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1
Lawson, Scott. "The Urban Therapeutic Environment: A Cancer Treatment and Rehabilitation Center in Corryville, Ohio." University of Cincinnati / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1337265353.
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Gokul, Sheila R. "Identifying Barriers to Enrollment and Strategies to Increase Enrollment at a Community-Based Cancer Treatment Center." Thesis, University of North Texas Health Science Center at Fort Worth, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1556271.
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<p> Although clinical trials are essential for the development of cancer treatments, only approximately 3% of cancer patients in the U.S. participate in them. While 55% of these patients are enrolled in cancer clinical trials through community-based practices and around 80% of all cancer patients are seen at this type of practice, there is a lack of knowledge about the enrollment barriers at these sites. This study evaluates enrollment barriers at a community-based cancer clinic at the levels of the investigative site, healthcare provider, and patient. Barriers to enrollment and strategies to increase enrollment are evaluated through historical data analyses and results from a survey assessing the opinions of healthcare providers on enrollment and research practices. </p>
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Marusak, Charles. "MT1-MMP: TARGETING THE CENTER OF MELANOMA METASTASIS, GROWTH AND TREATMENT RESISTANCE." Case Western Reserve University School of Graduate Studies / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=case1548327646756039.
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Fernandes, David Manuel Agostinho de Sousa. "Projetar com cor, cor e matéria." Master's thesis, Universidade de Lisboa, Faculdade de Arquitetura, 2019. http://hdl.handle.net/10400.5/19088.
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Dissertação de Mestrado Integrado em Arquitetura, com a especialização em Interiores e Reabilitação do Edificado apresentada na Faculdade de Arquitetura da Universidade de Lisboa para obtenção do grau de Mestre.<br>presente Projeto Final de Mestrado tem como objetivo a proposta arquitetónica de um equipamento de saúde, através da aplicação dos conceitos da Luz, da Cor e da Matéria, que se revelam como os principais métodos e ferramentas, para o desenvolvimento e conceção desta proposta que se situa na freguesia de Marvila, em Lisboa.
Situada na zona oriental da cidade de Lisboa, Marvila revela um passado com imensos marcos históricos e com um cariz industrial que ainda permanece. Esta zona encontra-se fragmentada e descaracterizada por consequência da desativação industrial e, por essa razão existem diversos problemas que necessitam de ser resolvidos. Ainda assim evidencia diversos pontos de interesse com imensos benefícios, e por meio da sua requalificação urbana, Marvila retorna a integrar-se na cidade de Lisboa.
Com a inserção do Equipamento de Saúde, que tem como objetivo servir a população residente e não residente, irá conceder-se uma nova vida ao local, com a promoção e o rejuvenescimento de Marvila. Irá então atrair novas pessoas à freguesia, impulsionando uma diversidade, como a integração, uma interação e convivência social, que outrora existia em Marvila.
O Projeto Final de Mestrado encontra-se estruturado por duas componentes de trabalho, sendo a primeira componente a teórica e a segunda componente a prática. Na componente teórica não só foram desenvolvidos os conceitos de Luz, Cor e Matéria, como também o de Arquitetura para Espaços de Saúde. Esses conceitos revelaram-se cruciais para adquirir os conhecimentos sobre estes temas, de maneira a que no processo de elaboração do projeto este se apresente como funcional, lógico e concebível. Relativamente à componente prática, foram exercidos diversos estudos de vários espaços de saúde, seguindo todo o desenvolvimento do equipamento de saúde e quais as soluções ideais, bem como quais as estratégias de luz, cor e matéria que foram implementadas, chegando-se assim à melhor solução de projeto.
De seguida, foi realizada uma análise e investigação sobre a freguesia de Marvila, finalizando-se com uma descrição sobre o projeto e todo o processo de trabalho para a conceção do mesmo.<br>ABSTRACT: This Master’s Final Project has as purpose an architectural proposal of a health equipment through application of the concepts Light, Colour and Matter that turns out to be the main methods and tools for the development and conception of this proposal which is located in the parish of Marvila, in Lisbon. Situated in the eastern area of the city of Lisbon, Marvila has a past filled with great historical landmarks and it still has industrial features. This area is divided and uncharacterized as a consequence of the industrial deactivation and for that reason there are several problems that need to be solved. Even so, it still shows several points of interest with a lot of benefits, and through its urban requalification Marvila returns to be integrated in the city of Lisbon. With the implementation of a health care equipment, which is intended to serve the resident and non-resident population, it will represent a fresh life to the parish with the promotion and rejuvenation of Marvila. It will also attract new people to the place, creating a new diversity as integration, interaction and social living, aspects that used to exist in Marvila.
The Final Master Project is structured in two components. The first one is the theoretical component and the second one represents the practical component. In the theoretical component, not only were the concepts of Light, Colour and Matter developed, but also those of Architecture for Health Spaces. These concepts proved to be crucial for acquiring knowledge about these themes, so that in the process of designing the project this is presented as functional, logical and conceivable. Regarding the practical component, were studied several cases of different health care facilities, following the development of the health equipment and the ideal solutions, as well which strategies of Light, Colour and Matter that were implemented, achieving through that way the best project solution.
The following step was the execution of an analysis and a research about the parish of Marvila, ending with a description about the project and all the work process for the conception of the same.<br>N/A
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Bitsko, Matthew John. "Psychosocial Adjustment of Adolescent Cancer Survivors: Time Perspective and Positive Emotions as Mediators to Quality of Life and Benefit Finding." VCU Scholars Compass, 2005. http://scholarscompass.vcu.edu/etd/673.
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Adolescents with cancer are surviving at improved rates with levels of psychopathology in line with their healthy peers. Thus, recent psycho-oncology research is focusing on finding significant predictors to their positive adjustment and psychosocial functioning. The author examined adolescent cancer survivors (n = 50; diagnosis age = 10 21; 2 10 years post-diagnosis) to test the mediation effects of positive emotionns (satisfaction with life, subjective happiness, and optimism) and time perspective on the outcome variables quality of life and benefit finding with demographic/medical variables (gender, number of treatments received for cancer, and previous psychotherapy) as independent variables. Results indicated that positive emotions fully mediated the relationship between the number of treatments received for cancer and quality of life and partially mediated the relationship between having engaged in psychotherapy and quality of life with adolescent cancer survivors. Importantly, results indicated that patients' with a relapse diagnosis scored significantly different than those with no relapse diagnosis on quality of life. Although positive emotions were significantly associated with scores on benefit finding in a positive direction, benefit finding did not fit two of the four criteria for mediation. Time perspective indices did not meet full criteria for significant mediation with the relationships between independent and outcome variables. Regarding time perspective indices, significant associations included: prior participating in psychotherapy was associated with higher scores on a Past-Negative time perspective, the more treatments received for cancer was associated with higher scores on a Present-Focused time perspective, and higher scores on the Past-Negative time perspective was associated with lower scores on benefit finding. Discussion centers on the use of evidence-based interventions that cultivate positive emotions with adolescent cancer survivors and the utility of implementing quality of life assessment in pediatric medical settings. Continued emphasis is placed on larger sample sizes via multi-center cooperation that may better illustrate adjustment difficulties within subgroups of this population (i.e. relapse diagnosis). Future research considerations are provided for the constructs of time perspective and benefit finding.
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Thompson, Eloine Caroline. "Environments that heal : an oncology centre at mediclinic midstream, South Africa." Diss., University of Pretoria, 2016. http://hdl.handle.net/2263/60212.
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This study focuses on creating optimal healing environments. It uses the healthcare sector as the vehicle for
design, research and understanding of the negative experiences associated with healthcare environments.
There is an untapped potential for these spaces to become not only curative but also spaces of healing.
This provides an opportunity to conduct a critical assessment of what optimal healing environments are
and the translation thereof to tangible and meaningful design. This is done through the implementation of
evidence-based theories made visible through design. This transformation takes form from the concept of
skin as a regenerative healing and protective organ - a comparison is drawn to buildings and their ability to
perform and protect. Spaces are identified as consisting of interdependent elements and layers, which, in this
study, are referred to as "enablers". These enable a designer to create spatial literacy, which is fundamental
in transforming information into visible design. Ultimately, spaces can then become catalysts for healing
through layers of intervention. The design outcome of the theoretical investigation is a design proposal for an
Oncology Centre in the future extension of Mediclinic Midstream. The proposed design aims to reinvigorate
the senses of cancer patients burdened by the emotional, biological and physiological typical of appointments
at various medical practitioners, chemotherapy sessions and operating rooms. The intention is to be a reflect
a movement in the field of interior design, which endeavours to shift the perception of healing in the medical
sector. It encapsulates the natural and structural elements of design in an environment that stimulate the
senses - imitating the ever-regenerating skin cells of the human body. Proving that that interior design should
play an active and critical role the healthcare sector.<br>Hierdie studie fokus op die skep van optimale gesondheidsorg omgewings. Dit maak gebruik van die
gesondheidssektor as die voertuig vir ontwerp, navorsing en begrip van die negatiewe ervarings wat verband
hou met gesondheidsorg omgewings. Daar is 'n onontginde potensiaal vir hierdie ruimtes om nie net
fisiese genesing maar ook ruimtes van emosionele genesing te word. Dit bied 'n geleentheid om 'n kritiese
evaluering van wat optimale genesing omgewings is en die vertaling daarvan na tasbare en sinvolle ontwerp
uit te voer. Dit word gedoen deur middel van die implementering van bewysgebaseerde teorie?, sigbaar
gemaak deur ontwerp. Hierdie transformasie neem vorm binne die konsep van die vel as 'n regeneratiewe
genesing en beskermende orgaan - 'n vergelyking word gevestig op geboue en hul vermo? van diensbaarheid
en beskerming. Spasies word ge?dentifiseer as bestaande interafhanklike elemente en lae, wat in hierdie
studie, verwys word as 'enablers'. Hierdie stel 'n ontwerper in staat om ruimtelike atmosveer te ontwerp, wat
fundamenteel is in die transformasie van inligting in sigbare ontwerp. Uiteindelik, kan spasies dan katalisators
word vir genesing deur lae van ingryping. Die studie neem vorm in die ontwerp van 'n onkologie-sentrum in die
toekomstige uitbreiding van Mediclinic Midstream. Dit is ontwerp om die sintuie van pasi?nte gebuk onder die
emosionele, biologiese en fisiologiese gebondenheid van die hospitaal afsprake, chemoterapie sessies en die
operasie kamer te versterk. Die verhandeling is 'n weerspie?ling van 'n ontwerp proses wat daarop gemik is vir
die verskuiwing van die persepsie van genesing in die mediese sektor. Dit omvat die natuurlike en strukturele
elemente van ontwerp in 'n omgewing wat die sintuie stimuleer - boots die immer-groeiende vel selle van die
menslike liggaam na. Hierdie ontwerp is in teenstelling met die meer steriele omgewing van die aangrensende
hospitaal. Die doel is om uiteindelik 'n ontwerp te skep, wat die rol wat ontwerp kan speel in die gesondheids
sector, te bewys.<br>Mini Dissertation (MInt (Prof))--University of Pretoria, 2016.<br>Architecture<br>MInt (Prof)<br>Unrestricted
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Rose, Pauline Mary-Therese. "Implementation and evaluation of a new model of nursing practice in radiation oncology." Thesis, Queensland University of Technology, 2010. https://eprints.qut.edu.au/37646/1/Pauline_Rose_Thesis.pdf.
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Patients undergoing radiation therapy for cancer face a series of challenges that require support from a multidisciplinary team which includes radiation oncology nurses. However, the specific contribution of nursing, and the models of care that best support the delivery of nursing interventions in the radiotherapy setting, is not well described.
In this case study, the Interaction Model of Client Health Behaviour and the associated principles of person-centred care were incorporated into a new model of care that was implemented in one radiation oncology setting in Brisbane, Australia. The new model of care was operationalised through a Primary Nursing/Collaborative Practice framework. To evaluate the impact of the new model for patients and health professionals, multiple sources of data were collected from patients and clinical staff prior to, during, and 18 months following introduction of the practice redesign. One cohort of patients and clinical staff completed surveys incorporating measures of key outcomes immediately prior to implementation of the model, while a second cohort of patients and clinical staff completed these same surveys 18 months following introduction of the model. In-depth interviews were also conducted with nursing, medical and allied health staff throughout the implementation phase to obtain a more comprehensive account of the processes and outcomes associated with implementing such a model.
From the patients’ perspectives, this study demonstrated that, although adverse effects of radiotherapy continue to affect patient well-being, patients continue to be satisfied with nursing care in this specialty, and that they generally reported high levels of functioning despite undergoing a curative course of radiotherapy. From the health professionals’ perspective, there was evidence of attitudinal change by nursing staff within the radiotherapy department which reflected a greater understanding and appreciation of a more person-centred approach to care. Importantly, this case study has also confirmed that a range of factors need to be considered when redesigning nursing practice in the radiotherapy setting, as the challenges associated with changing traditional practices, ensuring multidisciplinary approaches to care, and resourcing a new model were experienced.
The findings from this study suggest that the move from a relatively functional approach to a person-centred approach in the radiotherapy setting has contributed to some improvements in the provision of individualised and coordinated patient care. However, this study has also highlighted that primary nursing may be limited in its approach as a framework for patient care unless it is supported by a whole team approach, an appropriate supportive governance model, and sufficient resourcing. Introducing such a model thus requires effective education, preparation and ongoing support for the whole team.
The challenges of providing care in the context of complex interdisciplinary relationships have been highlighted by this study. Aspects of this study may assist in planning further nursing interventions for patients undergoing radiotherapy for cancer, and continue to enhance the contribution of the radiation oncology nurse to improved patient outcomes.
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Riches, John Charles. "The defects underlying impaired T-cell immunity in chronic lymphocytic leukaemia : the impact of lenalidomide." Thesis, Queen Mary, University of London, 2013. http://qmro.qmul.ac.uk/xmlui/handle/123456789/8446.
