Dissertations / Theses on the topic 'Medicinal documentation'

Mestrado em Biomedicina Farmacêutica
This thesis aims to highlight the importance of a Product Quality & Compliance department in a Pharmaceutical Industry, on the good performance of company's activities and the achievement of their goals and mission. Despite the wide activities performed by this Department, the purpose of this work will be completed by describing only some of their reponsibilities. The tasks described are specifically the ones I have been performing throughout my professional experience at Bluepharma - Pharmaceutical Industry, SA, initiated in June 2012 in the Quality Assurance Department until today in the currently named Product Quality & Compliance department. This thesis is structured into 4 parts. The first chapter is an introduction to this thesis, and includes its context and objectives, followed by a brief overview of the state-of-the art in the pharmaceutical industry, including the market environment, the regulatory environment and quality requirements. A small presentation of the company and the department where were and still are developed my professional activity is also made in this chapter. In the following chapter are described the main tasks performed, the complementary activities and key skills acquired throughout this professional experience. A discussion and conclusion is presented at the end, including an analysis of the reported activities, main difficulties encountered its role and importance in the company performance as well as the skills acquired during this work experience.
A presente tese tem como principal objectivo realçar a importância do trabalho desenvolvido num departamento de Qualidade de Producto & Compliance numa Indústria Farmacêutica no bom desempenho das actividades da empresa e no cumprimento dos seus objetivos e missão. Apesar da actividade deste departamento ser muito vasta o objectivo deste trabalho será cumprido através da descrição de algumas das tarefas executadas no âmbito deste. As tarefas descritas são, mais concretamente, as desempenhadas ao longo da minha experiência profissional na Bluepharma - Indústria Farmacêutica, S.A., iniciada em Junho de 2012 no departamento de Garantia da Qualidade, tendo continuidade até aos dias de hoje no agora designado departamento de Qualidade do Produto e Compliance. Esta dissertação está estruturada em 4 partes. No primeiro capítulo é feita uma introdução ao presente trabalho, com a sua contextualização e objetivos, seguindo-se uma breve abordagem do estado-da-arte da indústria farmacêutica, nomeadamente do contexto de mercado, do ambiente regulamentar e dos requisitos de qualidade. Neste capítulo é ainda apresentada a empresa e o departamento onde tem vindo a ser desenvolvida a minha atividade profissional. No capítulo seguinte são descritas as tarefas e atividades principais desempenhadas, as atividades complementares e as principais competências adquiridas ao longo desta experiência profissional. No final é apresentada uma discussão e conclusão, incluindo uma análise das atividades desenvolvidas, principais dificuldades sentidas, do papel e relevância das tarefas desenvolvidas no contexto global da empresa bem como das competências adquiridas durante esta experiência profissional.

The science of disaster medicine is more a descriptive than analytical type. Research, in most instances, has not employed quantitative methods and there is very sparse knowledge based on analytical statistics. One consequence of this is that similar mistakes are repeated over and over. Lessons that should be learned are merely observed. Moreover, there are almost no practical or ethical ways in which randomised controlled studies can be performed. The management, command and control of situations on different levels of hierarchy has eldom been evaluated and there have been no standards against which performance can be evaluated. Furthermore, the documentation of decisions and staff work is rarely sufficient enough to evaluate command and control functions. Setting standards that may be used as templates for evaluation and research is an issue that is constantly being addressed by leading experts in the field of disaster medicine and this is also an important issue that is expressed in the Utstein Template. Swedish National Board of Health and Welfare, templates of performance indicators were developed. These were tested on reports available from incidents, and our conclusion was that documentation in this form was not adequate enough for use in this method of evaluation. Documentation must be improved and data probably need to be captured and stored with the help of information systems. A template developed for the evaluation of medical command and control at the scene was tested in standardised examinations. When using this template in this setting it was possible to obtain specific information on those aspects of command and control that need to be improved. An information system using on-line Internet technique was studied twice. The first study concluded that in spite of technical disturbances the system was acceptable to the organisation but could not yet be recommended for use during major incidents. The second study concluded that the retrieval of information was, in all respects not as good as the control system, a conventional ambulance file system. In a study of staff procedure skills during training of management staffs in command and control it was concluded that documentation during training sessions was not adequate and this lack of staff procedure skills could possibly be a contributing factor to the fact that lessons in command and control are not learned from incidents. Conclusions in thesis are that measurable performance indicators can be used in the training of command and control. If performance indicators are to be used in real incidents and disasters, functioning information systems have to be developed. This may lead to a better knowledge of command and control and could possibly contribute to a process where lessons are learned and mistakes are not repeated.

We undertook a retrospective case review of medical records in two regional hospitals in Cape Town. All adult patients intubated in the EC during the 6 months 1 July to 31 December 2008 were included. A single researcher assessed the case notes to assess documentation of specific procedural criteria: indication for intubation, drugs & doses, endotracheal tube size, laryngoscopy, insertion depth, securing method, position confirmation, ventilator settings and complications. General medical documentation including demographics and legibility of physician name were also assessed. Results are presented using basic descriptive statistics of the 32 criteria analysed.

Policy makers view electronic medical records as a way of increasing efficiency in the U.S. health care system. However, hospital administrators may not have the clinical background to choose a documentation system that helps the health care team safely increase efficiency. The purpose of this case study was to examine health care team members' attitudes and perceptions of quality of care and efficiency amid a documentation system change. The theory of change was the theoretical foundation for the study. The 6 research questions were designed to elicit information about what the health care team experienced when a documentation system changed and how the change affected health care workers' stress level, chance of medical errors, ability to deliver quality care, and attitudes about hospital efficiency. Semi-structured interviews were conducted with the 15 members of a health care team who volunteered from the group and met the inclusion criteria for the study (i.e., employed during the documentation system change). The participants represented all aspects of the health care team to create a bounded case. The interview responses were hand coded to find common themes among the participants. Most participants revealed that the implementation of the new system increased their efficiency and the quality of care they offered to patients. Participants felt that the training and implementation of the system was inadequate and not specific enough for their group. By providing health care administrators with more information about the health care teams' perceptions during a change in documentation systems, they may be able to improve implementation of a new system, creating more sustainable change with less negative impact.

The purpose of this project was to develop a practice guideline for screening patients at risk for cardiovascular disease, educate the staff at the site about the guideline, and implement the guideline at a primary care clinic. The intention was to identify and treat patients at risk for cardiovascular disease to prevent occurrence of heart disease. Cardiovascular disease includes hypertension, coronary heart disease, heart failure, and stroke. Coronary heart disease is one of the leading causes of death in the Western world. The local practice problem and focus of this project was underprescribed statin therapy for patients at risk for developing heart disease at a clinic in the southern United States. The practice-focused question that guided this project explored whether an evidence-based clinical guideline that might impact the prescription of statins for the prevention of cardiovascular disease would be approved for implementation in a primary care clinic serving adult and geriatric patients. The appraisal of guidelines for research and evaluation and the Fineout-Overholt model were used to guide this project. Sources of evidence to meet the purpose of this project were obtained from the literature and scholarly articles. The results of the presentation to the expert panel indicated that this clinical practice guideline would be implemented at the project site and would be used by nurse practitioners and physicians. The implications of this project for positive social change might include improved management of patients who are at risk for heart disease and a decrease in premature deaths related to cardiovascular disease.

