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No. of bitstreams: 1 Rosane Brinques Lourenci.pdf: 1237369 bytes, checksum: 29d6bb70a92fd7edd03baf4e712c7a9e (MD5) Previous issue date: 2006 / Mestrado Profissional em Enfermagem Assistencial / Atualmente as doenças cardiovasculares representam um grave problema para saúde publica no Brasil e no mundo, esforços têm sido feitos no intuito de prevenir as intercorrências hospitalares, porém em alguns casos há necessidade da hospitalização em decorrência dessas doenças o que cria uma forte carga emocional para o paciente, que se sente carente de informações sobre a sua patologia e necessita sistematicamente da assistência dos profissionais, para o enfrentamento do desconhecido, principalmente em relação a sua imaginação acerca da gravidade do problema. O presente estudo surgiu da necessidade de buscar novos conhecimentos que venham nortear a prática dirigida para o cuidado aos pacientes coronários que se submeteram ao procedimento diagnóstico invasivo denominado Cateterismo Cardíaco - CAT. O objetivo deste estudo foi elaborar uma sistematização do cuidado ao paciente internado submetido ao cateterismo cardíaco identificando as necessidades do paciente discutindo a partir da literatura e dos modelos de sistematização. Utilizamos a abordagem qualitativa como técnica que permitiu a obtenção dos elementos que compõem a coleta dos dados, os sujeitos do estudo foram os pacientes submetidos ao cateterismo cardíaco internados em um hospital filantrópico do Município do Rio de Janeiro. A analise dos dados foi organizada em três etapas, sendo: Pré-análise (contato com o material a ser analisado), Exploração (transformação dos dados brutos) e Tratamento (a inferência e a interpretação dos resultados) seguindo a metodologia do discurso do sujeito coletivo de Lefèvre. A coleta dos dados teve início após a aprovação pelo Comitê de Ética em Pesquisa da Instituição do Hospital Universitário Antonio Pedro da Universidade Federal Fluminense - HUAP/UFF. Concluímos que os pacientes desconhecem a finalidade do exame e estes expressam seus sentimentos que oscilam entre a total falta de preocupação com o exame pela insuficiência de informação e a excessiva tensão e ansiedade pelo medo dos riscos advindos deste procedimento principalmente com a possibilidade da morte e a afastamento dos familiares. Portanto caberá aos profissionais uma aproximação mais humana ao paciente considerando a pessoa em equilíbrio harmônico com o conhecimento tecnológico e ofertando informações em linguagem acessível o que possibilitou neste estudo a criação de uma cartilha de orientação como produto da sistematização do cuidar / Nowadays, cardiac diseases represent a critical problem for public health in Brazil and around the world. Efforts are made to prevent hospital intercurrences, however, in some cases, there is a need of hospitalization due to these diseases, what crates a strong emotional effect to the patient that feels uninformed about his/her pathology and needs systemic professional care to face the unknown, mainly concerning his/her imagination towards the severity of the problem. The present study emerged due to the necessity of new knowledge to the practice given to cardiac patients submitted to the invasive diagnostic procedure called Cardiac Catheterization – CAT. The purpose of this study is to create a systematization of the nursing care to an admitted to hospital patient submitted to cardiac catheterization, identifying the patients‟ needs and discussing from systematization literature and models. We used qualitative approach as technique that made possible to obtain the elements of data collect; the subjects of the study were the patients submitted to cardiac catheterization admitted to a philanthropic hospital in Rio de Janeiro. The data analysis was organized in three steps: Pre-analysis (contact with the material to be analyzed), Exploration (transformation of data in the rough) and Treatment (inference and interpretation of results) following the methodology of the collective subject discourse from Lefèvre. The data collect started after the approval of the Research Ethics Committee at the Antonio Pedro University Hospital of the Fluminense Federal University. APUH/FFU. We conclude that the patients do not know the purpose of the exam and so they express their feelings that go from total relief of concern due to lack of information to excessive anxiety by the fear of the risks derived from this procedure, mainly with the possibility of death or keeping relatives apart. So, it is the professionals‟ duty to have a more humanized approach to the patient, making possible a harmonic balance between technological knowledge and information with an accessible language use, what generated the creation of a guideline as a product the care systematization