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CLL T cells exhibit functional defects and alterations in gene expression that show similarities to exhausted T cells in chronic viral infections. It is unclear whether CLL T cells are truly exhausted, or whether these defects are restricted to expanded populations of CMV specific cells. The phenotype and function of T cells from CLL patients was compared to age- and CMV-serostatus-matched controls. There were an increased proportion of effector T cells in CLL patients and CMV-seropositive individuals. CD8+ and CD4+ T cells from CLL patients had increased expression of exhaustion markers CD160 and CD244 irrespective of CMV-serostatus, whereas increased PD1 expression on CD8+ T cells was limited to CMV-seronegative patients. CLL CD8+ T cells also showed defects in proliferation and cytotoxicity irrespective of CMV-serostatus, with the cytolytic defect caused by impaired granzyme packaging into vesicles and non-polarized degranulation. In contrast to virally-induced exhaustion, CLL T cells had increased expression of TBET and increased interferon-γ production, but normal IL-2 production. As lenalidomide repairs the functional and phenotypic defects associated with T-cell exhaustion, the effect of this agent on the gene expression profiles of lymphocyte subsets from CLL patients and healthy controls was investigated. Lenalidomide induced the expression of genes involved in cytoskeletal signalling, lymphocyte activation, and proliferation. In particular, lenalidomide up-regulated the expression of several genes involved in tight junction signalling, a pathway that is potentially involved in lymphocyte motility, immune synapse formation, and transendothelial migration. This pathway was down-regulated in T cells from CLL patients, but, intriguingly, was up-regulated in CLL cells compared with healthy B cells. This pathway is known to be negatively regulated by a phosphatase, PP2A. Treatment of CLL cells and T cells with the PP2A inhibitor okadaic acid mimicked the effect of lenalidomide. In conclusion, CLL T cells exhibit features of pseudo-exhaustion irrespective of CMV serostatus. Lenalidomide up-regulates tight junction signalling, which is down-regulated in CLL T cells. Inhibition of PP2A is implicated in the mechanism of action of lenalidomide on T cells.
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Ribeiro, Coutinho Rita. "Exploring biomarkers from the tumour and the microenvironment in Diffuse Large B-cell Lymphoma." Thesis, Queen Mary, University of London, 2014. http://qmro.qmul.ac.uk/xmlui/handle/123456789/9108.
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In the last decade unprecedented improvement in cure rates and overall survival was achieved in diffuse large B-cell Lymphoma (DLBCL) through the introduction of rituximab and anthracyclin-based chemotherapy (R-CHOP) as first line treatment. However, 40% of patients are refractory or relapse after R-CHOP and are hardly salvaged. To date, only age, International Prognostic Index (IPI) stratification and genetic aberrations defining gray-zone lymphomas have been used in clinical trials to select high-risk patients for more aggressive regimens. However, these prognostic features do not take into account the full biological heterogeneity of DLBCL. This reflects our limited knowledge on comprehensive prognostication in this group of disorders and supports our choice to investigate old and new prognostic factors for DLBCL in this thesis. Molecular characterization is generating opportunities for personalized therapy in poor-risk DLBCL. In order for targeted therapies to succeed in this disease, reliable and reproducible strategies that adequately segregate patients into distinct molecular groups are needed. While gene expression profiling (GEP) is the gold standard method, there is presently a lack of standardized methodology for array analysis, which can lead to variable results. The lack of a routine methodology for GEP has led investigators to develop immunohistochemistry (IHC) based approaches for the molecular classification in DLBCL. In fact, the Hans algorithm is being used to identify non-GCB DLBCLs in clinical trials offering NF-kB targeting agents to patients with this subtype. By performing a systematic comparison of nine IHC algorithms for molecular classification in a new large dataset of diagnostic DLBCL, we document an extremely low concordance across all classifiers (<21%) when classifying each individual patient, and a lack of outcome impact of all strategies, demonstrating that IHC is not a reliable alternative to molecular-based methods to be used for clinical decisions in DLBCL. GEP studies also suggested that the microenvironment could provide prognostic biomarkers in DLBCL in the R-CHOP era. Most authors have focused on the use of IHC to enumerate and functionally characterize the microenvironment in DLBCL. In our second study, by comparing two methods of semi-automated analysis for IHC staining Abstract 6 of the microenvironment, we demonstrate that the computerized results are highly reproducible, add the required robustness to IHC studies and should be used in the future instead of manual analysis. By applying comprehensive statistical analysis we propose that CD3 and FoxP3 should be validated as predictors of response to R-CHOP in clinical trials. Whereas a number of mechanisms by which cancer cells influence macrophage function have been described, currently there is very limited understanding of the macrophage polarisation status and effector function in human DLBCL. In our third study we analysed the GEP of macrophages sorted from human DLBCL samples. Unsupervised hierarchical clustering does not resolve DLBCL macrophage samples from reactive macrophage samples, indicating that macrophage heterogeneity in DLBCL should be considered. 202 genes are differentially expressed in DLBCL relative to controls. Functional annotation supports that these genes are macrophage-specific. We demonstrate that DLBCL macrophages have a bidirectional M1 and M2 functional activation, challenging the concept, widespread in the literature, that macrophages in tumours have a predominant M2 transcriptome. In our fifth study we used a two-cell co-culture model in an attempt to demonstrate that DLBCL cells influence macrophage transcriptome and proteome. The heterogeneity of the results, which precludes the confirmation of our hypothesis, is fully discussed. In our last study we tease out the DLBCL macrophage GEP heterogeneity and propose IFN- as a culprit B-cell derived molecule influencing macrophage activation status. Finally, using immunofluorescence we demonstrate that both M1 and M2 proteins are expressed in DLBCL macrophages.
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Possari, João Francisco. "Dimensionamento de profissionais de enfermagem em centro cirúrgico especializado em oncologia: análise dos indicadores intervenientes." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/7/7140/tde-10052011-122056/.
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Com a finalidade de analisar os indicadores intervenientes do dimensionamento de profissionais de enfermagem, para assistência no período transoperatório do Centro Cirúrgico (CC), especializado em oncologia, foi realizada esta investigação de abordagem quantitativa, tipo estudo de caso, observacional, transversal e descritiva. A metodologia empregada compreendeu: identificação das atividades, por meio do registro no prontuário e da observação das atividades executadas pela equipe de enfermagem; mapeamento das atividades em linguagem padronizada de intervenções de enfermagem, segundo a Nursing Interventions Classification (NIC); validação das intervenções/atividades de enfermagem, utilizando a técnica de oficina de trabalho; mensuração do tempo despendido nas intervenções/atividades de enfermagem, adotando-se a técnica de amostragem do trabalho e identificação dos indicadores para o cálculo de profissionais de enfermagem. Foram identificadas e validadas 49 intervenções de enfermagem, sete domínios e 20 classes, segundo a taxonomia da NIC. Obteve-se 4831 mensurações de intervenções/atividades realizadas pela equipe de enfermagem, no transoperatório do CC. Os profissionais despenderam: enfermeiros 42,79% do seu tempo em intervenções de cuidados diretos e 42,00% em indiretos, 8,00% em atividades pessoais e 7,21% em associadas ao trabalho; técnicos de enfermagem (Circulação de Sala de Operação - CSO) 64,27% em intervenções de cuidados diretos e 30,46% em indiretos, 0,45% em atividades associadas e 4,82% em pessoais; técnicos de enfermagem (Instrumentação Cirúrgica - IC) 94,85% em intervenções de cuidados diretos e 2,20% em indiretos e 2,95% em atividades pessoais; técnicos de enfermagem (Recepção de Pacientes - RP) 57,08% em intervenções de cuidados diretos e 28,75% em indiretos, 7,92% em atividades associadas e 6,25% em pessoais e a equipe de enfermagem 70,91% em intervenções de cuidados diretos e 22,38% em indiretos, 2,05% em atividades associadas e 4,66% em pessoais ao trabalho. O domínio da taxonomia da NIC, de maior representatividade para a equipe de enfermagem, foi o Fisiológico Complexo (61,68%), com a intervenção Assistência Cirúrgica (30,62%), a mais frequente. No período de estudo, foram realizadas 85 cirurgias, com o maior movimento cirúrgico de porte I (34,12%); tempo médio do intraoperatório de 218,10min; tempo médio para o intervalo de substituição de cirurgia de 48,12min, correspondendo ao tempo médio de limpeza e reabastecimento da SO de 33,81min e ao tempo médio de espera de 14,31min. A taxa de ocupação do CC foi de 78,57% e a quantidade de SO foi adequada para o atendimento de cirurgias eletivas e urgência/emergência e encaixes. O enfermeiro participa 18,38% e os técnicos de enfermagem 81,62% da carga de trabalho. A produtividade da equipe de enfermagem atingiu 95,34%, considerada alta, com base nos dados preconizados na literatura. A análise dos indicadores intervenientes no dimensionamento de profissionais de enfermagem do CC possibilitou reformular a equação proposta por Possari (2001) e obter valores mais próximos à realidade do CC. O conhecimento da carga de trabalho, no que se refere à identificação das intervenções/atividades realizadas pela equipe de enfermagem, poderá contribuir na argumentação efetiva de um quadro de profissionais adequado às necessidades de cuidado, no período transoperatório, que proporcione segurança ao paciente e à equipe de enfermagem que o assiste.<br>In order to analyze indicators involved in nursing staff for assistance during the perioperative period of a Specialized Oncology Surgical Center (SC), this observational, transverse and descriptive case study was carried out in a quantitative method. The methodology included: identification of activities by means of written records and observation of activities performed by nursing staff; mapping activities in standardized language of nursing interventions according to Nursing Interventions Classification (NIC), validation of interventions / nursing activities using the workshop technique , measuring time spent on interventions / nursing activities adopting the work-sampling technique and identifying indicators for the calculation of nursing staff. Forty-nine nursing interventions, seven domains and 20 classes were identified and validated, according to NIC taxonomy. We obtained 4831 measurements of interventions / activities performed by nursing staff, in the perioperative period, at the SC. Time spent by the professionals were as follows: nurses 42.79% of their time in direct care interventions and 42.00% in indirect, 8.00% on personal activities and 7.21% in work-related activities; nursing technicians (Room Operating Circulation - ROC) 64.27% in direct care interventions and 30.46% in indirect activities, 0.45% in associated activities and 4.82% on personal activities; nursing technicians (Instrumented surgery - IS) 94.85% in direct care interventions and 2.20% indirect and 2.95% on personal activities; nursing technicians (Patient Reception area- PR) 57.08% in direct care interventions and 28.75% indirect, 7.92 % in associated activities and 6.25% on personal activities and nursing staff 70.91% in direct care interventions and 22.38% indirect , 2.05% in associated activities and 4.66% on personal related-work. The most representative NIC taxonomy domain for the nursing staff was the Physiological Complex (61.68%), being the Surgical Assistance intervention (30.62%) the most frequent. During the study 85 surgeries were performed, with predominance of surgeries of major size procedures (34.12%), mean time of intraoperative 218.10 min, mean time interval for replacement surgery of 48.12 min, corresponding to the mean time for cleaning and refilling the OR of 33.81 min and the mean time of waiting 14.31 min. The occupancy rate of SC was 78.57% and the number of OR was adequate for the assistance of elective and urgent/emergency and optional surgeries. The nurse participates 18.38% of the workload and nursing technicians 81.62%. The nursing staff productivity reached 95.34%, considered high when compared to data recommended in the literature. The analysis of the intervenient indicators involved in nursing staff on SC allowed to reformulate the equation proposed by Possari (2001) and to obtain values closer to the reality of SC. Knowledge of the workload with regard to identification of interventions / activities performed by nursing staff may help in effective reasoning about a professional staff appropriate to the needs of care during perioperative period, providing safety for patient and nursing staff.
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Valente, Catarina Beatriz Ribeiro. "Cuidados nutricionais centrados no doente em oncologia." Bachelor's thesis, [s.n.], 2018. http://hdl.handle.net/10284/7550.
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Trabalho Complementar apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciada em Ciências da Nutrição<br>Objetivo: Neste artigo pretendemos fazer uma revisão da literatura sobre Cuidados nutricionais centrados no doente em oncologia e compreender o papel do Nutricionista no âmbito dos cuidados centrados no doente oncológico, particularmente a dimensão da sua intervenção.
Metodologia: Revisão da literatura sobre cuidados nutricionais centrados no doente em oncologia, com particular atenção no papel do nutricionista como elo de ligação entre doente/familiares e restantes membros da equipa de saúde multidisciplinar em oncologia. Realizaram-se pesquisas na PubMed, Scielo, Institute for Healthcare Improvement e The Oncologist.
Resultados: A maioria das publicações é relativa aos últimos 10 anos. Do total de 70 artigos encontrados foram selecionados 23. Da pesquisa realizada é possível deduzir que há falta de dados sobre o papel do Nutricionista como elemento integrante da equipa multidisciplinar, em cuidados oncológicos.
Conclusão: Conclui-se que o nutricionista, sobretudo neste contexto, tem um papel chave, sendo ele o porta voz do mundo do doente, sendo que a nutrição pode ser um suporte adjuvante a outras terapias.
O nutricionista é uma mais valia no processo de cuidar o doente, através da implementação de rotinas de avaliação, intervenção nutricional, melhor comunicação entre o doente-família-equipa multidisciplinar.<br>Objective: In this article we intend to review the literature on nutritional care centered on the patient in oncology and to understand the role of the nutritionist in this type of care, particularly the dimension of his intervention.
Methodology: Review of the literature on nutritional care centered on the patient in oncology, paying particular attention to the role of the nutritionist as the link between the patient / family and the other members of the multidisciplinary health team in oncology. Research was done at PubMed, Scielo, Institute for Healthcare Improvement and The Oncologist.
Results: Most publications refer to the last 10 years. From the total of 70 articles found, 23 were selected. From the research conducted it is possible to deduce that there is a lack of data on the role of the nutritionist, as an integral element of the multidisciplinary team in Oncology Care.
Conclusion: We can conclude that the nutritionist, especially in this context, plays a key role, being the advocate of the world of the patient, and that nutrition can be a support to other therapies.