Forensic science is defined as the application of scientific or technical practices to the recognition, collection, analysis, and interpretation of evidence for criminal and civil law or regulatory issues. A combination of computer science in the field of 3D reconstruction and molecular biology science and techniques were employed in this research aims to document and record a complete picture of the body decomposition process including the changes of the microbiome over the decomposition process. In this thesis, the possibility to reconstruct the crime scene and the decomposition process was investigated. In addition, a 3D model aiming to integrate the biological and thanatological information was generated. The possibility of utilising Autodesk 123D Catch software as a new tool for 3D reconstruction of a crime scene was thoroughly evaluated. First experiments demonstrated that the number of photos required to obtain the best result was specified to be from 20 to 30 photos as a minimum. In addition, significant experiments were performed in different conditions of sizes, locations, and different involved materials. The measurements were obtained from the models using the same software were compared with the real measurements of the tested objects. The result of the correlation between real and estimated measurements showed a very strong agreement ranging from 0.994 to 1.000. With reference to the documentation of the decomposition process, there are different factors, intrinsic and extrinsic, have been reported affecting the decomposition of a carrion/body. These factors mainly interact with the rates of the biological and chemical reaction happening after death. The biological reactions are mainly due to the activity of microorganism and insects. Pigs (Sus scrofa domesticus) were used as a model for human studies and the results obtained have been applied to other mammals without considering the effect of fur on the decomposition process and on the insect and microbial colonisation. In order to investigate this point, rabbits (Oryctolagus cuniculus) with and without fur were used in two sets of experiments at Huddersfield in summer 2014 and in spring 2015. The results obtained in this study showed a similarity of the decomposition stages between animals with and without fur. However, the decomposition process was faster during the summer due to the fast of insect colonisation and activity. In addition, the entomological data collected during the summer and spring experiments were demonstrated that the same taxa nearly were present in both seasons, except Hydrotaea (Diptera, Muscidae), which was presented only in the summer experiment, moreover, only one sample of Lucilia sericata (Calliphoridae) was detected in the spring season. Differences in colonisation time were observed only in spring experiment; animals without fur were colonised two days before animals with fur. The season could have affected the insect’s activity and the spread of the decomposition volatiles. The microbial communities during the decomposition process were investigated using BIOLOG EcoPlateTM and the hypervariable V1-3 region of 16S rRNA gene was used for their molecular identification based on pyrosequencing. Eurofins Genomic Operon using 454-GS Junior pyrosequencing platform (Roche) carried out these analyses. The functional diversity of the bacterial communities on all carcasses samples showed a considerable variability depending on the stage of the decomposition and the sampling region (Oral cavity, skin and interface-sand-carrion) in both seasons. Furthermore, over the molecular analyses of bacterial communities at the phylum level, four main phyla of bacteria were detected among analysed carrion during the decomposition process. These phyla were changed significantly during the stages of the decomposition and between sampling regions. While no difference was observed due to presence or absence of fur. On the other hand, the analysis at the family level was able to highlight differences at the temporal scale but as well as carrion with and without fur. The statistical analysis results showed a significant difference in the bacterial community family distribution among the presence of fur and among the decomposition stages, with significant differences among sampling regions and seasons.

Dissertação de Mestrado Integrado em Medicina Veterinária
É cada vez mais indiscutível a necessidade do envolvimento das associações zoófilas e instituições de abrigo no resgate, alojamento, provisão de cuidados médico-veterinários, garantia de bem-estar e adoção responsável. Inevitavelmente, o Médico Veterinário que colabora com Abrigos irá lidar com os aspetos médicos de várias formas de maus-tratos e, consequentemente, com as investigações judiciais que estes despoletam. O percurso do animal de companhia suspeito de ser vítima pode ser longo e atravessa geralmente quatro fases: a investigação do local do crime, o exame clínico forense, a estadia no abrigo e a colocação para adoção. Durante este percurso, o animal é, simultaneamente, um ser vivo, com necessidades inerentes a essa condição, e prova do crime de que foi vítima que, como tal, tem de ser preservada. Por isso, é necessário aliar a prestação de cuidados ao animal em ambiente próprio, pondo em prática os princípios da Medicina de Abrigo, à preservação de provas, conseguida através da aplicação dos princípios da Medicina Forense. Assim, paralelamente ao exame clínico, diagnóstico, tratamento e alojamento do animal, tem de haver registos escritos e/ou fotográficos do estado de saúde, dos tratamentos instituídos, da alocação e da evolução clínica deste. Na presente dissertação são apresentados seis casos clínicos de animais suspeitos de serem vítimas de maus-tratos observados no decorrer do estágio e acompanhados desde a apresentação inicial na clínica veterinária até à sua estadia no Abrigo ou adoção. A experiência adquirida com estes casos, em conjunto com informação disponível na literatura, levou à criação de uma proposta de guia de atuação em casos de maus-tratos a animais de companhia destinado a facilitar todo o processo a Médicos Veterinários de Abrigo e associações zoófilas.
ABSTRACT - Shelter Medicine in cases of suspected pet animal maltreatment - The need to involve humane organizations and shelters in the rescue, housing, provision of medical veterinary care, welfare guarantee and responsible adoption is increasingly unquestionable. Inevitably, Veterinarians who collaborate with shelters will deal with the medical aspects of various forms of animal mistreatment and, consequently, with the legal investigations triggered by it. The course of a pet animal suspected of being a victim of maltreatment can be long and usually goes through four phases: crime scene investigation, forensic clinical exam, shelter stay and placement for adoption. During this, the animal is simultaneously a living being, with needs inherent to that condition, and proof of the crime of which it was a victim and that, as such, must be preserved. Therefore, it is necessary to combine animal care in a shelter environment, putting into practice the principles of Shelter Medicine, and the preservation of evidence achieved through the application of the principles of Forensic Medicine. Thus, in parallel with the clinical examination, diagnosis, treatment and housing of the animal, there must be written and/or photographic records of the animal‟s health, treatments instituted, allocation and clinical evolution. In this thesis, six clinical cases of animals suspected of being victims of maltreatment, observed during the internship and followed from the initial presentation at the veterinary clinic to their shelter stay or adoption, are presented. The experience gained with these cases, together with information available in literature, led to the creation of a proposal for an action guide on how to deal with cases of animal maltreatment to facilitate the whole process to Shelter Veterinarians and humane organizations.
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Health systems throughout the globe face challenges with rising drug costs, decisions regarding the implementation of new drug therapies or using conventional drug therapies, access to drugs across different income groups and geographical barriers (Govindaraj et al., 2000:5; Wiedenmayer et al., 2006:6). South Africa is an upper middle income developing country with an estimated population of 50.59 million, facing major challenges in the health sector (WHO, 2011:170; Engelbrecht & Crisp, 2010:18; Stats SA, 2011:2; Dambisya & Modipa, 2009:4). In South Africa the second largest expenditure item in the health system is medicine (DOH, 2011:68). Managing drug supply is essential and managers should focus on procurement, selection, distribution and use to ensure uninterrupted supply. The general objective of this study was to investigate the current documentation systems in the Dr Kenneth Kaunda district regarding medicine logistics. A mixed method study was done to record information using survey forms and doing observations in primary health care clinics and community health care centres within the DKK district. The research period was from 1 January 2010 until 31 March 2012. The results revealed that the availability of pre–selected essential drugs within PHC clinics were above 80% except for ibuprofen tablets that were only available in 68% of the clinics. Clinic managers indicated that the majority of the required services are rendered within clinics in the DKK district. Twenty seven of the thirty four services mentioned in the research study were provided in 77% of the clinics. Daily clinic registers are used in 55% of the clinics to capture patient information. According to the results, 53.85% administration clerks, 42.31% professional nurses and 7.7% health councillors are responsible for completing patient registers upon entering the clinic. The results revealed that recorded patient information is used for statistical purposes (67%) and DHIS (25%). The results revealed that professional nurses within the DKK are responsible for dispensing medicines, and SOP?s for dispensing are used in 70% of these clinics. The results also revealed that 80% of registered nurses are responsible for maintaining the Abstract (continued) ii medicine room. According to the results, medication is stored in the medicine rooms (30%), consulting rooms (27%) and store rooms (5%). Results revealed that 75% of clinics used standard operating procedures to order their medicine stock and are managed by 23% of sub–district pharmacists, 35% of professional nurses and 40% of clinic managers. The results revealed that minimum and maximum drug estimations, stock cards, frequent stock checking and limiting access to medicine/store rooms to ensure optimum stock levels. The results also revealed that 88% of the clinics in the DKK district had no computer systems. Sub–district pharmacists play an essential role in monitoring budgets, supplying essential medicine, improving quality of care, managing expired stock and visiting clinics on a routine basis. The limitations for this study were stipulated and recommendations for further research regarding medicine logistics were also made.
Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2012.

