El proyecto contempla el diseño de un Centro Gineco-Oncológico ubicado en Chorrillos, con la meta de brindar atención a la población femenina no solo de este distrito sino ser un Centro especializado con miras de carácter metropolitano. El diseño de este Centro se basó en el exhaustivo análisis de proyectos referenciales y entrevistas a especialistas de la salud y de la construcción de esta tipología. Se concluye que la distribución ideal para un Centro de este tipo es mediante la separación de dos espacios principales, los cuales marcan el inicio del diseño, el área pública en el que circularán pacientes y acompañantes, y el área de servicio, el cual es el espacio para la circulación de los pacientes internos, personal de salud, personal de nutrición y personal de mantenimiento. Del mismo modo, las circulaciones verticales guardan esta misma clasificación con la finalidad de salvaguardar la asepsia en todo momento del usuario principal y familias. Es destacable, como la arquitectura participa en la recuperación de los pacientes, mediante ambientes luminosos, amplios y destinados no solo al área de hospitalizaciones o consultas, sino también ambientes creados para el familiar y al tiempo entre pacientes y acompañantes, hasta la curación de la neoplasia. Con este resumen comienzo la explicación detallada de esta tesis. / The project contemplates the design of a Gynecologic-Oncology Center located in Chorrillos, with the goal of providing attention to the female population not only of this district but also to be a specialized Center with a view to metropolitan character. The design of this Center was based on the exhaustive analysis of referential projects and interviews with health specialists and the construction of this typology. It is concluded that the ideal distribution for such a Center is through the separation of two main spaces, which mark the beginning of the design, the public area in which patients and companions will circulate, and the service area, which is the space for the circulation of internal patients, health staff, nutrition staff and maintenance staff. Similarly, vertical circulations keep this same classification in order to safeguard the asepsis at all times of the main user and families. It is noteworthy, as the architecture participates in the recovery of patients, through bright, spacious and intended environments not only to the area of ​​hospitalizations or consultations, but also environments created for the family and at the time between patients and companions, until the healing of the neoplasia with this summary I begin the detailed explanation of this thesis. / Trabajo de suficiencia profesional

Made available in DSpace on 2014-12-17T15:38:51Z (GMT). No. of bitstreams: 1 ChristineMFCL_DISSERT.pdf: 730945 bytes, checksum: bf93983fe44a7b2aa210f3ebe005c785 (MD5) Previous issue date: 2011-03-31 / It is undeniable that all the extraordinary technological advances in contemporary society have increased the severe patients expectation and quality of life, especially cancer patients. On the other hand, it is easily verifiable by many researches that it was not possible to advance in the same proportion in caring for the human experience of death. Much is said about the anguish of a man facing death, of cancer patients in terminal stage, about their families, and very little about the feelings, anxieties and ways of coping with the medical professional who deals with this situation, specifically the clinical oncologist. Little is known about the experience of the doctor who has learned to take death as an enemy to be defeated, and increasingly is compelled to live at length with his advertisement. However, we started to watch in recent years a growing interest of researchers in this issue. This study seeks to add to this interest in order to understand the experience of clinical oncologists that accompany dying patients, the meanings they attach to death, ways of coping and the implications for providing care. This is a qualitative study in which was used as a tool for data collection an in-depth interview with the projective using script and scenes. Gadameriana Hermeneutics was used for analysis and interpretation of narratives. The subjects were 10 clinical oncologists who work at two institutions from cancer treatments in the state of Rio Grande do Norte, chosen from a variation in the time working in the specialty (minimum of one year, even old ones). However, you can bring some initial results for the dialogue. It was found that the death is still a topic that causes many difficulties in the daily lives of these professionals, the choice for oncology involves dealing with death without preparation in medical education; being close to the patient in the final moment, supporting the family, coping with own pain of loss and the inability to heal. These are central elements of the narratives. We also have investment in medical training and continuing education in setting up a demand that permeates the discourse of participants. Being able to listen to the subjective world of clinical oncologists will support the work not only for them as other professionals who deal with patients with advanced cancer, providing evidence to understand to what extent the meanings attributed to its know-how before patients on the verge of death interfere with the production of care and allow identify coping strategies in everyday life of these professionals that hinder or facilitate