The nutritionist is an asset in the process of caring for the patient, through the implementation of evaluation routines, nutritional intervention, better communication between the patient-family-multidisciplinary team.<br>N/A
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FREGATTI, PIERO. "No Ink on Ductal Carcinoma in Situ: A Single Centre Experience." Doctoral thesis, Università degli studi di Genova, 2020. http://hdl.handle.net/11567/1010024.
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Abstract
Introduction: The incidence of ductal carcinoma in situ (DCIS) of the breast has greatly increased thanks to the widespread use of screening mammography. The primary aim of surgery is to prevent local recurrence by achieving a clear margin of resection although its extent still represents a controversial issue. Hence, a retrospective analysis of patients undergoing surgery for DCIS was performed in order to assess the association of margin widths of < 1 mm, 1 to 2 mm, and > 2 mm with ipsilateral breast tumor recurrence (IBTR) considering also the potential role of host-, tumor- and treatment-related factors.
Methods: From 2000 to 2016, 388 patients diagnosed with pure DICS undergoing BCS with or without post-operative RT at the Breast Unit of “Ospedale Policlinico San Martino” in Genoa were selected. The pathologic analysis was always performed according to a standardized protocol including the measure of the microscopic distance to the nearest radial margin: positive margins were those with DCIS present at the inked margin; close margins were considered to have tumor between 0.1 to 0.9 mm, or 1 to 1.9 mm, and negative margins were > 2 mm.
Results: At a median follow-up of 90 months there were 26 IBTR (10 invasive and 16 DCIS). In univariate analysis there was a significant difference in IBTR by comparing positive versus close/negative margins of excision (P = 0.05) and the number of re-operations (P = 0.000). On multivariate analysis, both the margin status (P = 0.002) and the number of re-operations (P < 0.001) were still significantly associated with IBTR. The actuarial IBTR rates were significantly different in patients with a positive margin of excision at the primary operation as compared to patients with close/negative margins (log-rank test, P = 0,042) while the stratification by the margin width (0.1-0.9 mm; 1.0-1.9 mm; > 2 mm) was not significant (log-rank test, P = 0,243).
Conclusions: The policy of “no ink on the tumor” that is well accepted for invasive breast cancer can be translated to DCIS, because the actuarial IBTR rates were significantly different only in patients with a positive margin of excision as compared to patients with close/negative margins.
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Nagy, Eszter. "Characterisation of oncogenic LMP1 and CD40 signals in primary germinal centre B cells and their relevance to the pathogenesis Of Hodgkin's lymphoma." Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/4997/.
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Latent membrane protein 1 (LMP1) is an oncogene expressed in a subset of germinal centre (GC)-derived lymphomas including Hodgkin’s lymphoma (HL) and diffuse large B cell lymphoma (DLBCL). However, LMP1 shares functional homology with CD40, a receptor required for normal GC B cell development. Dissecting how LMP1 functions differently from CD40 in GC cells is central to a better understanding of lymphomagenesis and is the subject of this thesis. In Chapter 3, I show that GC B cells can be successfully isolated from normal human tonsils and that these cells retain a GC phenotype upon short-term culture. In Chapter 4 I explore how the transcriptional programmes of LMP1 and CD40 differ in GC B cells and identify a subgroup of genes regulated by LMP1 but not by CD40, which are also concordantly regulated in primary HL cells from which I focus on sphingosine-1-phosphate receptor 2 (S1PR2). I confirm that S1PR2 is an LMP1 target in GC B cells and show that it is not expressed in the tumour cells of the majority of cases of HL and DLBCL. In DLBCL, S1PR2 loss is associated with LMP1 expression. I also provide preliminary evidence that the over-expression of S1PR2 can inhibit the HL cell migration. In Chapter 5, I report my initial attempts to optimise a method for the measurement of the activity of transcription factors in GC B cells which can be used to delineate those pathways activated by LMP1, but not by CD40, in GC B cells.
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Santos, Joselito. "Assist?ncia a mulher com c?ncer de mama em um cenro de refer?ncia no Estado da Para?ba." Universidade Federal do Rio Grande do Norte, 2012. http://repositorio.ufrn.br:8080/jspui/handle/123456789/13812.
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Previous issue date: 2012-04-27<br>The assistance to women who have breast cancer is studied in a Reference Center in Paraiba
and also the way this assistance is performed in a School Hospital maintained by SUS
(Single Health System) is questioned. Breast cancer demands institutional organization,
provision of financial, material and human resources, requiring, from the health system,
effective assistance with new technologies which make it possible for the population their
access to specialized medical services although it not always is able to guarantee those
services nor the rights which the legislation granted them, inhibiting a proper relationship
between the health professional and the patient. The theme is discussed through a transdisciplinary
knowledge view and has as its theoretical referential the contribution of
classical and contemporary authors from the human and social sciences and, as an empirical
research strategy, the structured interview. The objectives of the research were: identify
how the assistance to women with breast cancer is carried on at a Reference Center on
Oncology in Campina Grande, Paraiba, identifying their difficulties and their satisfaction
with the received assistance; draw up a profile of the women with breast cancer who were
assisted in this Reference Center; understand their gynecological and obstetric antecedents,
life styles, age group and stage of the disease when the treatment started; check their
knowledge about their rights and which benefits they had received. Most women ranged
between 40 and 59 years old (63%), which corresponds to the risk range of developing
breast cancer. As to their occupations, 38.3% were housewives and 30.1% retired, whose
family income was among those who received between less than a minimum salary and one
minimum salary (58.2%). This population was mainly constituted of married women
(60.2%), whose most frequent schooling was an incomplete elementary school (27.6%) and
complete elementary school (24.1%), which added up to 51.6%. It was observed that the
majority of the women seemed to be satisfied with the assistance received, noting that a
minimum care was enough to define this satisfaction, although it is perceived that the access
to the health system does not ensure the ideal attention conditions they need; it was verified
that the availability of the services and the assistance itself are seen (in the local culture) as a
favor and not as a right. It is also observed that only 30% of the women mentioned that they
knew about their rights and the most mentioned ones were the disease assistance (13%), the
medicines (13%) and the treatment (12%), which represent the most important triad to face
the disease and around which the oncologic assistance most focus on. It is concluded that the
condition of the users? minimum existential of a public health unit and the condition of
belonging to a lower social stratum were variables that influenced the respondents?
satisfaction in relation to the assistance received but the importance of the Reference Center
for the women with breast cancer?s assistance for the whole region cannot be denied as well
as the need to broaden the way the policy of the oncologic assistance in Brazil in the local
realm is seen<br>Estuda-se a assist?ncia a mulheres com c?ncer de mama, em um Centro de Refer?ncia da
Para?ba, indagando-se como se d? a assist?ncia em oncologia, oferecida por um Hospital-
Escola, que o mant?m atrav?s do Sistema ?nico de Sa?de (SUS). O c?ncer de mama exige
organiza??o institucional, provimento de recursos materiais, humanos e financeiros,
demandando ao sistema de sa?de assist?ncia eficiente e com novas tecnologias que
possibilitem o acesso da popula??o aos servi?os m?dicos especializados, mas nem sempre
consegue garantir esses servi?os, nem os direitos que a legisla??o conferiu ? popula??o,
inibindo a adequada rela??o entre sistema de sa?de, profissional e paciente. Discute-se o
tema em uma vis?o transdisciplinar do conhecimento, tendo como referencial te?rico aportes
de autores cl?ssicos e contempor?neos das ci?ncias humanas e sociais em sa?de e, como
estrat?gia de pesquisa emp?rica, a entrevista estruturada. Delimitaram-se como objetivos:
identificar como ? realizada a assist?ncia a mulheres com c?ncer de mama em um Centro de
Refer?ncia em Cancerologia, no munic?pio de Campina Grande, PB, identificando suas
dificuldades e satisfa??o com a assist?ncia recebida; elaborar o perfil das mulheres com
c?ncer de mama assistidas nesse Centro; conhecer seus antecedentes ginecol?gicos e
obstetr?cios, estilos de vida, faixa et?ria e est?gio da doen?a quando iniciou o tratamento;
verificar seus conhecimentos acerca dos seus direitos e quais os benef?cios recebidos. A
maioria das mulheres encontrava-se na faixa et?ria entre 40 e 59 anos (63,1 %),
correspondente ? faixa de risco para desenvolvimento do c?ncer de mama. Quanto ?
ocupa??o, 38,3 % eram do lar e 30,1 % aposentadas, cuja renda familiar se concentrava
entre aquelas que ganhavam menos de um sal?rio e um sal?rio m?nimo (58,2 %). Essa
popula??o era constitu?da em sua maioria por mulheres casadas (60,2 %), com n?vel de
escolaridade mais frequente no ensino fundamental incompleto (27,6 %) e fundamental
completo (24,1 %), perfazendo um total de 51,6 %. Constatou-se que a maioria das
mulheres mostrou-se satisfeita com a assist?ncia recebida, observando-se que um m?nimo de
cuidado lhes foi suficiente para definir essa satisfa??o, embora se perceba que o acesso ao
sistema de sa?de n?o garante as condi??es ideais para a aten??o de que necessitam; constatase
que a disponibilidade de servi?os e de atendimento ? vista (na cultura local) como favor e
n?o como direito. Observa-se ainda que apenas 30 % das mulheres mencionaram conhecer
os seus direitos, sendo os mais citados o aux?lio doen?a (13 %), o medicamento (13 %) e o
tratamento (12 %), que se apresentam como a tr?ade mais importante para o enfrentamento
da doen?a, e em torno dos quais mais se foca a assist?ncia ?s mulheres no ?mbito da
assist?ncia oncol?gica. Conclui-se que a condi??o de m?nimo existencial das usu?rias de
uma unidade p?blica de sa?de e a condi??o de pertencimento a um baixo estrato social
foram vari?veis que influenciaram a satisfa??o das entrevistadas com rela??o ? assist?ncia
recebida, mas n?o se pode negar a import?ncia do Centro de Refer?ncia para a assist?ncia ?s
mulheres com c?ncer de mama para toda a regi?o, bem como a necessidade de se ampliar o
olhar em torno da pol?tica de assist?ncia oncol?gica no ?mbito local
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Ramis, Zaldívar Juan Enrique. "Decoding the genetic landscape of pediatric and young adult germinal center-derived B-cell non-Hodgkin lymphoma." Doctoral thesis, Universitat de Barcelona, 2021. http://hdl.handle.net/10803/672372.
Full textAbstract:
B-cell non-Hodgkin lymphoma (B-NHL) of pediatric and young adult population is a diverse group of neoplasms predominantly composed of aggressive B-cell lymphomas from the germinal center (GC). Molecular characterization of pediatric series has allowed the identification of several subtypes that predominantly occur in this subgroup of age. Despite of that, genomic features of these pediatric entities and their relationship to other B-NHL in this group of patients have not been extensively investigated. This thesis has aimed to address this gap of knowledge by performing a genetic and molecular characterization of large series of pediatric and young adult variants of GC-derived B-NHL including the Burkitt- like lymphoma with 11q aberration (BLL-11q) , pediatric type follicular lymphoma (PTFL) and large B-cell lymphomas (LBCL) such as diffuse large B-cell lymphomas (DLBCL) , high grade B- cell lymphomas, not otherwise specified (HGBCL, NOS) and large B-cell lymphoma with IRF4 rearrangement (LBCL-IRF4) entities.
In the Study 1 we have molecularly characterized a series of 11 BLL-11q observing that BLL- 11q differed clinically, morphologically and immunophenotypically from conventional BL and instead showed features more consistent with HGBCL or DLBCL. Genomic profile was also different from that of BL and DLBCL with a mutational landscape characterized by the lack of typical BL mutations in ID3, TCF3, or CCND3 genes and recurrent specific BTG2 and ETS1 mutations, not present in BL but in germinal center B-cell (GCB) DLBCL subtype. All these observations suggest that BLL-11q is a neoplasm closer to other GC-derived lymphomas rather than BL. In Study 2, we expanded our knowledge on the genetic alterations associated to PTFL by verifying the presence of MAP2K1 and IRF8 mutations in a previously well characterized series of 43 PTFL. We demonstrate the activating effect of MAP2K1 mutations by immunohistochemical analysis observing phosphorylation of the MAP2K1 downstream target extracellular signal-regulated kinase in those mutated cases. Besides, we demonstrate the specificity of MAP2K1 and IRF8-K66R mutations since they are absent in conventional FL or in t(14;18)-negative FL. Finally, in the Study 3 we characterized a large series of LBCL including DLBCL, HGBCL, NOS and LBCL-IRF4 through an integrative analysis including targeted next generation sequencing, copy number, and transcriptome data. Results showed that each subgroup displayed different molecular profiles. LBCL-IRF4 had frequent mutations in IRF4 and NF-κB pathway genes (CARD11, CD79B) whereas DLBCL, NOS was predominantly of GCB-DLBCL subtype and carried gene mutations similar to the adult counterpart (e.g., SOCS1 and KMT2D). A subset of HGBCL, NOS displayed recurrent alterations of BL-related genes such as MYC, ID3, CCND3 and SMARCA4, whereas other cases were genetically closer to GCB-DLBCL. Interestingly, we could identify age-related differences in pediatric DLBCL since pediatric and young adult cases were mainly of GCB subtype, displayed low genetic complexity and virtually lacked primary aberrations (BCL2, MYC and BCL6 rearrangements). Finally, we identify clinical and molecular features related to unfavorable outcome such as age >18 years, high LDH levels, activated B-cell (ABC) DLBCL profile, high genetic complexity, homozygous deletions of 19p13.3/TNFSF7/TNFSF9, gains of 1q21-q44/MDM4/MCL1 and TP53 mutations.
Altogether, we conclude that GC-derived B-NHL of pediatric and young adult population is a heterogeneous group of tumors including different entities with specific molecular profiles and clinical behavior. This thesis has contributed to increase the knowledge of these lymphoma entities identifying biomarkers that might be helpful to improve their diagnosis and to design management strategies more adapted to their particular biological behavior.