Recently, there has been a growing movement toward an Electronic Health Record (EHR) to improve quality of care. The paper-based medical record is still the primary source of information in today’s medical practice. In order to design the EHR, knowledge with regard to the current medium of documentation is required. In the MUHC Cedars Breast Clinic, 112 medical records for 7 surgeons were audited to determine what was recorded in the initial visits between year 2002 and 2003. A Likert scale questionnaire was developed and included 46 questions derived from the chart review. It was introduced to assess their opinions on important variables in managing breast patients. The correlation between the medical records and surgeons’ opinions was then sought. The majority of data points had a low rate of documentation with wide variation; breast cancer risk factors were recorded in less than one third of charts. Family history and physical examinations had relatively high rates of documentation. The survey showed a considerable variation among surgeons’ opinions. Surgeons reported that they addressed 63% of all data points (29 of 46 questions) very often/always. There was weak correlation between what each surgeon records and what he/she thinks is important.
Récemment, il y a eu un mouvement grandissant vers le dossier électronique de santé (EHR) pour améliorer la qualité du soin. Le dossier médical sur papier est toujours la source primaire d'information dans la pratique en matière, aujourd'hui. Afin de concevoir EHR, la connaissance en ce qui concerne le milieu courant de la documentation est exigée. Dans la Clinique du sein de l'Institut des cèdres du CUSM, 112 disques médicaux pour 7 chirurgiens ont été apurés pour déterminer ce qui est enregistré dans les visites initiales en l'année 2002 et l'année 2003. Un questionnaire de balance de Likert comprenant 46 questions dérivées des dossiers a été présenté pour évaluer leur avis sur des variables importantes dans les patients de gestion de sein. La corrélation entre ces deux a été cherchée. La majorité de points de repères a eu un bas taux de documentation avec une grande variation; des facteurs de risque de cancer de sein ont été enregistrés dans moins d'un tiers de dossiers. Les antécédents familiaux et les examens physiques ont eu des taux relativement élevés de documentation. L'aperçu a montré une variation considérable parmi l'opinion des chirurgiens. Les chirurgiens ont rapporté qu'ils ont adressé 63% de points de repères (29 de 46 questions) très souvent/toujours. Il y avait corrélation faible entre ce que chaque chirurgien enregistre et quel il/elle pense est important. fr

Obstetric hemorrhage is one of the most common causes of maternal morbidity and mortality. The measurement of quantitative blood loss (QBL) at delivery prevents clinicians from failing to recognize hemorrhage in healthy obstetric patients who initially compensate for excessive blood loss. The purpose of this project was to improve the compliance of labor and delivery nurses in a community hospital with consistent QBL measurement. Key theories that formed the basis for the project were Lewin’s theory of planned change and homeostasis. The project question addressed was: Is the use of weekly scorecards to provide feedback to nurses with both blinded individual data and aggregate unit data associated with an increase in the percent of patients with blood loss at delivery documented as a QBL measurement over a 12-week period of time? A blinded scorecard of the percent of deliveries attended by each nurse that had QBL documented and an aggregate run chart of the percent of all deliveries with QBL documented were posted in the unit weekly. The postings included discussions of means to enhance facilitators of and decrease barriers to QBL measurement. Over 12 weeks, the percent of deliveries with QBL documented increased from 22.7% to 80.0%. This result is consistent with previous reports that clear and objective feedback from scorecards is associated with improvement in performance. Scorecard feedback may be explored to determine if it is associated with improvement of other nursing practices. This project has implications for positive social change as it may contribute to a reduction in preventable maternal deaths. Decreasing maternal morbidity and mortality supports the health of women in a population and influences the health of the next generation.

Although guidelines and minimal standards for the care and documentation of wounds in home health care settings in the United States are available, there is a lack of compliance among many home health care agencies (HHAs) with regard to the accuracy of wound documentation and care of wounds. Failure to follow guidelines for wound care according to Centers for Medicare and Medicaid Services and Home Health Outcome and Assessment Information System standards could result in loss of revenue for HHAs, improper treatment of wounds, and legal ramifications. The purpose of this doctoral project was to develop and validate a staff educational module on wounds and wound documentation for an HHA. Benner's from-novice-to-expert model was the conceptual framework for understanding nurses' matriculation. The practice-focused question focused on whether a wound staff educational module increased the home health care nurse's knowledge about wounds and wound documentation. A 5-level Likert scale was used by an expert panel to validate the staff educational module. Descriptive analysis was used to evaluate the data. The results of the survey supported implementing the educational module with recommendations (overall percentage 93% [4.4]). The findings of this project contribute to social change by increasing nurses' knowledge of wound care, improving the quality of wound care, increasing reimbursement and revenue, and decreasing the cost of care for wounds.

Knowledge of The Joint Commission's National Patient Safety Goals and an effective provider cooperative practice involving communication and teamwork are essential for the delivery of safe and compliant patient care in the surgical setting. The purpose of this study was to assess the impact of an educational intervention for physicians and nurses designed to increase documentation of compliance with national patient safety standards. As events of noncompliance have impacted patient safety at the hospital where this project was conducted, measures were needed to assess barriers to compliance with standards of practice and to focus educational session plans on identified knowledge-base needs. The goal of this project involved bringing all surgical team members together for educational sessions on safety standards. Pre-intervention and post-intervention assessments of knowledge were administered to study participants. Additionally, random chart documentation audits were conducted before and after the intervention to assess the effectiveness of the education sessions on documentation compliance with the targeted standards. Outcomes of this study included improved knowledge of, and compliance with, national patient safety goals. Results may improve safe patient care at this hospital, reduce costs, and create mutual respect and teamwork, all contributing to the successful achievement of the organization's quality improvement goals.