coping with death, promote or preclude the care with others and with themselves. It is hoped that research can contribute to the field of knowledge about the know-how in clinical oncology and their terminal-care-death oncologist-patient relationships, bringing runways capable of promoting a better quality of care in the production of all involved in this process: professionals, patients and families / Na contemporaneidade muito se fala das ang?stias do homem frente ? morte, dos pacientes com c?ncer em estado terminal, e, muito pouco dos sentimentos, e formas de enfrentamento do profissional da medicina que lida com essa situa??o, especificamente o oncologista cl?nico. Este estudo tem como objetivo compreender a viv?ncia de oncologistas cl?nicos que acompanham pacientes terminais. Foi realizada uma pesquisa qualitativa, utilizando como estrat?gia metodol?gica a entrevista em profundidade, com roteiro e uso de cenas projetivas. Para an?lise e interpreta??o das narrativas recorremos ? Hermen?utica Gadameriana. Os sujeitos desta pesquisa foram 10 oncologistas cl?nicos que trabalham em duas institui??es de refer?ncia em tratamentos oncol?gicos no estado do Rio Grande do Norte, escolhidos a partir de uma varia??o quanto ao tempo de atua??o na especialidade. A an?lise dos dados permitiu identificar as motiva??es dos entrevistados quanto ? escolha profissional aos significados atribu?dos por eles ao ser oncologista a busca pelo t?cnico/cient?fico e o humano. Suas concep??es sobre morte real?am os aspectos existenciais e transcedentais, como sofrimento, descanso e religi?o. Os pap?is desejados para o enfrentamento do processo de morte de um paciente elencados foram: evitar ao m?ximo a chegada da morte; promover qualidade de vida/morte e suporte emocional, estabelecendo uma comunica??o eficiente e cuidar do paciente at? o fim. Por sua vez o cotidiano com a morte os desafiam a lidarem com as dificuldades do n?o curar, do comunicar a noticia ruim, e com o desejo de cuidar at? o fim de seus pacientes. Por fim, ressalta-se a necessidade do cuidado com a dor desses profissionais, por entender que a maneira como eles lidam com a morte pode interferir na produ??o de cuidado ao paciente. Espera-se que este estudo possibilite pistas capazes de promover uma melhor qualidade na produ??o do cuidado de todos os envolvidos nesse processo: profissionais, pacientes e familiares

Clinical guidelines developed from randomized controlled trials (RCT) recommend standard treatments for physicians to treat their patients. However, RCT are usually conducted among younger or healthier populations. Patients who did not participate in clinical trials, such as the elderly or patients with comorbidities, might not be suitable for the standard treatments; instead non-standard treatments can be an alternative treatment option to provide clinical benefits. Physicians are key stakeholders in determining the use of non-standard treatments in clinical practice. While a number of studies have reported on the use of non-standard treatments, little is known about factors associated with a physician’s decision to use non-standard treatments and which information sources are associated with their use. The objectives of this study were to identify factors associated with a physician’s decision to use non-standard treatments and to investigate which information sources were associated with their use. This study applied Rogers’ theory of diffusion of innovation to posit that a physician’s decisions to use non-standard treatments are a function of 1) the perceived advantages of non-standard treatments (effectiveness and toxicity), 2) the sources of information (scientific sources, professional contacts, patient demands, and commercial sources), 3) physician characteristics (years of practice, specialty, innovativeness, and practice experience), and 4) practice settings (practice location, academic affiliation, types of facility, and practice size). This study implemented a convergent parallel mixed-method approach consisting of interviews and surveys to address the objectives. For this study, a convenience sample of 10 medical oncologists was interviewed in January and February 2017. Interviews were transcribed and coded using a coding system based on the theoretical model of this study. Case reports were created to summarize each interview. The content analysis and multi-case analysis were both conducted to describe variable-level factors and contrast and compare factors within and across groups. Surveys were distributed to 1,500 medical oncologists and hematologists who currently practice in eight states across the Midwest. Dillman’s tailored design method was used to guide survey development and administration. The survey examined oncologists’ use of non-standard treatments in elderly patients with diffuse large B-cell lymphoma (DLBCL). Factorial survey design was applied to construct six hypothetical patient vignettes representing a variety of patient age and comorbidity. The dependent variable was whether a physician recommended a non-standard treatment to each vignette. Independent variables were selected from the theoretical model. The descriptive and frequency statistics were conducted for each survey item. The reliability tests were used to evaluate internal consistency of multi-item measures. Generalized Estimating Equations (GEE) were used to test the influence of factors on a physician’s decisions to use non-standard treatments. Among