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Leonard, Sarah Miriam. "An investigation of the epigenetic and transcriptional changes which follow Epstein-Barr virus infection of germinal centre B cells." Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/1200/.
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Although Epstein–Barr virus (EBV) usually establishes a harmless infection in human memory B cells, it is implicated in the development of germinal centre (GC) B-cell-derived malignancies, including Hodgkin’s lymphoma (HL). I have shown using gene expression profiling that lymphoblastoid cell lines derived from GC B cells are a useful model for studying early EBV-associated changes contributing to the pathogenesis of HL. EBV infection of GC B cells is followed by the up-regulation of the DNA methyltransferases, DNMT3A, and the down-regulation of DNMT1 and DNMT3B, a pattern of expression which is re-capitulated in HL cell lines. I have also shown that the major EBV oncogene, LMP1, is responsible for the down-regulation in GC B cells of DNMT1, and that DNMT3A binds to the EBV promoter, Wp which is silenced by DNA methylation. Genome-wide promoter arrays revealed that EBV infection of GC B cells is followed by methylation changes in a substantial number of cellular genes. These changes were not randomly distributed across the genome but clustered at certain chromosomal locations and were strongly associated with the CpG content of gene promoters. Finally, I have shown that EBV also modulates the expression of another set of epigenetic regulators which control arginine methylation.
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Yothathai, T. "Self-management for pain control in Thai patients who have cervical cancer in a Thai Regional Care Centre." Thesis, University of Southampton, 2014. https://eprints.soton.ac.uk/379618/.
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Cervical cancer is one of the most common cancers in Thailand with around 10% of these women experiencing persistent pain. One third of those are under treated and it is claimed that programmes of self-management may contribute to better managing this pain. However, self-management is a Western concept and it is not clear whether this concept is helpful to Thai people or how it might be conceptualised or how Thai people self-manage their pain. The aim of this study to explore the way in which Thai women with cervical cancer manage their pain with specific reference to the potential for self-management in hospital and at home and how they might be supported in this activity by their family and health professionals. A single embedded case study design was adopted over six months in a regional cancer centre located in the North-East of Thailand. The participants were purposively sampled for the phenomenon under investigation. Six patients with cervical cancer experiencing moderate to severe pain, six identified family caregivers and seven health care providers were 0interviewed and observed. Framework analysis was used to analyse the observational and interview data. The finding revealed six main themes of self-management including problem solving, decision making, information finding and utilisation, forming patient/health care professionals partnership, taking action and, especially, perception. These themes are influenced by Thai family and culture resulting in a revision self-management model for Thais is developed. The model explains relationship between two main aspects, thinking and behaving that people behave self-management. Thinking and behaving influence each other and can be changeable due to the real situation. Factors influence these two aspects including backgrounds of experience, knowledge, and social context of Thailand. Conclusion, the patients developed their ability to self-manage their pain in their everyday life. To improve self-management in Thai patients, the individual circumstance of family and Thai culture are important factors to be aware.
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Vice, President Research Office of the. "Target: The Big C." Office of the Vice President Research, The University of British Columbia, 2007. http://hdl.handle.net/2429/2663.
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Nicholas, Garth. "Survival analysis of patients seen at the Ottawa Hospital Regional Cancer Centre with early breast cancer, 1985--2001: Effect of changes in stage and adjuvant chemotherapy over time." Thesis, University of Ottawa (Canada), 2007. http://hdl.handle.net/10393/27542.
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Breast cancer is the commonest cancer affecting Canadian women. Recent decades have seen a trend of decreasing breast cancer mortality. This has been attributed to several causes, including greater use of screening mammography and increased efficacy of adjuvant chemotherapy. We studied the effect of these two factors on the overall survival of breast cancer patients at the Ottawa Hospital Regional Cancer Centre. Data were collected from 2985 charts from the years 1985, 1988, 1992, 1995, 1998, and 2001. Adjuvant chemotherapy was associated with a decreased hazard of death from any cause (HR=0.783 p=0.0208). A decrease in mean tumour size seen over the time period of the study is potentially attributable to mammography screening. Decreased tumour size was associated with a decreased hazard for death (HR 0.986 p<0.0001). No difference in overall survival between earlier and later cohorts could be demonstrated, perhaps due to shorter follow up in later cohorts.
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Chen, Yu-Ching. "Barriers to Music Therapy Participation for Cancer Patients during Hospitalization." Ohio University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou149036448068751.
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Bachelot, Thomas. "Les essais de phase i en oncologie medicale : analyse retrospective de 154 patients inclus dans 9 etudes realisees au centre leon berard de 1986 a 1993." Lyon 1, 1994. http://www.theses.fr/1994LYO1M210.
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Fiteni, Frédéric. "Les critères de jugement centrés sur le patient dans les essais cliniques en oncologie thoracique." Thesis, Besançon, 2016. http://www.theses.fr/2016BESA3012/document.
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La Survie globale (SG) est le critère de jugement de référence dans les essais cliniques en oncologie mais les critères de jugement dit intennédiaires centrés sur la tumeur qui sont évalués plus précocement sont de plus en plus utilisés comme critères substitutifs de la survie globale La qualité de vie (QdV) constitue un critère de jugement pour évaluer un bénéfice clinique direct pour le patient. Nos résultats ont montré que 32% des critères de jugement dans les essais de phase III de CBNPC avancés étaient pas du tout définis et seulement 43% était clairement défini et qu'aucun critère intermédiaire n'a démontré sa substitutivité sur la SG. Nous avons montré que la mesure, l'analyse et le report des données de QdV étaient hétérogènes entre les essais de phase III de CBNPC avancés d'où la nécessité de recommandations. Nous avons comparé longitudinalement la QdV chez 451 patients âgés de 70-89 ans atteints de CBNPC avancés randomisés entre une bichimiothérapie et une monochimiothérapie selon la technique du temps jusqu'à détérioration définitive (TJD) d'un score de QdV. Cette étude a montré : sur le plan clinique, le bénéfice du doublet de chimiothérapie pour les patients est renforcé par les données de QdV; sur le plan méthodologique: le TJD est une technique d'analyse faisable dans les essais de phase III de CBNPC et fournit des résultats faciles d'interprétation. Nous avons proposé l'utilisation de co-critères de jugement principaux associant QdV et critère centré sur la tumeur. Enfin, nous avons démontré la valeur pronostique de la dimension santé globale de QdV à baseline du questionnaire sur la SG chez les patients âgés atteints de CBNPC avancés<br>Overall survival (OS) is the gold standard endpoint in oncology clinical trials. Nevertheless, intermediate tumor-centered endpoints which are assessed earlier are more and more used as surrogate of OS. Health-related quality of life is an endpoint which assesses a direct benefit for the patient. We demonstrated that 32% of endpoints in advanced non-small-cell lung phase III clinical trials were not defined at all, 43% were not clearly defined and none ofthem has demonstrated its surrogacy on OS. We demonstrated the weakness and the heterogeneity of the measurement, analysis, and reporting of HRQoL in phase III advanced NSCLC trials. Precise and uniform recommendations are needed. We longitudinally compared HRQoL using tüne until definitive deterioration (TUDD) method in 451 patients aged 70-89 years with advanced NSCLC randomly assigned to receive a doublet of chemotherapy or a monochemotherapy. We demonstrated the benefit of the doublet chemotherapy in terms ofHRQoL. On a methodological point ofview TUDD method is feasible and provide clinically meaningful results. We proposed another approach which would be to combine intermediate endpoint• with HRQoL as co-primary endpoints. Finally, we demonstrated the additional prognostic value of HRQoL data at baseline to identify vulnerable subpopulations in elderly NSCLC patients
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Soares, Maria Carolina Coutinho Xavier, and 92-3346-0806. "Elaboração de protocolo de condutas em traqueostomias no hospital referência em tratamento do câncer do Amazonas." Universidade Federal do Amazonas, 2017. https://tede.ufam.edu.br/handle/tede/6270.
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Previous issue date: 2017-12-14<br>Background: tracheostomy is a surgical procedure that opens the trachea anterior wall and exteriorize it to the environment though the neck using a cannula, keeping airway open. It´s a common procedure especially in oncology hospitals. Amazon Oncology Control Foundation still does not have a tracheostomy protocol for routine care. Tracheostomy care is multiprofessional, and the elaboration of a protocol using the opinion of heath care specialists and experience allow reproducibility of clinical actions. Clinical, ambulatorial and home care routines will influence in less mortality and improve quality of life for tracheostomy patients. Objective: create a multi-professional manual of tracheostomy care to adult and pediatric patients of Amazon Oncology Control Foundation who needs this procedure. Methods: the protocol was developed using modified Delphi method. Two series of questionnaires were offered to 20 professionals. Results: 13 professionals concluded all two steps. The first questionnaire 53 of 92 questions offered achieved consensus (57,6%). Those selected questions were used to write the text of the second questionnaire, this was elaborated in 8 chapters, who each one was evaluated through Linkert scale answers. All chapters presented achieved consensus, this means Linkert scale answers (I agree and I fully agree) were above 70%. Conclusions: using consensus data, a manual of tracheostomy care for professionals and a manual for patients and caregivers were elaborated.<br>Introdução: traqueostomia é o procedimento cirúrgico que consiste na abertura da parede anterior da traqueia, comunicando-a com o meio externo, tornando a via aérea pérvia com a inserção de uma cânula. É um procedimento cirúrgico comum em hospitais de oncologia. Ainda não existe um protocolo que oriente a rotina de traqueostomias na Fundação Centro de Controle de Oncologia do Estado do Amazonas (FCECON). Tendo em vista que a abordagem desse tipo de paciente é multidisciplinar, a formulação de um protocolo levando em consideração a experiência dos envolvidos nos traz subsídio clínico para reprodutibilidade das ações. Estabelecer rotinas tanto hospitalares quanto ambulatoriais e domiciliares, visa influenciar na diminuição da morbimortalidade e na qualidade de vida do paciente com traqueostomia. Objetivo: criar um manual de rotinas multidisciplinar de condutas em traqueostomias para aos pacientes adultos e pediátricos da FCECON que necessitarem do procedimento. Métodos: o protocolo foi desenvolvido por meio do método Delphi modificado, que consistiu na aplicação de duas séries de questionários a 20 profissionais da unidade. Resultados: 13 profissionais concluíram as duas etapas. Na primeira etapa, 53 de 92 questões apresentadas obtiveram consenso (57,6%). Estas sentenças que obtiveram consenso formaram o texto da segunda etapa, que foi dividido em 8 capítulos que foram avaliados por meio da marcação de respostas oferecidas em uma escala Linkert. Todos os capítulos apresentados na segunda etapa obtiveram consenso, significando que a soma das respostas concordo e concordo plenamente foram todas acima de 70%. Conclusão: utilizando os dados obtidos no consenso, foi elaborado um manual de rotinas em traqueostomias e um manual de orientações de cuidados para os pacientes e seus cuidadores.
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Muñoz, Noelia, and Telma Urquiza. "Enseñanza de auto-cuidado en pacientes oncológicos." Bachelor's thesis, Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería, 2014. http://bdigital.uncu.edu.ar/5762.
Full textAbstract:
Esta tesis surge del deseo de hacer algo útil, de poder ayudar de alguna forma a los pacientes oncológicos que son los que necesitan una luz de esperanza en su vida y del interés de la educación y de la enseñanza del auto-cuidado desde el momento que empiezan los tratamientos quimioterapéuticos.
La enfermedad oncológica es compleja, puede revestir gravedad y se hace más llevadera y mejor si el paciente sabe como es el manejo de los efectos adversos para su auto-cuidado, día tras día la atención de los pacientes oncológicos es llevada a cabo por un equipo multidisciplinario incluyendo la enfermería como pilar fundamental, ofreciendo compromiso y dedicación y la guía para lograr una buena calidad de vida en el paciente.
A la falta de conocimientos sobre su etiología, se suma la incertidumbre sobre su futuro, asociada al dolor y la posibilidad inminente de la muerte. Ante el tratamiento, como el de la quimioterapia, es importante que el paciente construya una relación satisfactoria con el personal que lo atiende para poder evacuar sus dudas, como así también el involucrar a la familia.
Para el paciente el hecho de familiarizarse con las prácticas del cuidado y auto-cuidado en su propio hogar es de vital importancia. Contar con el apoyo del equipo multidisciplinario que lo atiende, saber que se evacuaran sus dudas, que se brindara información en forma clara y concisa, lo hace sentir que no está solo y que no es tratado de forma diferente.
El presente estudio será un canal para detectar las debilidades y fortalezas del centro oncológico. Y será de gran importancia para el equipo de salud, no solo para favorecer a la recuperación del paciente sino también para su reinserción en la sociedad brindándole mejor calidad de vida con los conocimientos de su enfermedad y contribuir al auto-cuidado del mismo.<br>Fil: Muñoz, Noelia. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..<br>Fil: Urquiza, Telma. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..
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Meyer, Pascal. "Aspects cliniques, pronostiques et thérapeutiques du mélanome malin cutané de l'adulte : à propos de 197 cas traités au Centre Paul Strauss de Strasbourg et au service de radiothérapie-oncologie de Metz." Université Louis Pasteur (Strasbourg) (1971-2008), 1985. http://www.theses.fr/1985STR1M152.
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Hamilton, Elma. "Meaning - centeredness in adult cancer patients in remission." Diss., University of Pretoria, 2014. http://hdl.handle.net/2263/43346.
Full textAbstract:
This study explores how cancer patients in remission derive meaning in their lives. A need for social work intervention was identified with cancer survivors, especially those patients who are in remission and who have to continue their lives, in spite of the incurable status of their cancer. In line with literature, the researcher, in her role as social worker at a radiation oncology clinic, observed that patients often report that they find benefit in the cancer experience. The framework for conducting this study is based on the existential theory and the ultimate concern of human existence, that life has meaning under all circumstances. Meaning and meaning-centeredness is described. The role of a meaning-centered approach to oncology social work was argued. The Meaning-Centered Counselling and Therapy (MCCT) model was described from a literature perspective, and proposed as an intervention model. MCCT offers a model that includes the existential domain in interventions.