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Esta pesquisa visa propor bases para a construção de redes de palavras-chave para artigos de divulgação científica da Medicina, que levam em conta a terminologia médica presente nesses textos. No Brasil, a carência de redes informativas no mundo virtual nos motivou para o trabalho com a terminologia da Medicina. Em virtude desse aspecto, nosso interesse volta-se para a importância de construir sistemas informativos que permitam a aproximação entre as denominações técnico-científicas e as de caráter sociolingüístico, considerando a diversidade que esta apresenta. Preencher esta lacuna significa melhorar o nível de informatividade para o público leigo que acessa o site brasileiro ABC da Saúde em busca de conhecimento especializado na área médica. O estudo se apóia nos fundamentos teóricos da Socioterminologia, da Teoria Comunicativa da Terminologia e da Documentação. O corpus da pesquisa é constituído de artigos de divulgação científica da Medicina, extraídos do site com o auxílio da ferramenta Corpógrafo. As i
This research paper aims to propose a framework for the construction of key-word networks for Medicine articles of scientific popularization. The lack of virtual informative networks in Brazil has motivated us to develop this work with the terminology of Medicine. Our main interest is focused on the importance of building informative systems which allow for the bridging between technical-scientific and sociolinguistic terms, considering the diversity which the latter presents. Bridging this gap involves improving the level of informativity for the lay public who use the Brazilian ABC da Saúde site to search for specialized knowledge in the medical area. The study is based on the theoretical assumptions of Socioterminology, Communicative Theory of Terminology and Documentation. The corpus used in this research contains Medicine articles of scientific popularization extracted from the site with the aid of a tool called Corpógrafo. The data was stored in specific records disposed in a Microsoft Access database,

Abstract          Background: End of life is difficult to establish in patients with dementia and many patients die due to complications related to the disease. To document that care are palliative in this group of patients is not common among nurses and physicians. This may depend on that the palliative course is extended and not similar to the palliative course common among patients with cancer. Aim: To describe how the registered staff in nursing homes document the care of persons with dementia in a late palliative phase. Method: A retrospective record study with a deductive approach. Nursing (n = 50) and medical records (n = 50) for departed patients were reviewed using a review guide based on the Liverpool Care Pathway (LCP). Data were analyzed with a manifest content analysis.  The occurrence of documentation in the records was also counted. Results: Three categories were formulated from the analysis: Initial assessment, Coherent assessment and Follow-up. According to medical records the nurses and physicians knew that patients with dementia were dying, but the position on palliative care was not always decided. Nurses and physicians knew that patients with dementia were dying but they did not take a stand that the patient needed palliative care.  Mainly physical symptoms were documented and to a lesser degree psychological, social or existential/spirituality needs. Discussion: It was difficult to form a true picture of patients’ situation from out the documentation. Partly because all caring actions were not documented and the review guide was limited as all parts provided to give a holistic care was not represented. That relative had been provided information that the patient was palliative was accurately documented. Conclusion: The holistic care that patients with dementia need in a palliative phase is not elucidated in the documentation in nursing homes in spite of nurses and physicians knowledge of that the patient are dying.

Introduction: Research show that patients frequently display abnormal vital signs as much as 48h before a serious adverse event occur, such as cardiac arrest or unplanned intensive care unit admission. Therefore, early recognition of these changes trough vital sign examination is essential in the prevention of deterioration. However, deterioration is often missed.Aim: The aim was to investigate to what extent nurses in the general ward are documenting vital signs prior to patient deterioration. Methods: A systematic literature review was done usingthe databases PubMed and CINAHL. Inclusion criteria: general ward and publication 2010-2020, exclusion criteria:emergency department, acute admission ward, paediatric ward, psychiatric ward, interventions and continuousmonitoring. Critical appraisalusingtools from Joanna Briggs Institute. PRISMA statement for reporting of systematic reviews.Results: Nine studies were included. It was seen that the fraction of cases who had vital signs documented prior to deterioration was diverse, although never complete. Some studies showed an acceptable fraction of patients who weremonitoredin the hours prior to deterioration, but it was seen that the monitoring did not always escalate as the patient got worse. The vital signs most frequently documentedwereheart rate and pulse, thoughstill missing in a large fraction of charts. Respiratory rate was documented less than the other vital signs.Conclusions: This study suggests that documentation of vital signs prior to deterioration is diverse but often incomplete. Further research is needed to understand what can be done to improve vital sign documentation on general wards.

Bakgrund: Munvård har en stor betydelse för människan både genom nutrition och via kommunikation. Ökade möjligheter för behandling, ekonomisk ersättning och tillgänglighet av vård bidrar till att tandlöshet inte är lika accepterat av samhället idag. Med ökad levnadsålder ökar både behoven och riskerna för att problem uppstår. Trots det är munhälsan ett stort problem inom sjukvård och äldreomsorg.Syfte: Att undersöka vårdspersonalens kunskaper om munhälsa, samt hur vårdpersonal prioriterar munvården av äldre personer som är beroende av hjälpinsatser.Metod: Studien genomfördes som en litteraturstudie och bygger på 5 kvalitativa och 5 kvantitativa studier. Dessa granskades och bearbetades för att slutligen analyseras till kategorier och subteman. Resultat: Vårdpersonal upplever att det förekommer brister i utbildningen och att kontinuerliga munhälsoutbildningar saknas på arbetsplatserna. Kunskap om munhälsa är viktigt för att kunna förstå innebörden av dessa arbetsuppgifter. Det framkommer även att vårdpersonalens prioriteringar avspeglas av attityder och deras personliga syn på munvård. För att underlätta munvårdsbedömning visar det sig att ROAG är ett bra bedömningsinstrument för att få jämlika och oberoende bedömningsresultat. Trots det är det vanligt förekommande att munvården saknas i dokumentationen.
Background: Oral hygiene plays an important role for humans both through nutrition and through communication. Increased opportunities for treatment, compensation and availability of care makes toothlessness less accepted by society today. With increased longevity will increase both the needs and risks of problems arising. The oral care is still a major problem in health care and elderly care.Aim: Investigate health professionals' knowledge of oral health and how health professionals prioritize the oral care of elderly people who are dependent on relief efforts.Method: The study was conducted as a literature review based on 5 qualitative and 5 quantitative studies. These were reviewed, processed and finally analyzed for categories and subthemes.Results: Caregivers perceive that there are shortcomings in education and the continuous education of oral care are missing in the workplace. Knowledge of oral health is important to understand the meaning of performing its task. However, it appeared also that nursing staff priorities were reflected in attitudes and staff´s views on oral hygiene. In order to facilitate oral care assessment, ROAG was a very good assessment instrument to obtain equal and independent evaluation results. Although it is a common practice that the oral care lacking in documentation.

Bakgrund: Dokumentationssystemet för sjuksköterskor har förändrats sedan sjuk-sköterskor blev skyldiga att dokumentera i patientjournalen. Detta har lett till att omvårdnaden har synliggjorts och därmed kan granskas. System för att kvalitetssäkra patientarbetet har med tiden arbetats fram, bl a VIPS-modellen och Melior. Sjuksköterskans dokumentationssystem är dock fortfarande i behov av utveckling.Syfte: Syftet var att undersöka sjuksköterskors skilda uppfattningar om omvårdnadsdokumentation.Metod: På ett sjukhus i södra Sverige genomfördes en fenomenografisk studie genom intervjuer av 11 sjuksköterskor. Resultat: Av 244 uppfattningar från intervjuerna skapades fem huvudkategorier och 12 subkategorier. De fem huvudkategorierna är: noggrannhet hämmar ändamålet, sådant som inte skrivs, vem dokumenterar sjuksköterskan för - och för vem dokumenterar hon inte, dokumentation och patientsäkerhet, Melior och VIPS-modellen.
Background: The system for nursing documentation has changed since nurses require, by law to construct nursing records. This has led to patient care and nursing becoming more visible and can therefore be reviewed and controlled. Systems for improving patient care using models such as the VIPS and Melior has through time, developed. But the system for nursing documentation still requires development. Aim: The aim of the study was to explore nurses perceptions of nursing documentation. Method: A phenomenographic study was conducted through 11 interviews with nurses in a hospital in southern Sweden. Results: 244 perceptions were formulated. These were categorised into five main categories, and from these 12 sub categories were identified. The five main categories include: attention to details may prevent the purpose, what's not written, for whom does the nurse construct nursing records -and for whom doesn't she, documentation and safety of the patient, Melior and the VIPS-model.