In a hospital environment the focus is on quality patient care. One of the important factors to improve the quality of patient care is the implementation of a continuous professional development programme. In a continuous professional development programme of a hospital three stakeholders namely management, clinical facilitators and the nurse practitioners are identified as partners. When the stakeholders reach a point where it is believed that the continuous professional development programme does not serve its purpose to improve the quality of patient care it is time to evaluate and refine the programme. This study evaluate the critical care and high care units in a private hospital in Gauteng’s continuous professional development programme and the conclusions and recommendations are therefore limited to this specific clinical setting. The refinements recommended cannot be utilised in other clinical setting but the evaluation and research methodology can be utilised to evaluate similar continuous professional development programmes. Evaluation of a continuous professional development has the potential to negatively influence the nurse practitioners attitude towards continuous professional development. The objective of the research approach chosen namely a 4-D Appreciative Inquiry approach was to gain the collaboration of all the stakeholders in an effort to ensure that the evaluation of the continuous professional development programme of the critical care and high care units in the private hospital in Gauteng does not negatively affect the delivery of quality patient care. The Appreciative Inquiry research approach with its positive approach lends it to be the most appropriate research methodology of the study. The study utilised a Focus Group Inquiry as data a collection mechanism. From the study In-service training emerged as the element that form an important element of an effective continuous professional development programme but that it is of the at most importance that an effective Workplace learning environment exists. The supportive role of Management for a continuous professional development programme also emerged as one of the main themes required for the implementation of a continuous professional development programme. These findings were utilised in the refinement for the continuous professional development programme for the critical care and high care units in the private hospital in Gauteng. The research recommends that a steering committee be appointed to implement a pilot continuous professional development programme that incorporate the refinement elements identified. Due to the continuous improvement nature of the Appreciative Inquiry methodology it is also recommended that the pilot continuous professional development programme been re-evaluation to ensure long-term success and improvement. / Dissertation (MCur)--University of Pretoria, 2013. / gm2014 / Nursing Science / unrestricted

Magister Public Health - MPH / Aim: The aim of this study was to assess the prescribing practices and availability of antimalarial drugs to children under five years of age in primary health care facilities in Bondo district.

A cirurgia de terceiro molar é um dos procedimentos mais realizados na área de cirurgia e traumatologia bucomaxilofaciais. A evolução pós-cirúrgica era baseada em evidência clínica. No nosso trabalho, propusemos acompanhar a evolução pós-cirúrgica através da utilização do eletromiografia de superfície. Realizamos quatro tomadas, no pré-operatório, normalizando, e três no pós-operatório, 7, 14, 21 dias, em amostra de 30 pacientes. Observamos, no vigésimo primeiro dia, recuperação próxima da normalização no gênero feminino e ainda aquém no gênero masculino. Constatamos que a eletromiografia de superfície é sensível para controle da evolução pós-cirúrgica, demonstrando ser um método eficaz e seguro. / The third molar surgery is one of the most frenquently performed procedures in the buccal-maxillary-facial traumatology and surgery areas, whereas the post-surgery evolution has been based on the clinical evidence until now. In our study, we proposed to analyze the post-surgery clinical evolution through the use of electromyograph of surface. We have made four takes, on the presurgery, normalizing, and three on the 7, 14 and 21 postoperative days, in a sample of 30 patients. We observed, in the twentieth-first day, a recovery close to normalization on women, but men did not reach normalization. The electromyograph of surface is sensitive to the post-surgery evolution control, and is an efficient and safe method.