Within the context of this study, remission refers to the period that the cancer is under control. It may be that there is no indication of the cancer, but the cancer is expected to recur, or that some of the symptoms have disappeared, or that the progression of the cancer has slowed down. During remission, patients are under surveillance only, or on maintenance treatment. Thus, they do not have regular contact with the oncology team. Patients live with uncertainty and ambiguity, resuming activities, responsibilities, careers and relationships that were influenced by the cancer diagnosis and treatments. The demands of living in remission are described.
This research study explores the quest for meaning in patients who are living with incurable, recurrent cancer. The goal of this research study was to explore meaning-centeredness in adult cancer patients who are in remission. This research study was guided by the following research question: “Does meaning-centeredness play a role in adult cancer patients’ coping with remission?”
The research population included oncology patients who are in remission, and have experienced one or more recurrences, and where the cancer has metastasised. A qualitative approach was followed, using the collective case study design. The research was conducted at the Radiation Clinic, Sandton Oncology Centre in Morningside, Johannesburg. Data was collected using an interview schedule to guide 4 focus group interviews, totalling 21 participants, who were selected by means of purposive sampling. All participants gave voluntary and informed consent to take part, and the focus group interviews were voice-recorded, with their permission. The researcher transcribed these recordings. Creswell’s steps for qualitative data analysis were implemented.
From the findings, the following themes and sub-themes were identified, demonstrating the search for meaning amongst these participants who are in remission and answering the research question:
Theme 1: Meaning-construal associated with attribution with the sub-themes of hope, spirituality, and death awareness and a foreshortened future. Theme 2: Meaning-construal associated with appraisal, with the sub-themes of benefit finding, growth, relationships, and an increased appreciation of life, and prioritising.
Theme 3: Meaning-construal associated with reappraisals, with sub-themes of sense of self, sense of coherence, assumptive world, adapting to new normal, and transcendence.
The findings demonstrated that a perspective that provided the participants with the means to explore their unique meanings, purposes, and life tasks helped them to cope with remission and the fear or reality of recurrence or metastases. Participants were able to derive meaning in their lives despite living with incurable cancer. Participants, who had integrated the knowledge that their cancer is incurable and recurrent into their meaning-system, were able to adapt and adjust to living in remission. They had a sense of purpose and maintained realistic hope. Their hopes were proportional to the prognosis. They did not dwell on their own death, but focused on what life offers them each day. They developed a new normal that incorporates the knowledge of a foreshortened future, coping with side effects and late effects of treatment, and the uncertainty that the cancer is expected to recur or metastasise again. They were aware of their life tasks, and embraced life to the full.
Intervention strategies, based on the existential oriented proposition that life has meaning under all circumstances, were recommended. This included the Meaning-Centered Counselling and Therapy (MCCT) model for integration in oncology social work.
Recommendations in this study include enhancing the understanding of members of the transdisciplinary team regarding the needs and experiences of patients in remission. Furthermore, a better understanding of the role of meaning-centeredness intervention amongst oncology social workers can improve interventions, specifically for patients in remission.<br>Dissertation (MA)--University of Pretoria, 2014.<br>lk2014<br>Social Work and Criminology<br>MA<br>Unrestricted
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Růžička, Věroslav. "Poliklinika Proficlinic." Master's thesis, Vysoké učení technické v Brně. Fakulta stavební, 2020. http://www.nusl.cz/ntk/nusl-410084.
Full textAbstract:
The subject of my diploma thesis is the processing of project documentation of the construction part for the realization of the new build private health centre Proficlinic in the outskirts of České Budějovice. It is a two-storey partially basement building. On the first floor there is a pharmacy with the preparation of cytostatics, surgery x-ray and facilities for staff. On the underground floor there are technical facilities for new buildings and storage facilities. On the second floor there are individual surgeries and day care center of oncology. The ceilings are made of prestressed panels. The roof of the building is flat single-skinned.
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Ringnér, Anders. "Information till föräldrar som har barn med cancer." Doctoral thesis, Umeå universitet, Institutionen för omvårdnad, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-68729.
Full textAbstract:
Bakgrund. Föräldrar till barn som har cancer upplever en livssituation som präglas av osäkerhet och oro och de ställs inför sociala och känslomässiga utmaningar. Jämfört med föräldrar till friska barn, upplever de också högre stress och drabbas i större utsträckning av posttraumatiska stressymptom. Trots att information om barnets sjukdom är ett centralt behov för föräldrarna, upplever de otillfredsställelse med den information som ges. Syfte. Syftet med denna avhandling var att inom barnonkologisk vård beskriva vårdares och föräldrars upplevelser av information, studera deras inbördes interaktion samt beskriva upplevelser och effekter av en intervention för personcentrerad information till föräldrar. Metod. I delstudie I–III användes fokusgruppintervjuer (I, II), individuella intervjuer (II, III) och deltagande observationer (III). Deltagarna bestod av 20 vårdare (I), 14 föräldrar till barn med cancer (II) respektive 25 vårdare och 25 föräldrar (III). Data analyserades med kvalitativ innehållsanalys (I, II) och diskurspsykologi (III). I delstudie IV testades en intervention för personcentrerad information på åtta föräldrar med hjälp av en experimentell single-case-design. Data samlades in med kvalitativa intervjuer och internetenkäter. Upplevd stress, kroppsliga symptom på stress, ångest, nedstämdhet och tillfredsställelse med information var utfallsmått. Resultat. I delstudie I bestod resultatet av två teman: anpassa mängden information till föräldrarnas behov, som handlade om skillnader i hur mycket information som gavs till föräldrarna utifrån vårdarnas bedömning av föräldrarnas behov, och navigera i en vag struktur, som handlade om brister i ansvar, miljö, tajming och språk när informationen lämnades. I delstudie II konstruerades två teman. Känna sig bekräftad som en viktig person handlade om att föräldrarna kände sig trygga, kunde hålla hoppet uppe och fick stöd från andra föräldrar. Temat var mer framträdande under behandlingens tidiga skeden. Det andra temat var känna sig som en objuden gäst vilket handlade om att kännas övergiven vid viktiga milstolpar, att tvingas tjata sig till information och att belastas av att själv behöva informera andra inom sjukvården. I delstudie III använde vårdarna tolkningsrepertoarer som var barn-, föräldra- eller familjeorienterade, vilket avspeglade deras primära fokus i interaktionen. Föräldrarna använde tolkningsrepertoarer som talesperson, observatör eller familjemedlem. Hur dessa kombinerades inbördes påverkade interaktionen. I delstudie IV erfor föräldrarna stor tillfredsställelse med den personcentrerade informationen och upplevde att de hade nytta av att på egen hand få diskutera barnets sjukdom och ställa frågor de annars inte skulle ställt. Interventionen visade ingen effekt på stress eller kroppsliga symptom på stress, ångest och nedstämdhet. Slutsatser. För att förbättra information till föräldrar som har barn med cancer är det en central uppgift att bedöma hur mycket och vilken information som ska ges vid varje tillfälle, att uppmärksamma att föräldrarna kan ha andra informationsbehov än barnet och att möten med föräldrarna ska ske i lugn och ro samt att organisera vården så att ansvaret är tydligt. I synnerhet bör det ske förbättringar kring det som föräldrarna upplever som viktiga milstolpar under barnets sjukdomstid. Interventionen för personcentrerad information uppskattades av föräldrar som har barn med cancer men effekten på föräldrarnas psykosociala välbefinnande behöver utforskas ytterligare.<br>Background. Parents of children with cancer experience a life situation characterised by uncertainty and worries, and they face ongoing social and emotional challenges. Compared to parents of healthy children, they also experience increased levels of perceived stress and they suffer to a greater extent from post-traumatic stress symptoms. Even though information about the child’s disease is crucial for parents, they still experience low satisfaction with the information given to them. Aim. The aim of this thesis was to, within the field of paediatric oncology care, describe health care professionals’ and parents’ experiences from information, study their joint interaction and describe experiences and effects from an intervention based on person-centred information to parents. Methods. For study I–III, focus group interviews (I, II), individual interviews (II, III), and participant observations (III) were used. Participants were 20 health care professionals (I), 14 parents of children with cancer (II) and 25 health care professionals and 25 parents (III). Data were analysed by qualitative content analysis (I, II) and discursive psychology (III). In study IV, an intervention for person-centred information was tested on 8 parents using a single-case experimental design. Data were collected with qualitative interviews and web questionnaires. Outcome measures were perceived stress, physical symptoms from stress, anxiety, depression, and satisfaction with information. Results. In study I, the analysis resulted in two themes, Matching the amount of information to the parents’ needs, which dealt with differences in the amount of information provided to parents according to the health care professionals’ assessment of parental needs, and Navigating through a vague structure, which was about shortcomings in responsibilities, setting, timing, and language when parents were informed. In study II, two themes were constructed. Feeling acknowledged as a person of significance was about feeling safe and secure, having one’s hopes supported and getting relief from other families. This was accentuated early in the treatment trajectory. Feeling like an unwelcome guest was about feeling abandoned at important milestones, feeling forced to nag for information and being burdened by informing others. In study III, the health care professionals used interpretative repertoires that were child, parent, or family oriented, which mirrored the primary focus of the interaction. Parents used repertoires as a spokesperson, an observer, or a family member. The combination of the repertoires steered the interaction. In study IV, parents reported a high satisfaction with the person-centred information intervention and perceived benefits from having their own time to discuss the child’s disease and pose questions that they otherwise would not have an opportunity to ask. No effects from the intervention were demonstrated on perceived stress, physical symptoms of stress, anxiety, and depressive mood. Conclusion. To improve information to parents of children with cancer, a central task is to assess the amount of and what information given to parents, pay attention to possible differences in information needs between parents and children, as well as to organise the care so that the responsibilities are clear and that parents are met in a calm setting. Improvements at important milestones during the illness period should be prioritised. A person-centred information intervention is perceived as beneficial by parents, however, its effect on perceived parental stress has further to be investigated.
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Cheng, Chia-Hsien, and 成佳憲. "Cost and Effectiveness Analysis for Patients with Nasopharyngeal Cancer from a Single Oncology Center." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/15518338504372895479.
Full textAbstract:
碩士<br>國立臺灣大學<br>醫療機構管理研究所<br>90<br>Purpose: This study is to calculate the charge-based cost, outcome, and cost-effectiveness (CE) of diagnosis and treatment for nasopharyngeal cancer (NPC), to investigate the factors impacting cost and outcome, and to demonstrate the difference in CE between treatment protocols at a single oncology center.
Materials and Methods: From April 1995 to December 1998, 207 patients who were diagnosed with NPC and completed full-course therapy and follow-up were enrolled. Charge-based cost data was retrieved from the receipt files from the first visit day to February 28, 2002. Clinical information was obtained and updated accordingly, from the medical records for each patient. The cause and date of death were also verified with the Death Registration Database from the Department of Health. Charge-based cost was described as total cost or separate costs in different periods. Treatment outcome was estimated by 5-year overall survival rate and disease-free survival rate. CE was calculated both for total cost per life year saved, and diagnosis/treatment cost per one percent increase in 5-year survival rate. Linear regression model was used to evaluate variables impacting diagnosis and/or treatment costs. Cox regression model was used to evaluate variables impacting survival outcomes.
Results: Median follow-up interval was 50.1 months. The 5-year overall survival and disease-free survival rates were 72.2% and 75.1%, respectively. The average costs in diagnosis, treatment, follow-up, diagnosis/treatment, and all three periods were 38,437.1, 276,530.5, 125,618.5, 314,967.7, and 440,617.3 dollars, respectively. Type of radiotherapy, type of chemotherapy, grading of acute side effects, stage, and age were statistically significant factors correlating with diagnosis/treatment and treatment costs. Stage and the diagnosis confirmed before the first visit were factors significantly impacting diagnosis cost, with R square of 0.093. Both treatment protocol and stage were significantly associated with diagnosis/treatment cost for stage I-IVB patients, with R square of 0.650. In Cox regression model stage and post-radiotherapy adjuvant chemotherapy were significant factors impacting survival. Treatment protocol sustained stronger correlation with survival than type of radiotherapy or chemotherapy did. Dollars per life year saved were 99,588.4 for stage I, 99,329.8 for stage IIA, 161,773.0 for stage IIB, 149,982.9 for stage III, 214,210.7 for stage IVA, 261,119.0 for stage IVB, and 470,191.2 for stage IVC patients. The best choices with CE were protocol no.1 for stage I-IIB patients, and protocol no.3 for stage III-IVB patients.
Conclusion: Stage, type of treatment or protocol, and severity of acute side effects were important factors impacting diagnosis/treatment cost. The difference in CE among different stages was similar to that in clinical prognosis. The preference based on CE between different treatment protocols was close to that in evidence-based clinical medicine. CE may be used as an important reference in the design of reimbursement policy or selection of treatment protocols.
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WANG, AI-LING, and 汪藹齡. "The Study of Hospital Choice in China：Case study of the Radiation Oncology of BenQ Medical Center SuZhou." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/06858791214599573356.
Full textAbstract:
碩士<br>銘傳大學<br>觀光事業學系碩士在職專班<br>105<br>Sicne Year 2000 China opened its medical service market gradually. Its portential market attracted foreign investment including Taiwan. Taiwan believe the quality of medical care are more advanced than China; however,after running more than 10years, the medical care business is not as good as what Taiwan-funded hospital expected. We know very little about Chinese consumer choice of a hospital in Taiwan’s literature. The case study is based on the radiation oncology of benQ hospital, SuZhou and the purpose of the study is to provide marketing strategy and management advice to the hospital woned and operated by Taiwanese enterprise through both the qualitative and quantative research. The research apply EKB model and marketing mix 4Ps to understand whether consumer behavior will affect the choice of a hospital or not; furthermore, 68 underlying items based on literature review help to understand which item is the most important and consent to consumer choice of a hospital;in addition, the IPA analysis was adopted to investigate patients’ satisfaction to BenQ hospital SuZhou. Total 302questionnaries were released, 135 released to patients inside hospital,122 respondents,96 valid samples. 167 were released to consumer outside of hospital, 160 respondents, 151 valid samples. On the other hand, Corporate internal and external enviornment are also key drivers that impact on medical service industry. The research used Porter’s five force analysis, PEST analysis, and SWOT analysis to analyse corporate enviornemt by interviewing 6 experts in depth.