Introduktion: Dokumentation av omvårdnad är varje sjuksköterskas skyldighet och ansvar enligtPatientdatalagen (SFS 2008:355). Operationssjuksköterskan dokumenterar omvårdnad och information utifrån den perioperativa vårdprocessen. Tydlighet i dokumentationen kan säkerställainformationsflödet mellan olika vårdgivare. Syftet var att sammanställa forskning som beskriver operationssjuksköterskans uppfattningar om dokumentation av omvårdnad inom perioperativ vård. Metod: En integrativ systematisk litteraturstudie genomfördes enligt Statens Beredning för Medicinsk och Social Utvärdering [SBU]. Materialet analyserades med integrerad analys enligt Kristensson (2014). Resultatet baserades på åtta vetenskapliga artiklar. Tre kategorieri dentifierades utifrån analysen och var: varierande egenansvar och skiftande attityder till dokumentation av omvårdnad, påverkbara och skiftande förutsättningar för dokumentation av omvårdnad och i dokumentationen prioriterade omvårdnadsdiagnoser och omvårdnadsåtgärder. Konklusion: Standardiserad terminologi kan tydliggöra operationssjuksköterskans dokumentation av omvårdnad både för hen själv och för övriga vårdgivare. Ett för operationssjuksköterskan anpassat dokumentationssystem kan vara av betydelse för att dokumentationen av omvårdnad ska prioriteras. Ledarskapets inställning till dokumentation ansågs ha betydelse för om operationssjuksköterskan gavs förutsättningar till dokumentation av omvårdnad.

Tidigare forskning visar på att utvecklingen inom sjukvården har gått snabbt, framförallt prehospitalt. De tekniska lösningarna har utvecklats och det finns många gånger datorer både fram och bak i dagens ambulanser som har ersatt de traditionella pappersjournalerna. Forskning pekar på åldersfaktorer och tidigare datorkunskap som faktorer som påverkar hur väl nya system mottagits. Patientsäkerheten, tydligheten och enhetligheten framhålls i nutidens journalsystem samtidigt som den eventuella dehumaniseringen kring omvårdnaden lyfts fram i och med teknikens framfart. Få studier beskriver hur ambulanspersonal upplever de nya journalsystemen prehospitalt en tid efter införandet. Syftet med studien var att belysa ambulanssjuksköterskors upplevelser av att arbeta med digitala journalsystem prehospitalt. En kvalitativ ansats valdes och personliga intervjuer genomfördes. Åtta ambulanssjuksköterskor deltog i studien och intervjuerna analyserades med hjälp av kvalitativ innehållsanalys. Analysen resulterade i 7 kategorier. Studiens frågeställningar blev resultatets 3 huvudrubriker. Huvudrubrikerna var ”Ambulanssjuksköterskans upplevelse av den prehospitala journalföringens utveckling”, ”Ambulanssjuksköterskans upplevelse av dagens digitala journalsystem” och ”Ambulanssjuksköterskans upplevelse av det patientnära arbetet”. I resultatet framkom att ambulanssjuksköterskor såg en negativ påverkan på det patientnära arbetet sedan införandet av digitala journalsystem som kopplades till utökade åtgärder och undersökningar. Patientsäkerheten hade förbättrats sedan införandet av standardiserat och strukturerat omhändertagande. Möjligheter för ambulanssjuksköterskorna att påverka utvecklingen kring det digitala journalsystemet skulle leda till underlättande av arbetssätt. Förutom nöjda ambulanssjuksköterskor skulle det ge en positiv påverkan för patienten i form av tid och omhändertagande. Vidare forskning kring utvecklingen av de digitala journalsystemen behövs för att kunna följa hur det påverkar patienten, vårdaren och den prehospitala verksamheten.

Distriktssköterskan är ofta den sista länken i vårdkedjan från den somatiska vården och hemsjukvården. En fungerande överrapportering från den slutna somatiska vården till hemsjukvården är av yttersta vikt för patientens trygghet och säkerhet och det är därför viktigt att innehållet i omvårdnadsepikrisernas uppfattas som relevant för den fortsatta vården. En omvårdnadsepikris skall innehålla en slutanteckning över de omvårdnadsåtgärder som genomförts på sjukhuset och en kort beskrivning över patientens aktuella omvårdnadsbehov. Syftet med studien var att beskriva distriktssköterskors uppfattning om omvårdnadsepikrisernas relevans och användbarhet i den fortsatta vården i hemmet av palliativa patienter samt att jämföra dessa med det faktiska innehållet i omvårdnadsepikriser skrivna av sjuksköterskor inom den slutna somatiska vården.Studien har genomförts med en innehållsanalys av 16 omvårdnadsepikriser insamlade från en kirurgiavdelning på ett större sjukhus i Göteborgsregionen samt semistrukturerade intervjuer med fem distriktssköterskor i Göteborgsregionen. Avslutningsvis jämfördes resultatet från de två datakällorna för att bedöma överensstämmelsen mellan dessa. Sammanfattningsvis visar resultatet att omvårdnadsepikriserna kan förbättras inom ett antal områden för att garantera palliativa patienter en fortsatt god palliativ omvårdnad i hemmet. De bör beskriva patienternas problem och symtom men fokus bör vara på beskrivningen av patienternas upplevelser. De bör också innehålla en tydlig beskrivning av vilken information patienterna och deras anhöriga har fått om sjukdomen och sjukdomens förlopp och prognos. Medicinska formuleringar och interna förkortningar i omvårdnadsepikriserna bör minska samtidigt som användandet av det vårdvetenskapliga och omvårdnadsmässiga språket bör öka.--------------------------The public health nurse often constitutes the final link in the chain of care from somatic care in hospitals, to continued care in patient’s homes. In order to guarantee patient safety and quality of care, it is important that the final report accompanying the patient home contains nursing information that is regarded as relevant for the continued home care. The nursing report written when the patient is discharged from the hospital should contain a short description over the patients immediate care need. The aim of this study was to describe the public health nurses perceptions of the relevance and the usefulness of nursing reports in continued home care with focus on palliative patients, and to compare their perceptions with the actual content in nursing reports accompanying the patient when discharged from the closed somatic care. Method used was content analyze in analysing 16 functional reports, documented by nurses at a surgery ward specializing in abdominal surgery in a large hospital in the Gothenburg region. In addition five public health nurses in the Gothenburg region were interviewed, and the interviews were analysed using content analysis approach. The last and final part consisted of a comparison between the nursing reports and the result of interviews in order to assess similarities and differences.The result of this study showed that the nursing reports can be improved in several aspects to guarantee palliative patients continued good palliative care in there home environment. The reports should describe the patients health problems and symptoms on the basis of the patients experience. They should also contain a description of which information the patient and relatives has been given regarding the disease and the course of the prognoses. Medical terminology and internal shortenings in the nursing report should decrease at the time as the use of language of nursing theory and nursing process should increase.