Objetivos: Determinar la proporción de pacientes que cumplen los criterios internacionales de gastrectomía en manga así como estimar la asociación entre el porcentaje de pérdida de peso en el primer, tercer y sexto mes del tratamiento nutricional con la tasa de abandono del mismo. Materiales y métodos: Estudio de tipo cohorte retrospectivo realizado con historias clínicas de pacientes con gastrectomía en manga laparoscópica operados desde el 2008 hasta marzo 2014 en una clínica privada. Dos fueron las variables resultado de interés: la elegibilidad para cirugía bariátrica según criterios internacionales (IMC ≥40 kg/m2o ≥ 35 kg/m2 con comorbilidades) y el abandono antes o durante (inasistencia por más de 60 días desde la consulta previa sin haber sido dado de alta (IMC < 25)) el tratamiento nutricional. La exposición fue el porcentaje de peso perdido en las primeras cincos semanas después de la cirugía (< 10% vs. ≥ 10%). Se utilizaron modelos de regresión de Poisson y se calcularon riesgos relativos y sus respectivos intervalos de confianza al 95% (IC95%). Resultados: La muestra estuvo compuesta por datos de 423 historias clínicas de pacientes bariátricos, 294 (69.5%) fueron mujeres, edad media 39.2 (DE: 12.3) años. Solo 117 (27.7%) pacientes cumplieron con los requisitos establecidos para la cirugía, y 48 de esos 117 (41%) abandonaron el tratamiento nutricional antes de iniciarlo. Controlando por sexo y edad y tomando como referencia aquellos que perdieron <10% de peso, los que perdieron ≥10% del peso inicial redujeron el riesgo de abandonar el tratamiento nutricional (RR = 0.10; IC95% 0.01–0.68) en el primer mes. Conclusión: A pesar de las recomendaciones internacionales, una gran proporción de los pacientes de cirugía bariátrica no cumple los requisitos. La incidencia de abandono antes y durante el tratamiento nutricional es alta. Los resultados resaltan la necesidad de tener guías para el manejo de cirugía bariátrica en nuestro contexto. / bjectives: To determine the proportion of patients who meet international recommendations for bariatric surgery and to assess the impact of weight loss in the first, third and sixth month of nutritional treatment on it’s abandonment. Methods: A retrospective cohort study was performed using data from clinical records of patients who underwent sleeve gastrectomy in a private clinic of Lima, Peru. Two outcomes were evaluated, eligibility for bariatric surgery according to international recommendations (BMI ≥40 kg/m2 or ≥35 kg/m2 with comorbidities) and abandonment before and after starting nutritional management (no nutritional assessment after 60 days from the previous visit without achieving ideal BMI). The exposure was the percentage of weight lost in the first five weeks after surgery split into <10% and ≥10%. Poisson regression was used and relative risks and 95% confidence intervals (95%CI) were calculated. Results: Data from 423 medical records of bariatric patients, mean age 39.2 years (SD 12.3), 294 (69.5%) women, were analyzed. Only 117 (27.7%) patients met international recommendations for bariatric surgery. Before starting nutritional management, 48/117 (41%) abandoned treatment, whereas an additional 29/69 (42.0%) abandoned before six months of nutritional management. In multivariable model, a weight loss ≥10% in the first five weeks reduced the risk of abandoning nutritional management (RR = 0.10, 95% CI 0.01-0.68) in the first month. Conclusions: Despite of international recommendations, a great proportion of patients undergoing bariatric surgery did not meet the criteria. Rates of abandonment before and after starting nutritional management are high. Results highlight the urgency of having appropriate guidelines for managing bariatric surgery in our context. / Tesis

abstract: Empathy is a critical component of high-quality healthcare. When present in the clinical encounter, empathy is important to physicians (empathy is correlated with reductions in physician anxiety and burnout) and to patients (empathy is correlated with better medical decision making, enhanced trust, and improved treatment adherence). Unfortunately, there is an empathy gap in healthcare–physicians often miss opportunities to demonstrate empathy to their patients. This leaves patients feeling unheard, less likely to bring up details important to their care, and less likely to follow treatment guidelines from physicians, thus disrupting the physician-patient relationship. Luckily, communicating with empathy is a skill that can be taught and learned. With the right tools, learners can strengthen their empathic muscle and become better prepared for responding in difficult situations. The present thesis aims to validate a new tool for teaching empathy to medical trainees. This tool, an empathic communication guide, is drawn from social work as well as medical expertise. It is catered specifically to how medical trainees are accustomed to learning and provides the actual words to say in order to respond with empathy in difficult situations. A group of 8 palliative care fellows at MD Anderson Cancer Center in Houston, Texas received a copy of this guide and participated in an accompanying communication workshop. To gauge empathic responding ability, fellows completed pre- and post- surveys and patient simulations. These data were analyzed using a combination of novel and established methods for quantifying empathic behaviors. Fellows’ empathic communication skill significantly improved after exposure to the guide opening avenues for future study and application. / Dissertation/Thesis / Masters Thesis Social Work 2020

This thesis "Disease from the perspective of selected world religions" first defines related terms, such as health, illness and religion, and then presents the problem of disease in the Buddhist, Judaic, Christian and Islamic concepts. Information is obtained from the basic religious texts and then from considerations of experts who dealt with the issue. The main objective of this thesis is to show how the religion looks at the causes of disease and how these causes have been associated with human sin. There are also reflected differences that result from the historical development and the different currents of thought within each religion. The study also examined the impact that a religious basis for the practical life of the faithful in the medical and social. In conclusion, the positions of the various religions are compared.