A good hospital needs a good physician and a good physician needs a good reputation.A good physician takes time to train and pay well.A good word of mouth also takes time to obtain. It is important to recruit and retain the talented and superior workforce aggreesively. In order to get substantial development,the health care sector needs to foucos on its profession and quaility. If only consider the short term profit or lack of capital,the loading will be heavy. China is proceeding to reform its health care system. If the reforms policy such as multi-site practice and graded medical treament can be implemented in all regions, it will be helpful to private hospital. Encouraging private hospital and government hospital corporation and technical exchange will be more productive to private hospital. Encouraging patient and physician share their experience that is also the better promotion to consumer to accept. Overall, China’s potential market is still optimistic , and private hospital is making progress.
Due to the health care system, private hospital is perceived as lower quality than government hospital in China generally. People consider that Taiwan-funded hospital is indifferent to other local private hospitals; therefore, Taiwan-funded hospital cannot keep the image out of business.This is one of the reason why the private hospital is struggling in China. How to build a better corporation image or take more corporate social responsibility,is Taiwan-funded hospital needing to take it more seriously.
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Wang, Ya-Lan, and 王亞蘭. "Exploring the End-of-Life Care of Pediatric Oncology Patients in a Medical Center - 2010~2012 Chart review." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/59568206254435480936.
Full textAbstract:
碩士<br>國立臺灣大學<br>護理學研究所<br>103<br>Background and Purposes:
Childhood cancer is one of leading causes of death in children and adolescents. Cancer children received aggressive treatments near the end of life. This study aimed to explore the end-of-life care and the use of palliative care among cancer children in Taiwan, and to explore the correlation between the characteristics of cancer children, the use of palliative care and the end-of-life care.
Methods:
A retrospective chart review was conducted. All subjects were diagnosed of cancer under 18, and died between January 2010 to December 2012 in a medical center in Taipei. The total valid sample size was 67.
Measurement:
The data were collected by a self-developed structured form, which included: (1) patient and family characteristics, (2) oncology summary, (3) information of last hospitalization, (4) aggressiveness of cancer care near the end of life, (5) medical use in the last 24 hours of life, (6) CPR status, (7) DNR status, and (8) the use of palliative care. The data were analyzed by the Software SPSS 18.0.
Results:
In 67 study subjects, 56.7% were male, 16.4% were single child, 56.7% were diagnosed of leukemia/lymphoma. The average age of diagnosis was 8.50±5.23, and the average age of death was 11.75±5.70.
Cancer children experienced long-term hospitalization and aggressive treatments near the end of life. 91% were hospitalized more than 14 days in the last 30 days of life. 43.3% were admitted to ICU in the last 30 days of life, and 34.3% were died in ICU. 16.4% received new chemotherapy in the last 30 days of life, and 34.3% received chemotherapy within 14 days before death. 35.8% received inotropic agents in the last 24 hours of life, and 13.4% received cardiac pulmonary resuscitation within 3 days before death.
Although the use of palliative care is increasing, the referral timing was still late. In all subjects, 56.7% received hospice consultation before death, and 40.3% received hospice shared care. The average days of first hospice consultation to death was 50.61±54.83 days (median: 36.5 days), and 21% received first hospice consultation within 7 days before death. DNR permits completed 27.85±56.8 days prior to death (median:4.5 days), and 18.3% completed at the same day of death.
Patients who were diagnosed of leukemia/lymphoma and died at the age above 12, are more likely to receive aggressive treatments near the end-of-life than other subjects. They were more likely to die in ICU (p<0.05), and were more likely to use ventilators, antibiotics and inotropic agents within the last 24hours of life.
Relationship exists between the usage of palliative care and the end-of-life care of cancer children. Patients who had received hospice shared care were less likely to die in the ICU (p<0.01), and had a lower rate of the use of ventilator and inotropic agents within the last 24 hours of life (p<0.01). The DNR orders were completed earlier in the patients received hospice shared care (p<0.01).
Conclusions and Nursing Applications:
Relationship exists between the usage of palliative care and the end-of-life care of cancer children. Clinical health providers should consult hospice/palliative care team and conduct palliative discussion with patients and family at a proper time, to improve the end-of-life care for cancer children.
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Lin, Ching-shun, and 林敬順. "Application of radio frequency identification records system - A medical center in northern Department of Radiation Oncology,for example." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/63050136390982474452.
Full textAbstract:
碩士<br>國立中正大學<br>資訊管理所暨醫療資訊管理所<br>98<br>The Bureau of National Health Insurance (BNHI) continusely promote the quality
of cancer care which includes patient safty systems and regulations.
In order to enhance patient safty and surpass the accreditation of quality cancer
care, the case hospital introduced the Radio Frequency Identification technology
(RFID) system to manage the flow of Paper-based medical charts and records
in Radiation Oncology Department (RTD).
The RFID system records the locations and flow of paper-based medical charts and
records. It assists and enhances the flow efficiency and decreases patient waiting
time. This study compared the flow of medical records between the manual and
the new RFID assisted system. The results of this study can be used as a reference
for other related RFID applications in the case hospital and as a model in
the future development of cancer care department, or patient identification.
or patient identification to achieve the requirements of the BNHI Council in quality and safety of cancer treatment and personalized patients service.
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Chang, Chih-Hui, and 張治會. "The Obstacles of Site Research Nurse on Conducting Multi-center Clinical Trial-A Case Study on Taiwan Cooperative Oncology Group." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/45257725769013034534.
Full textAbstract:
碩士<br>臺北醫學大學<br>醫務管理學研究所<br>96<br>This study mainly discusses the obstacles that research nurses of TCOG face when execute multi-center clinical trials, and in the end to give away suggestions to advance organizational development and performance of the nurses from the perspective of organization, process, and human resource management.
We utilize qualitative research methodology. Firstly, we set interview guidelines, including how nurses perceive the way hospital and staff interacts with them, the operation obstacles, and their career planning. Secondly, we interview 11 research nurses and transcribe the content to transcripts. Thirdly, we analyze the content through grounded theory to explore the code and construct on the issues.
In order to successfully complete their jobs, research nurses of TCOG consume their energy and patience on hospital’s complex administrative system, exercise their interpersonal impact to finish jobs, supply available information to medical staff, advocate patient’s right to support their terminal lives, complete mass paper work to assure the quality of trial, give concern and suggestion to TCOG and roles of nurses, and continuous learning to assure their competency.
This study focuses on three perspectives of organization, process and human resource management. Organization perspective includes the policy of government and hospital, and how nurses evaluate the strategies now hospital utilizing. And the restructuring of TCOG on replaced diseases committees by study working groups, replaced member hospitals by collaborate hospitals, create Protocol Review Committee to improve review procedure.
Process perspective includes the quality maintenance of case data. It needs to build standard operation procedure on patient out of reach, review and improve the operation of case follow up, and create monitor operation to guarantee the requirement of data quality assurance. Due to analyze work lording of research nurses, the most important task is to build their job description by protocols and sites. To ensure case report forms are designed to be as relevant and reasonable as possible, it is necessary to have research nurses’ involved in the planning of protocol.
Human resource perspective includes the effective support and assistance from TCOG, human resource management and on-job-training program. In order to achieve effective support to research nurses, it also needs to build coordinator’s job description by protocols and evaluate manpower demanding accordingly. An activity can be feasible immediately to heighten the interest and involvement of research nurses is to change the pattern of nurse meeting. The application of group meeting assists coordinators getting better understanding the practice of certain hospital, promotes the communication between TCOG executive and research nurses, provides research nurses a space to discuss the research topics basis on their professional on oncology nursing. To approach an attractive work environment and long-term career opportunities, TCOG should provide funds for the research nurses to attend a major meeting of oncology nursing and when they are involved with an abstract or poster being presented.
Research nurses play an important role of clinical trial because they are the one to connect and fully utilize resources. Executive of TCOG faces the biggest challenge how to plan and motivate these nurses, and ultimately improve the quality and efficiency of clinical trial under restricted resources.
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Hsiao, Fang-Yu, and 蕭芳瑀. "The Analysis of Health-Related Quality of Life and Medical Expenditures for Patients with Oral Cavity Cancer from an Oncology Center." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/09796198681581502003.
Full textAbstract:
碩士<br>國立臺灣大學<br>醫療機構管理研究所<br>90<br>Economic analysis has been playing an important role in cancer treatment. The studies of Health-Related Quality of Life (HRQoL) of cancer therapy have widely been considered as an essential issue in the world. Oral cavity cancer sustains the most prevalent head and neck malignancy in Taiwan. Therefore, it deserves further investigations on its significant impact on personal health, as well as the wealth of the society and country.
The purposes of this study were to investigate the status of HRQoL and medical expenditures of patients with primary oral cavity cancer and the influencing factors, also to investigate the relationship between HRQoL and medical expenditures. Study sample were 96 patients with primary oral cancer undergoing treatment in one oncology center in Taipei from March to May, 2002. Data were collected by interviewing patient with a specially designed questionnaire which contains the Taiwan (Chinese) versions of EORTC QLQ-C30, EORTC QLQ-H&N35 modules and basic social demographic questions. Additional demographic characteristics, clinical information, and the insurance claims data of medical expenditures of these patients were also retrospectively reviewed.
The major results of this study are as follows:
1. According to the results from EORTC QLQ-C30 and EORTC QLQ-H&N35, “dry mouth”, “sticky saliva”, “teeth problem”, and “trismus” were the most serious problems in EORTC QLQ-C30 and EORTC QLQ-H&N35 scoring systems. All of these problems were related to the long-term side effects of radiotherapy. The results of multiple regression analysis showed that patients younger than 50 years old had significantly better HRQoL.
2. The average medical expenditures in the periods of diagnosis, treatment, and follow-up were NT$24,901, NT$260,632, NT$77,219, respectively. The average diagnosis/treatment medical expenditures and average total medical expenditures were NT$285,533, and NT$362,751, respectively. The proportions of expenditures in different periods comprised 6.9% in diagnosis, 71.8% in treatment, and 21.3% in follow-up periods. From the results of multiple regression analyses, patients at clinical stage III or IV disease, had primary buccal or gingival cancers, had recurrence after first treatment, or received combined treatment modalities including surgery/radiotherapy or surgery/radiotherapy/concomitant chemotherapy, were significantly associated with higher medical expenditures in treatment period, with the adjusted R square of 0.791. Primary retromolar trigone cancer was associated with higher follow-up expenditures, with the adjusted R square of 0.554. Patients with the monthly family income of more than NT$60,000, at clinical stage III or IV, had primary buccal or gingival cancers, had recurrence after first treatment, or received combined treatment modalities including surgery/radiotherapy or surgery/radiotherapy/concomitant chemotherapy, had significantly higher medical expenditures in diagnosis/treatment period, with the adjusted R square of 0.785. The statistically significant factors associated with higher total medical expenditures were patients that had educational level of higher than junior high school, at clinical stage III or IV disease, had primary buccal or retromolar trigone cancers, had recurrence after first treatment, or received combined treatment modalities including surgery/radiotherapy or surgery/radiotherapy/concomitant chemotherapy, with the adjusted R square of 0.798.
3. From the results of the analysis of correlation between medical expenditures and HRQoL, except to the expenditures of diagnosis period, all other expenditures sustained negative correlation with the scores of functional scales, which included “physical functioning”, “role functioning”, “cognitive functioning”, and“ social functioning”. In contrast, positive correlations were shown between the medical expenditures in different periods and the scores of symptom scales/items, especially for “swallowing”, “speech”, “social contact”, “social eating”, ”trismus”, “dry mouth” and “sticky saliva”.
4. In general, primary site of cancer, clinical stage, treatment modality, and disease recurrence, were the most important factors that affect medical expenditures and HRQoL for patients with primary oral cavity cancer undergoing treatment. The findings also implied the essential concept of “early diagnosis and early treatment”, so does the importance of health education and screening program.
Based on the results of this study we suggest that the Department of Health to include the important clinical variables when designing the reimbursement system for oral cavity cancer, and to include cancer stage into the files of health insurance. We also suggest that the health care provider to set up the accurate cost basis by regularly updating the patient data. Finally, for future investigators, we suggest that they could proceed with long-term multi-institutional economic studies, and to combine measurements of utility, survival outcome, and medical expenditures, and the data collection from the societal point of view.
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SUNG, CHIEN-CHENG, and 宋建成. "A Study of The Cancer Patients’ Intention to Adopt The High-tech Medical Technique - The Radiation Oncology Experience at a Medical Center in Southern Taiwan." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/88684701791524432821.
Full textAbstract:
碩士<br>國立高雄應用科技大學<br>資訊管理系碩士在職專班<br>96<br>Purpose：With the progress of technique, the demand of radiation therapy in cancer patient is expanded. Therefore, the development of radiation therapy to cancer tends to become “high-tech”. Although lots of facilities are thrown in radiation therapy to cancer in many hospitals, the utilization rate of high-tech medical technique to treat cancer patient is still low. It is necessary to investigate the behavioral intensions of cancer patients to adopt high-tech medical technique. In this study, we introduced the theory of planned behavior (TPB) by Ajzen (1985) and diffusion of innovations theory to construct the behavioral intension model of cancer patients to adopt the high-tech medical technique. We included the cancer patients to radiation therapy for study and the questionnaire method for evidence, in order to explore the factors, predictors and reasons to accept high-tech medical technique.
Methods：This study invited the cancer patients who accepted high-tech medical technique and 160 questionnaires were distributed. Ninety-eight questionnaires were valid, and 62 questionnaires were in vain or rejected. The study circumstances according to individual cancer patients were controlled for improved study effectiveness. In data analysis, we took PLS pathway analysis to verify the model. By the measurement model and pathway coefficient, in the affections of cancer patients to adopt high-tech medical technique, attitude toward the behavior, subjective norm and perceived behavioral control were significant to behavioral intension.