Program: Specialistsjuksköterskeutbildning med inriktning mot distriktssköterska

Uppsatsnivå: D

This thesis analyse how life-histories are expressed and reformulated in connection to a life crisis of ill health. The study is based on ten interviews with people who in connection with ill health have made use of treatments within both orthodox medicine and complementary medicine and who have also developed various forms of self-treatment. The overall aim is, with a point of departure in the concepts health, healing and trust, to analyse narratives as a practice through which the respondents create identity and a life-context. The signifi cance of constructing the (auto)biography of the healing narrative – a form of narrative and performative act – runs as the main thread through the thesis. This act makes up the practice that is recurrently discussed in several of the thesis’ chapters and is synonymously termed the telling of healing narratives or or to narrate health and healing. The analysis of the narrative’s The analysis of the narrative’s healing main themes is mirrored in the order of the chapters. The study is broadly thematic and structured as a generalised healing process beginning with upheaval, continuing with crisis and social drama, and further to the endeavour of expressing values and judgements in a public context.

The interview themes of self-treatment and alternative treatment have occasioned the investigation into what an ethno-medical perspective can bring to analyses of people’s experiences of ill health in an everyday medical context. One of the points of having the concept ethno-medicine as a starting point is that every practice or narrative formation is ascribed with a potential for interpretation in its creation of knowledge. Another chapter deals with two themes of identity and life-history construction in the practice of healing narratives – the need for a chronology and reappraised perspectives on body, health and lifestyle. Healing narratives can be understood as a genre of life-historical narratives where life is often described as a linear course of events. A model by the anthropologist Victor Turner on the course and content of social drama is used as a comment to analyses of three respondents’ narratives in another chapter. A drama can be understood as a tragic course of events, based on an accident or an upsetting incident that roughly revolves around event/crisis, chaos and the striving for restoration. The concept of other journals is then used to make visible the everyday medical administrative practice and refers to the documentation used in the form of collected documents, written notes, and diaries. As an unexpected part of healing processes, the necessity of familiarising oneself with rules, laws and health insurance systems in order to be able to claim one’s rights is brought forward.

The social transformation process of various care practices in society makes up both a context and a commonly occurring theme in the narratives that the thesis is based upon. A modern health culture that gains strength from loosely composed social movements exerts infl uence on all levels of society. With an increased individual responsibility, the need grows to fi nd one’s own healing strategies and to create one’s own life-history in narratives that mirror this transformation in an everyday context. Healing narratives can be seen as a form of evaluation of health-care practices where experiences of treatment and notions of health and cure and healing are concretised.

DIABETESFOTEN HOS INNELIGGANDE STROKEPATIENTER: RISK, OMFATTNING, OCH OMVÅRDNADSÅTGÄRDERBAKGRUND: Fotkomplikationer är de allvarligaste komplikationerna till diabetes som ofta leder till kostnadskrävande behandlingar och amputation. Stroke resulterar i förlust eller begränsning av tidigare fysiska, psykiska och sociala aktiviteter, inklusive nedsatt förmåga att skydda sina fötter och utföra egenvård. Strokepatienter med diabetes har stor risk att skada sig i den förlamade sidan av kroppen. Nedsatt mobilitet är en riskfaktor som kan orsaka patienten skada. På vårdavdelning för strokedrabbade patienter kan sjuksköterskan genom god omvårdnad och preventiva åtgärder bidra till att risken för utveckling av skada på fötterna hos strokepatienter minskar.SYFTE: Syftet med studien är att kartlägga omfattningen av diabetesfot på en neurologisk klinik samt granska omvårdnadsdokumentationen om preventionsåtgärder hos strokepatienter med diabetes avseende risken att utveckla fotsår.METOD: En retrospektiv journalgranskningsstudie med kvantitativ och kvalitativ ansats. Studien genomfördes på en neurologisk klinik på ett universitetssjukhus i södra Sverige. Samtliga journaler N=101 från strokepatienter med diabetes som vårdades på kliniken från 1 januari 2015 till den 20 december 2015 granskades med hjälp av Global Trigger Tool (GTT). Dataanalysen delades i två delar: deskriptiv statistisk analys och manifest kvalitativ innehållsanalys.RESULTAT: Medianåldern är 78 år (41-93 år). Kvinnor n=40, män n=61. Journalgranskningen visade generellt på bristande dokumentation. Riskbedömning för fotsår var inte dokumenterad i någon av journalerna. För patienter som hade dokumenterade fotsår (n= 3) var lokalisationen av fotsår på samma sida som patienten var förlamad. Dokumenterade preventions- och omvårdnadsåtgärder i sängen: (n=12) och i stolen: (n=0). Enligt IWGDF riskklassifikation identifierades (n =12) som har riskfaktorer för fotproblem och fotsår. Dokumentation av omvårdnadsprocessen följdes inte i journalerna.SLUTSATS: Patienterna har hög ålder, är multisjuka och förlamade helt eller på ena sidan av kroppen. Lokalisationen av fotsår på samma sida som patienten var förlamad. Brister i omvårdnadsdokumentation och preventionsarbete medför risk för patientens säkerhet. Studien ger mer kunskap när det gäller risk för utvecklandet av fotsår hos patienter med stroke och diabetes som vårdas på neurologisk klinik. Studien ger ett underlag för att utveckla klinikens kvalitetsarbete och försäkra patientsäkerhet genom att öka kunskap om diabeteskomplikationer och riktlinjer, omvårdnadsdokumentation enligt omvårdnadsprocessen, samt kritiskt tänkande av omvårdnad. Fler studier om fotsår hos strokepatienter rekommenderas.
THE DIABETIC FOOT IN HOSPITALIZED STROKE PATIENTS: RISK, PREVELANCE AND NURSING ACTIONS.BACKGROUND: Complications in the foot is the most serious one of the diabetes. Often, this leads to expensive treatments and amputation. Stroke results in loss or limitation of previous physiological, psychological and social activities and including a reduced ability to protect their feet and perform self-care. Stroke patients with diabetes have a high risk of injury in the paralyzed side of the body. Impaired mobility is a risk factor that can cause patient harm. On the nursing ward for stroke patients the nurse can through good nursing intervention and preventive actions contribute to the risk of developing damage to their feet in stroke patients decreases.AIM: The aim of the study is to explore the prevalence of diabetic foot at a neurological clinic and review the nursing documentation of preventions actions in stroke patients with diabetes with regard to the risk of developing foot ulcers.METHOD: A retrospective medical record review study with quantitative and qualitative approach. The study was conducted at a neurological clinic at a university hospital in southern Sweden. All the records (n = 101) of stroke patients with diabetes who were treated at the clinic from 1 January 2015 to 20 December 2015. The examination was conducted using Global Trigger Tool (GTT). Data analysis was divided into two parts: the descriptive statistical analysis and manifest content analysis.RESULTS: Median age is 78 years (41-93). Women (n = 40), men (n = 61). Journal review showed insufficient documentation. Risk assessment for foot ulcers was not documented in any of the journals. Patients with documented foot ulcer (n= 3), the localization of ulcers is on the same side as the patient is paralyzed. Prevention and nursing actions, (n = 12) documented action in bed, (n = 0) documented actions in the chair. According IWGDF risk classification (n =12) identified as having risk factors for foot problem and foot ulcer. Documentation of nursing process was not followed in the journals.SUMMARY: The patients had high age with multiple comorbidities and paralyzed in the whole or on one side of the body. The localization of foot ulcers is on the same side as the patient is paralyzed. Insufficiency in nursing documentation and prevention work result in risk to patient safety and impaired quality of care. The study provides more knowledge about the risk of the developing foot ulcer for patients with stroke and diabetes who treated in the neurological clinic. The study provide foundation to develop the clinic quality work and ensure patient safety through increasing knowledge to the clinic about diabetic complications and guidelines, nursing documentation in accordance with the nursing process and critical thinking of nursing. More studies of foot ulcers in stroke patients are recommended. Keywords: diabetes mellitus, diabetes foot ulcers, documentation, Global Trigger Tool, journal examination, nursing, prevention,