ten interview participants, three were open and five were intermediate open toward using non-standard treatments. Approximately 41.5% of survey participants recommended non-standard treatments for two or more vignettes. Both interviews and surveys showed that sources of information were key factors affecting oncologists’ use of non-standard treatments. In particular, interviewed oncologists used various information sources to justify their use of non-standard treatments such as early phase clinical trials or colleagues’ suggestions. Survey data showed that oncologists who placed higher importance on scientific sources were less likely to use non-standard treatments although scientific or medical journals were the top sources where they learned about rituximab with non-anthracyclines. In vignettes involving patients with rheumatoid arthritis with chronic neutropenia, those who placed a higher importance of professional sources were more likely to use non-standard treatments. Additionally, interview data showed that oncologists who have a sub-specialty, practice in academic settings, have high patient volume, have positive past experience with non-standard treatment and were aware of colleagues’ use non-standard treatments were relatively more open toward using non-standard treatments. Survey data showed that oncologists who agreed that rituximab with non-anthracyclines has a safer toxicity profile than rituximab with anthracyclines, those who commonly encounter younger patients, and those who had more years since graduating from medical school were more likely to use non-standard treatments. In addition to patient characteristics such as comorbidity, physicians’ characteristics and their sources of information are influential to the decision of using non-standard treatments.

[pt] O estudo apresentado trata da forma como a morte é entendida no contexto hospitalar junto dos profissionais, e como eles vêem o processo de fim de vida de seus doentes. Descobrir se existe humanização no cuidar e se o tratamento oferecido nos hospitais concede ao doente respeito e dignidade pela sua situação, foram os objetivos da pesquisa. Foi realizada no Serviço de Oncologia do Hospital de Santa Maria da Feira, em Portugal, junto de 6 profissionais (3 médicos, 1 enfermeira, 1 psicóloga e 1 assistente social). O que se observou é que a morte é entendida como algo inevitável, um processo de aceitação para uns, e uma derrota e frustração para outros. No entanto, por parte dos profissionais não se observa desprezo ou afastamento em relação ao doente. Outra observação foi o fato de não existir um assistente social permanente no serviço, o que constitui um lapso na equipe multidisciplinar existente. A comunicação, a solidariedade, bem como a preocupação de proporcionar uma boa qualidade de vida que se traduz em autonomia, liberdade de escolha e o poder de decidir sobre suas coisas, assim como conferir dignidade ao doente, mostraram ser as prioridades dos profissionais deste serviço. / [en] The present study deals with the way death is understood in hospital context by professionals and how they feel the process of life ending of their patients. The goals of this research were to find out if there is humanization in the way patients are taken care and if the treatment offered by hospitals to sick people gives them respect and dignity. This research was carried out in the Oncology Department of Santa Maria da Feira Hospital in Portugal, in connection with 6 professionals ( 3 Doctors, 1 Nurse, 1 Psychologist and 1 Social Assistant). After the research the conclusion is that death is understood as something inevitable, an acceptance process for some people and a defeat and frustration for others. Nevertheless contempt or exclusion for patients was not observed by professionals. Another conclusion was the fact of the inexistence of a permanent Social Assistant in the Department, which is a lack in the multidisciplinary team. Communication, solidarity, as well as the concern of providing a good quality of life in terms of autonomy, freedom of choice and the power of deciding about their things and giving dignity to the patients were the main priorities of the professionals of this Department.

Cancer is regarded as a global disease and one of the leading killer diseases in the world. The reason why cancer is so widespread and often misunderstood stems from multiple factors, namely, the lack of knowledge about cancer, unfair discrimination of persons living with cancer, inadequate or inappropriate treatment provided to patients, the stigma attached to cancer, misdiagnosis and late diagnosis of persons living with cancer, as well as the inadequate provision of screening programs to detect cancer at an early stage. The combination of these issues raises alarming medico-legal problems that merit further attention. The thesis will explore the origin, nature, philosophical and clinical aspects pertaining to cancer, as well as legal issues related to cancer and oncology. The study will conclude with recommendations aimed at mitigating and addressing the shortcomings that exist in the medico-legal framework. The study will also draw on a legal comparison of relevant South African, English and American laws and regulations. Since this thesis entails focussing on medico-legal principles, the study will draw on aspects of medical law, labour law, law of contract, law of delict, constitutional law and criminal law. / Private Law / LL. D.