Results and Conclusion:
1.The most significant factor to cancer patient to adopt the high-tech medical technique was perceived behavioral control, following with attitude toward the behavior, and subjective norm in the last.
2.The most significant factor of the attitude toward the behavior in cancer patients to adopt the high-tech medical technique was relative advantage, following with word-of-mouth, and perceived risk in the last.
3.The social pressure was the most significant factor for cancer patients to adopt the high-tech medical technique in subjective norm.
4.The economy was the most significant factor for cancer patient to accept high-tech medical technique in perceived behavioral control.
5.The opinion from authority to the attitude toward the behavior of cancer patients to adopt the high-tech medical technique was modulated by medical image.
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Adank, Marc. "Infusion: A public outpatient oncology centre." Thesis, 2013. http://hdl.handle.net/10539/12971.
Full textAbstract:
For many health practitioners death is seen as a failure and dying patients are avoided because they are reminders of that failure. A disconnection in the system in society exists. Patients are not educated to recognize the symptoms they present; first line practitioners are often not able to diagnose and refer patients to specialists who in turn should view the treatment of the cancer patient as holistic and that the support of the family and immediate care givers as
paramount.
‘It is the denial of death that is partially responsible for people living empty, purposeless lives; in contrast when
you fully understand that each day you awaken could be the last you have, you take the time that day to grow,
to become aware of who you really are, to reach out to other human beings’.
(Elizabeth Kubler-Ross, 1975).
The prevailing uneasiness and denial of death is reflected in medical procedures where quite often modern medical care isolates the patient from the community of loving caring persons. Personal and human needs are abandoned as the patient is isolated on a special wing or floor in a hospital, left alone by doctors and nurses especially when death is evident. Physicians and health care workers are trained to deal with life and not with death. Many physicians are strangers to the issue of death simply because they have been taught to diagnose, treat and cure. ( McKay, 1985).
We need to see the individual as a part of a group of interacting, inter-related or inter-dependent elements that form a complex whole. This whole or system is what Lefebvre describes as that space that is directly connected and
influenced by the society that inhabits it and conversely it also has an influence on society’s structure.
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Healing, Sara. "Development of a Method of Analysis for Identifying an Individual Patient’s Perspective in Video-recorded Oncology Consultations." Thesis, 2013. http://hdl.handle.net/1828/4835.
Full textAbstract:
Patient-centred care has become an important model for health-care delivery, especially in cancer care. The implementation of this model includes patient-centred communication between the clinician and his or her patient. However, most research on patient-centred communication focuses on the clinicians’ initiative: what clinicians should do and what information they should seek to elicit from patients. It is equally important to recognize what each individual patient can contribute about his or her unique perspective on the disease, its treatment, and the effects on what is important to this patient. This thesis reports the development of a system for analyzing over 1500 utterances made by patients in eight video-recorded oncology consultations at the British Columbia Cancer Agency, Vancouver Island Centre. The analysis distinguishes between biomedical information that the patient can provide and patient-centred information, which contributes the individual patient’s unique perspective on any aspect of his or her illness or treatment. The resulting analysis system includes detailed operational definitions with examples, a decision tree, and .eaf files in ELAN software for viewing and for recording decisions. Two psychometric tests demonstrated that the system is replicable: high inter-analyst reliability (90% agreement between independent analysts) on a random sample of the data set and cross-validation to the remainder of the data set. A supplemental idiographic analysis of each consultation illustrates the important role that patient-centred information played in these consultations. This system could be an important tool for teaching clinicians to recognize the individual information that patients can provide and its relevance to their care.<br>Graduate<br>0992<br>0451<br>0350<br>shealing@uvic.ca
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Bandeira, Matilde Sá da. "Fighting childhood cancer and the innovative project of the Princess Maxima Centre for Paediatric Oncology." Master's thesis, 2016. http://hdl.handle.net/10400.14/20071.
Full textAbstract:
Cancer is one of the most feared diagnoses for the present generations. Yet, for a parent more than for anyone else, knowing that their child has got cancer can be devastating. Childhood cancer is intense and consuming for all people involved, and its physical and psychological consequences are difficult to evaluate. This dissertation aims to understand the main challenges of paediatric cancer, and explore a possible solution to address some of them with a case study: The Princess Maxima Centre for Paediatric Oncology, the Netherlands.
To better contextualize the opening of this Centre, a review of literature was conducted to understand the dimension, costs and most important challenges faced by all stakeholders involved. In fact, the project for the Princess Maxima Centre is the Netherlands’ response to some of these challenges. By concentrating all professionals dedicated to this cause, childhood cancer patients and their families in one single building, the Centre aims to cure all children with cancer in the country, but also to make their lives easier. Children will be receiving the most appropriate care as a result of the Centre’s strategy, with particular attention to their natural development. Great accomplishments are expected by all professionals in virtue of the Centre’s environment and therefore better treatment solutions for their patients.<br>Cancro é um dos diagnósticos mais receados pelas gerações actuais. Para os pais, mais do que ninguém, tomar conhecimento de que um filho tem cancro pode ser devastador. O cancro infantil é intenso e desgastante para todas as pessoas envolvidas, e as suas consequências físicas e psicológicas são difíceis de medir. Esta tese tem como objectivo procurar entender os maiores desafios relativos ao cancro infantil e explorar uma possível solução através de um caso concreto: O Princess Máxima Centre for Paediatric Oncology nos Países Baixos.
Para melhor contextualizar a abertura deste Centro, uma recensão da literatura foi conduzida para compreender a dimensão, custos e desafios mais importantes encarados por todas as partes interessadas. De facto, o Princess Máxima Centre é a resposta dos Países Baixos a algumas destas questões. Através da concentração de todos os profissionais envolvidos nesta área, dos pacientes e das suas famílias em um único edifício, o Centro tem como objectivo curar todas as crianças com cancro do país, mas também tornar a sua vida um pouco melhor. Estas crianças vão receber os cuidados mais apropriados graças à estratégia do Centro, com uma atenção especial ao seu desenvolvimento natural. Todos os profissionais envolvidos esperam resultados excepcionais em virtude de toda a envolvente do Centro, e por isso melhores soluções de cura para os seus pacientes.
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Annapina, Mazzotta. "A patient-centred approach in neuro-oncology: definition and measurement of clinical outcome in brain tumor patient." Doctoral thesis, 2022. http://hdl.handle.net/11562/1070652.
Full textAbstract:
Brain tumors, independently from histology, share a similar progressive growth pattern that often requires multiple treatment modalities. Surgery, radiotherapy, chemotherapy and medications are often administered in close proximity to one another or, sometimes, contemporaneously. For that reason, the assessment of the effectiveness of any single treatment is extremely difficult. Brain tumors are a rare cancer but they are among the most devastating forms of cancer and afflict the very core of the person. Optimizing the life style of patients should become essential and on a par with the life prolongation goal of anti-cancer therapy. A potential solution to this problem is a patient-centered approach to different tumor types and treatments in which the comprehensive patient assessment is included in the outcome set. Traditionally, clinical trials of treatments for gliomas have relied on measures such as the reduction in tumor size, or on time-dependent metrics including the progression-free survival and the overall survival. The procedure used to evaluate of treatment effects by means of these measures can be complemented by the assessment of clinical outcomes such as measurements of the functional or symptomatic effects of the condition on the person. Unfortunately, the most commonly reported outcome measures are not necessarily the most appropriate. They are often selected and motivated since they are widely cited in the literature; this is an incorrect approach on a scientific ground and also precludes new and more effective instruments to be introduced and accepted. The instruments currently used in neuro-oncology are influenced by notions anchored to the type of treatment (such as chemotherapy or radiotherapy) rather than to tumor and, particularly, to patient characteristics. The utility of patient-reported outcome data can be maximized with standardization of methods to assess, analyze, interpret and report results. Nevertheless, neuro-oncological guidelines do not mention instruments and parameters but rather generically prescribe “neurological monitoring”. A paradox is that, while new therapies and diagnostics are improving survival rates, much remains unknown about the patient clinical conditions and performance at an instrumental level. However, in the last years, a growing interest on cognitive response in clinical trials has been observed and the cognitive performance is now considered as an important patient-related outcome to assess response to treatments. Tracking symptoms and function can inform clinicians about whether a treatment results in measurable benefits or adverse effects to patients. 6 We should not forget that patients want to live longer, but they also want to continue to function as well as possible for as long as possible. This research. arose from the considerations set forth above. The aim of the thesis is to provide an overview of the clinical outcome assessment of patients with brain tumors. The thesis analyzes the role of the assessment in collecting information about the direct impact of neoplastic invasion of the cerebral parenchyma and in monitoring the effects of therapies. This thesis is composed of three different studies. The first study describes the characteristics of clinical trials on gliomas and the outcome profile (objective, endpoints, domains, categories and instruments), since the 1990 (the advent of evidence based medicine) to 2019. The second study describes the neuropsychological tests mainly used in the brain tumor clinical trials published over the last 30 years and tries to evaluate the methodological quality of studies on measurement properties by means of the COSMIN checklist. Finally, the third study focuses on the neuropsychological assessment of language in multilingual people. Due to the increasingly widespread integration, this has become a crucial issue in neuro-oncology, especially in the perioperative evaluation of patients undergoing surgical treatment for brain cancer. The aim is to verify to what extent the variables that affect linguistic processing in multilingual speakers have been considered during planning and decision making in awake surgery for brain tumors.
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Stoewen, Debbie Lynn. "Clients' Service Expectations and Practitioners' Treatment Recommendations in Veterinary Oncology." Thesis, 2012. http://hdl.handle.net/10214/3671.
Full textAbstract:
Service provision in veterinary oncology in Ontario was examined using a mixed methods approach. First, an interview-based qualitative study explored the service expectations of oncology clients at a tertiary referral centre. Next, a survey-based quantitative study established an understanding of oncology service in primary care practice and investigated the treatment recommendations of practitioners for dogs diagnosed with cancer.
The first study, which involved 30 individual and dyadic interviews, identified “uncertainty” (attributable to the unpredictable nature of cancer and its treatment) as an overarching psychological feature of clients’ experience. Consequently, “the communication of information” (both content and process) was the foremost service expectation. For clients, it enabled confidence in the service, the ability to make informed patient care decisions, and preparedness for the potential outcomes of those decisions; it also contributed to creating a humanistic environment, which enhanced client resiliency. Findings suggest that services can support client efforts to manage uncertainty through strategic design and delivery of service, and incorporate intentional communication strategies to support clients’ psychological fortitude in managing the cancer journey.
The second study, a vignette-based survey of primary care practitioners across Ontario (N=1071) which investigated veterinarian decision-making in relation to oncology care, determined that 56% of practitioners recommended referral as their first choice of intervention, while 28% recommended palliative care, 13% in-clinic treatment, and 3% euthanasia. Recommendations were associated with patient, client and veterinarian factors. Specifically, referral and treatment were recommended for younger dogs, healthier dogs, and dogs with lymphoma versus osteosarcoma; for strongly bonded clients, and financially secure clients; and by veterinarians who graduated from a North American college, had experience with treating cancer, felt confident in the referral centre, and believed treatment was worthwhile, with variation in relation to practitioner gender and the type of medicine practiced. The human-animal bond appeared to be the primary factor associated with practitioners’ advocacy for quality of medical care for patients.
Through a blend of qualitative and quantitative methodologies, this thesis contributes to the evidence upon which best practices may be built so as to enhance the quality of patient and client care in veterinary oncology.<br>Ontario Veterinary College Pet Trust Fund 049406 and 049854
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Westlund, Anna E. "Embodying spirit, fostering connections: the design of an integrated cancer treatment centre." 2010. http://hdl.handle.net/1993/4280.
Full textAbstract:
For most people in North America, undergoing treatments for cancer occurs exclusively in a healthcare setting. All too often, this healthcare setting provides a backdrop privileging the technological requirements of conventional medicine over the well-being of the people who inhabit it. Conversely, this practicum project is founded on a different, more holistic approach to cancer care called integrative oncology. The project investigates how an integrative cancer treatment centre can be designed to be more than a technological backdrop, endeavoring to become an active entity that truly supports those dealing with cancer. The investigation includes an extensive literature review of theoretical and evidence-based sources that relate to fostering connections to nature on a variety of levels. Informed by this, a review of relevant design precedents and the functional issues of integrative cancer treatment, the investigation concludes with a design solution for an integrated cancer treatment centre and related findings.
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Zucca, Alison Cheree. "Do we deliver patient-centred care for cancer patients? Exploring care delivery in Australian medical oncology treatment centres." Thesis, 2018. http://hdl.handle.net/1959.13/1395268.
Full textAbstract:
Research Doctorate - Doctor of Philosophy (PhD)<br>A cancer diagnosis poses a number of physical, emotional and practical challenges to patients and their families as they traverse an unfamiliar cancer care system. A patient-centred approach to care delivery is one of the key criteria for enabling a high-quality health care experience during this challenging time. Outpatient medical oncology treatment centres are visited by one-third of all new cancer patients in Australia, and chemotherapy, the primary treatment modality of medical oncology, is the most common treatment recorded for same-day cancer-related hospitalisations. This underscores the importance of ensuring the delivery of high-quality patient-centred care within medical oncology services. There is a paucity of research focused on patient-centred care delivery in outpatient medical oncology treatment centres, including whether care varies across centres. Such data can help to highlight aspects of care that need to be improved, and determine whether problems are limited to one site or are more systemic. Such data allow for tailoring quality improvement interventions within medical oncology centres to enhance the delivery of patient-centred care. This thesis by publication contains an introduction, five papers and a discussion. The published papers review how the quality of patient-centred care provided by treatment centres is measured, and discuss approaches for generating credible data (Paper 1); explore aspects of medical oncology outpatients’ experiences of cancer care across domains of patient-centred care endorsed by the United States of America (USA) Institute of Medicine (IOM) (Papers 2–5); and explore whether variation exists in the delivery of aspects of patient-centred care across medical oncology treatment centres (Papers 3–5). Data-based papers are based on data collected from a large multicentre cross-sectional survey of medical oncology outpatients’ perceptions of patient-centred care. The discussion draws together the six principal findings of the thesis and considers future research and implications, including rigorous methodological evaluation of the effectiveness of potential system-oriented interventions for care delivery.
