challenges that these professionals are facing and what are their solutions. The findings of the empirical part are based on a qualitative research using mostly semi-structured interviews with 17 professionals. Most of the professionals from the nonprofit type of organizations and from the treatment facilities had one permanent coordinator and they used regular team meetings as a part of the coordination. On the other hand the professionals with their private practice cooperating with each other were choosing the coordinator case by case or had none at all and they shared the information mostly irregularly by phone or email. The most frequent challenges of this cooperation were its time, financial, energy and coordination consuming character, insufficient knowledge or experience of some other professionals regarding EDs or their unwillingness to cooperate, myths about EDs or a disharmony among the cooperating professionals. The recommendations for practice are: a careful selection of the colleagues according to their competence, similar views and willingness to...

This thesis focuses on the direction and coordination of volunteers in organisations with multidisciplinary teams working with homeless people, and the challenges faced by both these organisations and their volunteers. The results of the experimental section, which focuses on the motivation of volunteers and stimulation from the organisations, have their basis in practical research using semi-structured interviews with leading workers at the organisations, their volunteers, and volunteers from the Labre project, which represents an introductory characterisation of the problem in practice; one which the respondents then refer to in the interviews. Problem areas as identified by both the workers and the volunteers themselves include integration into the organisation, unsupervised activity, non-stimulating conditions, irregular contact, and apathy from the side of the target group. Systematic leadership by a volunteer coordinator is financially demanding for the organisations, and the workers attend to their volunteers in addition to other competences, making systematic leadership more difficult. A recommendation for workers in non-profit organisations working with volunteers is derived from the results of the empirical part. It is based on a careful consideration of the application of volunteer work,...

Syfte: Syftet med denna studie var att beskriva arbetsterapeuters erfarenheter inom specialiserad palliativ vård. Metod: En kvalitativ studie genomfördes. Deltagarna bestod av elva arbetsterapeuter yrkesverksamma inom specialiserad palliativ vård. Datainsamlingen skedde med semistrukturerade intervjuer per telefon och datan analyserades med en kvalitativ innehållsanalys. Resultat: Analysen resulterade i ett övergripande tema; Att möjliggöra aktivitet och delaktighet till livets slut med tre kategorier; Flexibilitet och följsamhet, Interventioner med livskvalité som mål och Teamet fyller flera funktioner. Resultatet visar att arbetsterapeuternas erfarenheter är att samtal och följsamhet utgör grunden för den terapeutiska relation som behövs för att stödja klienten i sin process och genomföra interventioner som bygger på klientens egna behov och önskemål. Resultatet visar att det krävs framförhållning och flexibilitet eftersom det sker snabba förändringar hos klienterna. Interventioner som utförs syftar till att klienten skall uppleva livskvalité till livets slut vilket bland annat görs med kompensatoriska åtgärder, handledning, anpassning av aktiviteter och miljö samt symtomlindring. Att arbeta i ett multiprofessionellt team utgör grunden för att möta klientens fysiska, psykiska, sociala och existentiella behov där teamet även utgör ett emotionellt och kunskapsmässigt stöd för arbetsterapeuten. Slutsats: Resultatet kan bidra med förståelse och kunskap för det förhållningssätt och arbetssätt som arbetsterapeuten använder sig av inom palliativ vård för att möta klientens behov och möjliggöra aktivitet och delaktighet till livets slut. Studien kan även bidra till en förståelse för betydelsen av ett fungerande teamarbete, samt varför arbetsterapeuten som profession inom de palliativa teamen behövs. Ytterligare forskning behövs för att beskriva arbetsterapeutens unika kompetens i den palliativa vården samt hur den kompetensen förvärvas. Vidare behövs forskning om arbetsterapi inom olika palliativa vårdformer för att belysa och tydliggöra arbetsterapi inom palliativ vård och skapa en gemensam teoretisk grund. / Aim: The aim of this study was to describe occupational therapists’ experiences of specialized palliative care. Method: A qualitative study was conducted. The participants consisted of eleven occupational therapists working in specialized palliative care. The data collection was conducted with semi-structured interviews using telephone and the data was analyzed with a qualitative content analysis. Result: The analysis resulted in an overall theme; To enable occupation and participation until the end of life with three categories; Flexibility and compliance, The goal of interventions is quality of life, The multifunctional team. The result shows that the occupational therapists experiences is that conversation and compliance form the basis of the therapeutic relationship required to support clients in their process and implement interventions based on the clients individual needs and requests. The result shows that it takes foresight and flexibility to meet the clients rapid changes. The aim with interventions is that clients shall experience quality of life till the end of life. This is for instance made with compensatory interventions, guidance, adapting activities and environment and symptomatic relief. Working in a multi-professional team is the basis for meeting the client's physical, mental, social and existential needs, where the team also stands for knowledge exchange and as an emotional support. Conclusion: The result can contribute with understanding and knowledge of the approach and working method used by the occupational therapist in palliative care to meet the client's needs and enable activity and participation towards the end of life. The study can also contribute to an understanding of the importance of teamwork in palliative care and why the occupational therapist is needed in the palliative care teams. Further research is needed on the occupational therapists unique competence and how it is acquired. Further research is needed on occupational therapy in various palliative care forms to clarify occupational therapy in palliative care and to create a common theoretical basis.