Ce travail de recherche porte sur les descriptions du corps des Africain(e)s dans la littérature médicale française de la fin du XVIIIe siècle jusqu'au milieu du XXe siècle. Si la "race noire" est perçue comme un ensemble monolithique dans les écrits médicaux du début de la période, la pluralité africaine apparaît peu à peu sous la plume des médecins coloniaux dans le dernier tiers du XIXe siècle. Au-delà de la classification des principales races humaines, une taxinomie ethnique apparaît dans leurs écrits, distinguant les peuples noirs d'Afrique subsaharienne, depuis le Cap de Bonne-Espérance jusqu'à la Sénégambie. La description sexuée des populations se développe afin de préciser les catégorisations ethniques ainsi que le savoir sur les Africain(e)s. Si la diversité africaine est progressivement mise en lumière, certains stéréotypes raciaux demeurent prégnants comme l'hypersexualité des Noir(e)s ou l'inversion sexuelle en Afrique. Notre travail, qui s'appuie sur des dictionnaires médicaux, des monographies sur les races humaines ou encore sur des ouvrages de médecine coloniale, démontre l'imbrication des théories sur la race, le sexe et le genre au sein de ces discours ainsi que la similarité des procédés rhétoriques utilisés pour définir l'Autre, qu'il soit de sexe féminin et/ou de race noire. Cette recherche éclaire également la façon dont ces représentations se sont nourries des controverses scientifiques et des préoccupations politiques de la période. Si les discours médicaux stigmatisent l'infériorité raciale des Africain(e), ce travail montre aussi les voix dissonantes et les oppositions de certains médecins à ces schémas consensuels
This research focuses on the descriptions of African people's body according to French medical literature from the end of the 18th century to mid-20th century. Though the « black race » is seen as monolithic group in the medical writings at the beginning of the period, the african multiplicity slightly came up under the colonial doctors' pens, in the last third of the 19th century. Beyond the principal human races classification, the french doctors established a hierarchy between the black peoples of Sub-Saharan Africa, from The Cape of Good Hope to Senegambia. A sexual description of the peoples is added to raciological studies in order to clarify the racial classifications, ethnic hierarchies and to develop knowledge on African people. The african diversity is being highlighted all along the studied period, despite the permanency of numerous racial stereotypes as the hypersexuality of black people or the inversion of gender in Africa. Based on medical dictionaries, work about human races or even on colonial medecine work, our work displays, within the descriptions of the black bodies, the overlapping of the theories about race, gender and sex, and also explains the similarity of the rhetorical methods used to define and describe the Other, should they be female and/or black. Moreover, this research highlights how these representations were influenced by the scientific controversies and the political issues of the period, what they influenced in turn. Though the medical speeches stigmatize racial inferiority of the African people, this work also underlines the antithetical opinions and the conflicts between some doctors about these consensual patterns

A master thesis „Clinic of holistic medicine“ is processed as a project documentation. The building is projected for the plat no.170/1 in Kladruby u Vlašimy (Benešov district). Is a three-storyed wooden building from large-format wooden panels. Ceilings are ribbed constructions from spruce wood. Stairspaces are made of reinforced concrete. The house is roofed with a saddle roof made by woodentrusses. Stairspaces and machine room of air conditioning are roofed with a one-sheat flat roof. The project is planned as an extension of the Rehabilitation institute complex in Kladruby.

Indiana University-Purdue University Indianapolis (IUPUI)
Reducing medical error remains in the forefront of healthcare reform. The use of health information technology, specifically the electronic health record (EHR) is one attempt to improve patient safety. The implementation of the EHR in the Emergency Department changes physician workflow, which can have negative, unintended consequences for patient safety. Inaccuracies in clinical documentation can contribute, for example, to medical error during transitions of care. In this quasi-experimental comparison study, we sought to determine whether there is a difference in document quality, error rate, error type, cognitive load and time when Emergency Medicine (EM) residents use paper charts versus the EHR to complete physician documentation of clinical encounters. Simulated patient encounters provided a unique and innovative environment to evaluate EM physician documentation. Analysis focused on examining documentation quality and real-time observation of the simulated encounter. Results demonstrate no change in document quality, no change in cognitive load, and no change in error rate between electronic and paper charts. There was a 46% increase in the time required to complete the charting task when using the EHR. Physician workflow changes from partial documentation during the patient encounter with paper charts to complete documentation after the encounter with electronic charts. Documentation quality overall was poor with an average of 36% of required elements missing which did not improve during residency training. The extra time required for the charting task using the EHR potentially increases patient waiting times as well as clinician dissatisfaction and burnout, yet it has little impact on the quality of physician documentation. Better strategies and support for documentation are needed as providers adopt and use EHR systems to change the practice of medicine.