This thesis focuses on the role of communication from healthcare professionals to patients, their relatives, and colleagues and its impact on patient care outcomes. We demonstrate the importance of appropriate communication style and strong communication skills to these outcomes (i.e. higher adherence, overall satisfaction, and social support). We also illustrate various situations requiring difficult communication that healthcare professionals commonly encounter in practice. The aim is to capture the most common communication demanding situations from the practice of healthcare professionals and provide a "reference" for their successful completion. The outcome of the practical part of this work is to map the difficult communication situations of Czech healthcare professionals (doctors, nurses and others) through questionnaire survey , and to design a mobile application that will serve as a form of aid for healthcare professionals or medics in individual communication situations with adult patients, their relatives, and colleagues. Keywords: Communication in healthcare, communication-demanding situations, patient care, health professionals

The following documents a research through design inquiry into how socialites of a hospital environment are disrupted or improved by implementing a service robot. The robot, support for excessive work, represents a new intermediary between a patient and a caregiver. Robotic work routines appear as better, more efficient, and more affordable. Apart from other ethical and inclusive considerations given to this dialogue, the social values hidden in traditional workflows are of equal importance.  This thesis attempts to generate constructive design research about emergent social norms and social dynamics caused by service robots’ implementation. The lessons learned are presented in a final research discussion. Further applied, the knowledge held common grounds with a rehabilitation robot developed by Blue Ocean Robotics.

Introduction: The consequences of the opioid epidemic and various prevention, mitigation, and treatment strategies have a strong hold on Appalachian communities. However, limited research has been conducted to understand the experiences of special populations impacted by opioids in this region, such as women of childbearing age living with opioid use disorder (OUD) prior to and during pregnancy. The objective of this review is to summarize existing literature on the care experience for women of childbearing age receiving treatment with medications for opioid use disorder (MOUD) in rural east Tennessee. This literature review will allow for better understanding of current treatment practices, potential gaps in care, and needed care system improvements for this patient population. Methods: A systematic PubMed search identified studies focused on MOUD and pregnancy in the rural eastern Tennessee region. Search results were screened to remove publications older than five years or from outside the region. Relevant information concerning the MOUD care experience for women of childbearing age in the area was collected from these studies. Results: Five studies were included: four surveys and a systematic review. All were published within the last five years and described experiences spanning preconception to postnatal care as well as Tennessee opioid laws that affect women of childbearing age. Two studies detailed the pre-pregnancy care experience, including information about prior pregnancies, intention of conception, contraceptive use, and perceived barriers to contraception access among women receiving MOUD. Two studies described the care experience during pregnancy and its evolution in recent years with changes in acceptance of insurance for MOUD treatment, rates of MOUD-positive prenatal drug screens, and MOUD tapering practices during pregnancy. The final included study reviewed several Tennessee opioid laws enacted over the years to combat prenatal substance use and neonatal abstinence syndrome (NAS). Notably, while total reported cases of NAS have decreased statewide in recent years, the highest rates continue to be observed in east Tennessee, with a majority of cases linked to MOUD exposure. The requirements and enforcement of NAS-related legislation in Tennessee have changed over time but their existence may deter pregnant women from seeking treatment due to fear of punitive consequences. Conclusion: The evidence compiled in this literature review points to many areas in which the care experience can be improved for women of childbearing age receiving MOUD in east Tennessee. There are concerns regarding pregnancy planning, contraceptive access, availability of evidence-based OUD treatment, cost of treatment, and fear of actual or potential negative repercussions from opioid use during pregnancy. These findings suggest multiple efforts can be undertaken by clinicians, researchers, and policymakers to enhance the experience of care for women of childbearing age living with OUD, and consequently improve the health of the population in general, in this region of Appalachia.