[pt] O presente estudo partiu do questionamento: Como os programas de atendimento a mulher que sofreu violência doméstica e familiar em Manaus-AM tem incluído os homens autores dessa violência, HAV, em seus serviços. A Lei 11.340-2006, reconhecida como Lei Maria da Penha prevê em seus artigos 35 e 45 serviços de atendimento aos HAV em centros de educação e reabilitação e ou programas de recuperação e reeducação,por considerar a importância de ser oferecida uma assistência resolutiva a todos os envolvidos na dinâmica da violência acometida. Assim, para alcançar resposta a indagação feita, foi desenvolvida uma pesquisa exploratória de natureza qualitativa, junto aos profissionais que atuam em dois programas públicos de atenção a mulher acometida de violência doméstica, visando conhecer como se dá a aplicabilidade da Lei em relação aos HAV, para além de sua responsabilização pelos atos cometidos. Os depoimentos obtidos revelam a inexistência de ações que atinjam nesse sentido, especialmente os HAV, na esfera governamental, embora os profissionais ouvidos nas entrevistas semi-estruturadas realizadas considerem de real necessidade a implementação de medidas preventivas e assistenciais voltadas para os homens no enfrentamento da violação dos direitos das mulheres no meio doméstico. Eles compreendem a complexidade da situação de violência vivenciada pela mulher, identificam os obstáculos e a precariedade de recursos disponíveis para se efetivar o acompanhamento de todos os envolvidos no âmbito da violência doméstica. Apontam também algumas iniciativas nessa direção. A aplicabilidade integral da Lei Maria da Penha ainda tem um longo caminho para ser realidade. / [en] This study began with the questioning: How care programs that women who suffered domestic and famile violence in Manaus-AM has included men perpetrators of this violence, HAV in their services. Law 11.340-2006, known as the Maria da Penha Law provides in Articles 35 and 45 care services to HAV in centers of education and rehabilitation and or recovery and rehabilitation programs, considering the importance of being offered a problem-solving assistance to all those involved in the dynamics of violence affected. Thus, the quest to achieve response was developed made an exploratory qualitative research, the professionals who work in two programs of public attention to women suffering from domestic violence, to determine how is the applicability of the Act in relation to HAV for beyond its responsibility for the acts committed. The statements obtained show the absence of actions to achieve this effect, especially HAV, in the governmental sphere, although the professionals heard in the semi-structured interviews of real need to consider the implementation of preventive measures and assistance aimed at men in dealing with violation women s rights in captivity. They understand the complexity of the situation of violence experienced by women, identifying the obstacles and limited resources available to effect the monitoring of all those involved in domestic violence. Also suggest some initiatives in this direction. The full applicability of the Maria da Penha Law still has a long way to reality.

No / Chronic pain is currently under-diagnosed and under-treated, partly because doctors' training in pain management is often inadequate. This situation looks certain to become worse with the rapidly increasing elderly population unless there is a wider adoption of best pain management practice. This paper reviews current knowledge of the development of chronic pain and the multidisciplinary team approach to pain therapy. The individual topics covered include nociceptive and neuropathic pain, peripheral sensitization, central sensitization, the definition and diagnosis of chronic pain, the biopsychosocial model of pain and the multidisciplinary approach to pain management. This last section includes an example of the implementation of a multidisciplinary approach in Belgium and describes the various benefits it offers; for example, the early multidimensional diagnosis of chronic pain and rapid initiation of evidence-based therapy based on an individual treatment plan. The patient also receives continuity of care, while pain relief is accompanied by improvements in physical functioning, quality of life and emotional stress. Other benefits include decreases in catastrophizing, self-reported patient disability, and depression. Improved training in pain management is clearly needed, starting with the undergraduate medical curriculum, and this review is intended to encourage further study by those who manage patients with chronic pain.

The care of people with Parkinson’s disease (PD) involves input from different healthcare professionals (HCPs). A literature search identified that the HCPs involved in PD multidisciplinary (MDT) clinics, including interdisciplinary team (IDT), varied both in the number and type of HCPs. None of the studies identified involved pharmacists. Pharmacists have shown benefits when working in MDTs for other long-term conditions (LTCs); however, their role in PD MDTs was identified as a gap in the literature. The aim of the study was to determine the role of pharmacists in a PD IDT. Patients attended a PD IDT clinic comprising PD nurse, physiotherapist, occupational therapist and pharmacist. A mixed methods convergent design was used to collect both qualitative and quantitative data. Qualitative focus group and interview data were analysed using The Framework Method. Quantitative data analysis involved counts of HCP interventions. Pharmacists can support PD IDTs as they have in other LTC MDTs by conducting holistic medication reviews. Three new roles were identified for pharmacists in PD IDTs as: 1) independent prescribing, 2) supporting HCPS in their roles by supporting staff knowledge, and 3) leading the PD IDT clinics. Quantitative data showed the pharmacist made a medication review intervention for all patients. HCPs and patients identified the roles and value of involving pharmacists in PD IDTs. The PD IDT clinics offer a holistic approach to patient care and a greater opportunity for patients to be involved. The findings identified a ‘review-shared care template’ for PD IDTs and recommends development of a ‘pharmacist’s PD competency framework’.

No description available.