Torture is a relevant issue in human interactions for its pervasiveness, gravity and tremendous consequences. Unfortunately is still remains a reality in many countries of the world. This presentation aims approach to the concept of torture and the situation of torture in Portugal and worldwide; analyze international laws and ethical principles on documentation and investigation of torture; and address the contribution and importance of clinical forensic medical examination in these situations, how it best can be carried out and what kind of results may provide. There is no consensus about how to define torture but the most cited definitions in literature are those put forward by the World Medical Association and the United Nations. Both of these definitions include severe physical and psychological forms of suffering and require coercive intent by perpetrators with the consent or acquiescence of state authorities. The prohibition of Torture is absolute and applies to all times and in all circumstances. This prohibition is present in several international treaties and agreements. In 1984 the United Nations adopted the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment highlighting the particular attention given to this absolute prohibition, creating a legally-binding document and providing additional rules to assist in prevention and investigation of allege cases of torture. Nevertheless, between January 2009 and May 2013, Amnesty International received reports of torture and other ill-treatment committed by state officials in 141 countries, and from every world region. This only indicates cases reported to or known by the organization and does not necessarily reflect the full extent of torture worldwide. Besides forbidding it, International law also obliges states to investigate allegations of torture and to punish those responsible. It also requires that victims are able to obtain reparation. One of the major challenges in accomplishing this is to obtain sufficient evidence in cases against perpetrators. If there is no proof that torture took place, a climate of impunity can come to exist and the practice will endure. Medico-legal reports are a way of gathering evidence of torture. Even in countries where a fair trial is rare, medico-legal documentation strengthens the victims’ position since it becomes more difficult to disregard the complaint. The area of application of the medico-legal reports is not restricted to medico-legal investigation. It can be broadened to the investigation and documentation of other violations of human rights in national and international legal proceedings, and monitoring such as cases of asylum seekers, cases of forced confessions through torture, identification of therapeutic needs of victims and the need for reparation and redress by the state. There are also a role for it in activities like research, advocacy and lobbying. Therefore, participation and support of health professionals are of crucial importance for the abolition of torture and other forms of ill-treatment. Ensuring that doctors are aware of how to perform a medico-legal report and how to use it in legal proceedings is a needed step forward in the prevention of torture. Because a large of the large number and the severe suffering of many survivors, the question of torture should become a part of health care curricula.
A tortura é uma questão relevante nas interações humanas pela sua perversidade, gravidade e consequências tremendas. Infelizmente ainda continua a ser uma realidade em muitos países do mundo. O objectivo principal deste trabalho é o de proceder à elaboração de um texto que permita aos profissionais de saúde, adquirirem com a sua leitura uma rápida percepção do que é tortura e os maus tratos, do enquadramento legal destas situações e do potencial que uma adequada abordagem do ponto de vista médico pode proporcionar para uma correta identificação de tais práticas. Neste sentido, o presente trabalho procede inicialmente a uma revisão do conceito de tortura e da situação da tortura a nível mundial e ao nível de Portugal. Seguidamente, efetua uma breve análise das leis internacionais relativas à investigação e documentação de tortura e aborda as questões éticas levantadas por esta temática. Por último analisa o contributo do exame médico-legal nestas situações, como pode ser realizado e quais as mais valias que pode proporcionar. Não há consenso sobre como definir a tortura mas as definições mais citadas na literatura são as fornecidas pela Associação Médica Mundial e pela Organização das Nações Unidas. Ambas incluem formas físicas e psicológicas graves de sofrimento e exigem uma intenção coerciva por parte dos agressores, com o consentimento ou aquiescência das autoridades do Estado. A definição da Organização das Nações Unidas exige ainda que a agressão seja perpetuada especificamente por membros do, ou ao serviço do, Governo ou por forças militares ou policiais pertencentes ao Estado. Há também outras práticas que, apesar de não estarem incluídas nas definições de tortura, são um ataque à vida humana em toda a sua dignidade. Este outro tratamento cruel, desumano e degradante, que será referido neste trabalho como "maus-tratos", também tem a intenção de expor os indivíduos a condições que causam sofrimento físico ou mental significativo, mas sem um propósito específico. As pessoas vítimas desta prática, serão neste trabalho equiparadas a vítimas de tortura. A proibição da tortura e maus-tratos é absoluta e aplica-se a todos os momentos e em todas as circunstâncias. Esta proibição está presente em diversos tratados, acordos internacionais e o direito a estar livre de tortura é contemplado na Declaração Universal dos Direitos do Homem. Em 1984, as Nações Unidas adoptaram a Convenção Contra a Tortura e Outros Tratamentos Cruéis, Desumanos, Degradantes ou de Punição (CAT) destacando a particular atenção dada a esta proibição absoluta. Este é um documento juridicamente vinculativo que prevê regras adicionais para auxiliar na prevenção e investigação de alegados casos de tortura. Apesar de todas as normas e tratados que contemplam a proibição de tortura, esta continua a ser ainda uma prática comum e mundialmente disseminada. Entre Janeiro de 2009 e Maio de 2013, a Amnistia Internacional recebeu relatos de tortura e outros maus-tratos cometidos por funcionários do Estado em 141 países, e de todas as regiões do mundo. Isso só indica casos notificados ou conhecidos pela organização, e não reflecte necessariamente a extensão total da tortura em todo o mundo. Portugal não é excepção a isto. Além de proibir a prática de tortura, a lei Internacional obriga também os Estados a investigar alegações de tortura e a punir os responsáveis. Requer ainda que as vítimas possam ser ressarcidas da forma mais completa possível. Um dos principais desafios na realização disto é a obtenção de elementos de prova suficientes em casos contra os agressores. Se não há nenhuma prova de que a tortura ocorreu, um clima de impunidade pode vir a existir e a prática será perpetuada. Relatórios médico-legais são uma forma de apresentar provas de tortura. Mesmo em países onde um julgamento justo é raro, a documentação médico-legal fortalece a posição das vítimas tornando mais difícil ignorar a acusação Para mais, médicos da área dos cuidados de saúde primários são importantes detectores na identificação das vítimas. Eles podem encontrar sobreviventes de tortura em contextos de cuidados primários ou nos serviços de urgência e emergência médica, e serem quem inicia o encaminhamento para o tratamento destas vítimas e acciona os mecanismos legais necessários. A área de aplicação dos relatórios médico-legais não se restringe à investigação médico-legal. Estes podem ser utilizados na investigação e documentação de outras violações dos direitos humanos, em processos judiciais nacionais e internacionais. Podem ter ainda um papel importante em casos de requerentes de asilo, na identificação das necessidades terapêuticas das vítimas e da necessidade de reparação e reparação por parte do Estado. Há também um papel para ele em atividades como pesquisa, advocacia e lobby. Portanto, a participação e apoio de profissionais de saúde é de importância crucial para a abolição da tortura e outras formas de maus-tratos. Garantir que os médicos estão cientes de como executar um relatório médico-legal e como usá-lo em processos judiciais é um passo necessário na prevenção da tortura. Dado a grande quantidade de pessoas vítimas desta prática e o papel preponderante dos médicos na sua prevenção, a abordagem da tortura e o exame médico-legal deveriam tornar-se parte dos currículos das escolas médicas.

Includes bibliographical references (leaves 185-194)
Underpinned by the premise that any text can be studied as a translation provided it is identified as such, this study theoretically uses Descriptive Translation Studies (DTS) to investigate English-Swahili healthcare texts. The aim of the study was to: identify, describe and analyse linguistic and cultural aspects in the texts; identify, describe, and analyse translation strategies used in the texts; and describe and analyse the use of illustrations in the texts. The study made use of Kruger and Wallmach’s (1997) analytical framework. The Tertium Comparationis of the study was descriptive terms, cohesive devices, translation strategies, division of texts, illustrations, text titles, and taboo words. On the linguistic aspects, the study’s main findings were: that the English texts use more descriptive terms than the Swahili texts; Swahili texts have a higher frequency use of references because it contains a number of derivational and inflectional morphemes; substitution is sparingly used whereas ellipsis is almost non-existent in Swahili texts in spite of its presence in the source texts; additive and causal conjunctions were the most prevalent in the texts; and inasmuch as there were no significant differences in the use of lexical cohesion in the ST and TT, Swahili texts were found to be more cohesive due to the slightly higher number of lexical items. Regarding the cultural aspects, it was found that translators use euphemism in the translation of words considered taboo and this informed the conclusion that there reigns the euphemism norm in Swahili texts. It equally emerged that strategies used to overcome non-lexicalisation include: use of pure loan words, use of pure loan words preceded by explanation, use of indigenised loan words, use of omission and translation by a more general word. On the other hand, translators used strategies of substitution, use of general words, paraphrasing and cultural substitution to translate words considered taboo. In addition, the study found that illustrations are used in more less the same way both in the ST and TT save for some slight modifications that are done in order to align them with the target culture expectations. Furthermore, the study theoretically effectuated four norms: explicitation norm, explicitness norm, euphemism norm, and illustration norm
Linguistics and Modern Languages
D. Litt.et Phil. (Linguistics)