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Shepherd, Erin Jennifer Watt. "Caring for the child who has completed treatment for cancer: the lived experience of parents who do not live near their child's tertiary cancer centre." 2010. http://hdl.handle.net/1993/4060.
Full textAbstract:
Caring for children with cancer involves caring for the entire family. Treatment for childhood cancer is centralized in major centres. A phenomenological study was conducted to elicit the lived experience of parents caring for a child who had completed treatment for cancer who do not live near their child’s cancer treatment centre. Interviews with five parents exploring their recollections of parenting their child with cancer during and after treatment were conducted. Data analysis revealed the essence of the parents’ lived experience as a journey within a journey.
Four themes characterized the essence of parents’ lived experience: (1) travelling for care, (2) learning to navigate their journey with healthcare providers, (3) coping with change, and (4) giving back. Similarities and differences between the findings from this study and other studies of families with childhood cancer are presented. Recommendations relating to nursing practice, education, research and healthcare policy are provided.
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Janela, Andreia Isabel Pires. "Os maggie cancer caring centres : a arquitectura como "fenómeno transitivo"?" Master's thesis, 2015. http://hdl.handle.net/10316/30055.
Full textAbstract:
Dissertação de Mestrado Integrado em Arquitectura, apresentada ao Departamento de Arquitectura da Faculdade de Ciências e Tecnologia da Universidade de Coimbra<br>Dentro de uma sociedade que, parece viver alheia aos problemas de saúde decorrentes do seu estilo de vida, encontram-se doenças crónicas, dentro das quais se destacam os problemas cancerígenos decorrentes dos processos de industrialização, da proliferação das cidades, do desenvolvimento económico e da globalização alimentar.
Charles Jencks entende que a arquitetura, enquanto meio de comunicação, acaba por refletir os problemas contemporâneos e, com efeito, tende a encontrar respostas para os mesmos através da sua linguagem. A ‘expressão univalente’, característica do modernismo, alterou-se durante o pós-modernismo e, ao que parece, atualmente, rege-se de acordo com o cosmos. Não será novidade, então, que as alterações sofridas se reflitam, também, nos espaços de saúde que passaram de uma grande instituição a edifícios de ‘escala doméstica’, onde o tipo deixa de ser facilmente identificável e, onde, os cuidados prestados tentam encontrar as necessidades dos seus pacientes.
Com efeito, surgem instituições de saúde em que, como são exemplo os Maggie’s Cancer Caring Centres cujo cofundador é Charles Jencks, o tratamento se foca no bem-estar físico,
mental e social. Nestes espaços, localizados no Reino Unido e construídos em memória de Maggie Keswick, não se trata a parte física da enfermidade, mas sim, a fração emocional. Como tal, questiona-se o objetivo terapêutico do ‘objeto arquitetural’.
No sentido de melhor entender este papel, tem-se investido em organizações que estudam a influência das características físicas do espaço no resultado médico dos pacientes, dentro dos quais se destaca o Evidence Based Design. Verifica-se que, em alguns casos, existe uma relação direta entre input e output e assim, os espaços obtidos, de acordo com estas regras espaciais, formam um ‘Ambiente Terapêutico’.
Contudo, há variáveis de ordem subjetiva que dificilmente se podem medir desta forma, incluindo o efeito social e o poder que a imagem pode ter na psicologia do indivíduo. Por se considerar que há mais do que um efeito estritamente clínico, Charles Jencks escreve sobre o possível efeito ‘placebo arquitetural’ e ainda, Annemans, Van Audenhove, Vermolen, & Heylighen avançam com um novo conceito, ‘Ambiente Saudável’, para melhor caracterizar o papel terapêutico da arquitetura. Assim, no sentido de melhor perceber o efeito psicológico dos objetos sobre o utilizador e a possível criação de ‘vínculos emocionais’, entendeu-se ser necessário cruzar a psicanálise com a arquitetura, mais propriamente, com os Centros Maggie.
A ‘teoria da relação de objeto’, de Donnald Winnicott, sobre os ‘fenómenos transitivos’ permite precisamente fazer esta reflexão. Percebendo a construção mental do ser humano, pode equacionar-se como é que estes Centros, na condição abstrata, a de objeto, criam uma relação com os seus usuários e podem, por isso, contribuir para o requerido bem-estar. Chega-se a um momento em que o ‘objeto arquitetural’ parece querer interagir com o indivíduo, reequilibrando-o emocionalmente e, por este motivo, faça, talvez, sentido considerar a arquitetura como o ‘fenómeno transitivo’ do referido psicanalista ou, adaptando a resposta, como um ‘objeto de reequilíbrio emocional’.<br>For a society that seems to live ignoring the health problems caused by their life style there are the chronical diseases, namely cancer, coming from the industrial processes, the spreading of cities, the economic development and the food globalization.
Charles Jencks argued that architecture, as a mean of communication, reflects societies’ troubles and due to them, tries to find solutions in order to fight them through the ‘architectural language’. The ‘univalent expression’, something characteristic of modernism, suffered changes during the post-modern era and, taking what concerns this issue nowadays, the expression changed to a ‘cosmic language’. This means that the same happened when it has to do with architecture for health. The scale changed from an institutional to a domestic one, where the type of building is hard to define and where the treatments have as aim the patients’ needs.
As an effect, there are health institutions that aim to give support to their users, since physical, psychological to social support. This is the case of the Maggie’s Cancer Caring Centres that have as its co-founder Charles Jencks and that are built in the United Kingdom
in memory of his gone wife, Maggie Keswick. There, the physical part of the disease is left for the hospital, having as a main concern the emotional support. Taking this in account, one questions the therapeutic goal of the ‘architectural objet’.
As an answer to this issue, there are some institutions measuring the environmental factors on the clinical results of the patients being studied, specifically Evidence Based Design. They suggest that there is a direct relation between the output and the input of the measured factors, resulting in a ‘Healing Environment’, if the health institution applies these space codes.
However, one considers that some subjective factors, such as the social effect and the power of the image, are difficult to measure in what has to do with the individual psychology. It is in this sense that Charles Jencks writes about the possible ‘architectural placebo’ and that Annemans, Van Audenhove, Vermolen, & Heylighen suggest the use of the term ‘Wholesome Environment’ instead. In order to better understand the kind of emotional links that one might create towards objects, one recurred to psychoanalyses, overlapping its theory with architecture, namely the Maggie’s Centres.
There is precisely the ‘theory of objet relations’, coming from Donnald Winnicott about the ‘transitional phenomena’, that allows this argument. If there is a better understanding of the human psychological structure there might be a way to explain how this Centres, in the condition of objet, might interact and create a relation with its users in a way that might contribute to their well-being. What is understood is that the ‘architectural object’ generates a kind of emotional equilibrium and, in this sense, one might consider architecture as a ‘transitional phenomena’, or by adjusting the answer, as an ‘object of emotional equilibrium’.
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LATINA, ROBERTO. "Chronic pain management in non-oncologic patients: multicentric study on adult patients referring to the centers for pain management in the Lazio Region (Italy)." Doctoral thesis, 2013. http://hdl.handle.net/11573/918178.
Full textAbstract:
Introduction
Chronic pain is a complex phenomenon usually associated with psychological stress, which implies
falling back on the National Health Service and reducing work capacities, indeed affecting Activities
of Daily Living. Studies based on efficacy have identified the multidisciplinary approach as the most
effective means to obtain therapeutic results. These programs can be provided by the Centers for Pain
Management (CPMs), where multidisciplinary teams are likely to provide the necessary expertise to
outline the best treatments for the diagnosis and management of chronic pain. To date, very little
information is available on the kind of assistance and support these centers can provide, as well as on
the clinical and socio-demographic characteristics of patients who refer to these facilities.
Aims
The present investigation has the following objectives:
• to describe what kind of assistance the centers for pain management (CPMs) in the Lazio
Region are able to provide;
• to describe the clinical and socio-demographic characteristics of the population referring to the
CPMs;
• to describe the type of pharmacologic, complementary and intervention treatments;
• to describe the clinical characteristics of patients who turn to the two different levels of
available assistance (hub and spoke system).
Methods
In 2011 a non-profit, retrospective and multicentric study was performed on all the CPMs existing in
the Lazio region. All relevant information on the centers was collected. As well, the health records of
patients between the age of 18 and 71 (paper and digitized documents) affected by chronic benign pain
for at least six months were analyzed. Patients suffering from migraine and from cancer pains were
excluded. The study was approved by the Ethic Committee (CE) of each participating center and of
the preeminent CPM (Tor Vergata). An average number of 1600 patients was estimated. All data were
collected in a SPSS database and processed according to a statistical analysis.
Results
Data collected between January 2012 and February 2013 from 1606 patients from all the twenty-six
(26) participating CPMs in the Lazio Region were analyzed.
Centers characteristics: CPMs are generally located in University and General Hospitals (among
these, 2 hubs) and in public or private hospital facilities. They are all equipped with a clinic, some of
them are able to provide Day Hospital surgery and day-beds. CPMs are managed by anesthetists and
in most instances they do not have multidisciplinary staff members. As well, the number of health
professionals, nurses, psychologists and physiotherapists is scarce. CPMs mainly supply patients with
pharmacotherapy, Complementary Alternative Medicine (CAM) and with interventional treatments
which may be complex, as well. The median waiting time is of about 90 days. The clinics are not
homogeneously distributed in the Region; Rome turned out to be the city with a greater range of
offers, while in the provincial areas there is an under-utilization of the existing facilities.
6
Characteristics of the population: Most of the patients referring to the CPMs had been previously
evaluated by the General Practitioner (38%), 34% of them were directed to the pain centers by a
specialist different from an anesthesiologist, while 28% of patients refer to a CPM on their own
choice. 33.1% of patients are male, 66.9% are female (ratio 1:2); the most representative category of
patients was of an age between 65-69. In most cases, marital status, employment and education were
not documented. Almost all patients, regardless of their age, refer to a CPM at an average median time
of 48 months after onset of pain; female patients seem to experience more intense symptoms with
respect to males. The use of stairs was limited in order to guarantee a multi-dimension evaluation.
Localization/multi-localization of pain is different between males and females; as for the nature of the
pain, 45% of patients suffered from a somatic pain, while 21% of neuropathic pain and 31% mixed
nature (somatic and neuropathic).There is a prevalence of muscle-skeletal diseases (low back pain,
lumbar pain and spondyloarthrosis), immediately followed by neuropathic pain. The older the patient
is more are the clinical disturbances at the origin of the pain. In most cases a proper diagnosis is not
made, but pain is always related to the localization of the pain.
Pain relief treatments: Medications are the most widely used treatments for pain relief and
management. Medications for pain may range from selective and non-selective FANS, adjuvants
(anticonvulsants, benzodiazepine, antidepressants), opioids (i.e. tapentadol) and strong opioids, such
as the oxycodone-naloxone combination which may be of help in limiting the irreversible effects of
opioids. The choice of the treatment depends on the diagnosis and nature of the pain.
Medications alone are often not sufficient in the management of chronic pain and may be more
effective when combined with other treatments, such as acupuncture, massages and other
interventional treatments (perinervous injections, epidural, Pulsed Radiofrequency (RFP), trigger
points injections). No significant difference emerged between male and female patients. Associating
pharmacological medications to CAM is an innovative approach in pain management, which differs
from the traditional western model. By doing this, health care providers focus on the total person, not
just the pain, evaluating both the biological and psychological components of the patient. CAM
treatments may also reduce the use of medications and, as a consequence, of their side effects. We
have to keep in mind that in chronic pain the emotional component very often prevails on the
biological one, considering that the latter can be resolved.
Population referring to the hub and spoke centers: Patients referring to the two different models of
pain clinics differ significantly. This depends both on the length of time from the onset of pain and on
the intensity of the pain (spoke). Patients referring to hub centers show a prevalence of mixed and
neuropathic pain. This information proves that patients with a more complex clinical history turn to
hub centers, although these are not always able to offer the advanced and innovative treatments, which
would be necessary for an effective pain relief in patients.
Conclusions
In 2011, the availability of hub and spoke centers was not equally distributed throughout the territory.
Documents providing clinical data and case history of patients were more reliable than the information
obtained with phone interviews. Overall characteristics of patients, as well as the type of assistance
provided are still scarcely recorded, although this information would be helpful especially when
making a complete multidimensional evaluation on how to better manage chronic pain patients.
However, the 2011 network and system seems to be changing: this is demonstrated by the typology of
patients referring to the hub and spoke centers. Female patients usually turn to the CPMs, considering
their different hormonal and biological characteristics and that they may be more sensitive to the pain
threshold level.
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Mackenzie, Lisa Jane. "Patient-centred cancer care: a road less travelled: an investigation in Australian radiotherapy settings." Thesis, 2014. http://hdl.handle.net/1959.13/1043108.
Full textAbstract:
Research Doctorate - Doctor of Philosophy (PhD)<br>Cancer is a common health issue worldwide, with an estimated 30 million new diagnoses in the last five years. For over half of all newly diagnosed cancer patients, radiotherapy is recommended for cancer control or symptom relief. Despite the contribution that radiotherapy makes to extended survival of those diagnosed with cancer, this treatment is associated with a broad range of potential practical, physical and psychosocial impacts. To support patients dealing with this treatment burden, a holistic patient-centred approach to cancer care is needed. This thesis by publication reports on radiotherapy outpatients’ perceived experiences of cancer care, and the degree to which these experiences were responsive to their needs, values and preferences (i.e. patient-centred). The thesis introduction provides an overview of the burden of cancer worldwide and in Australia, and includes a review of the patient-centred cancer care literature, with a focus on radiotherapy settings. The five journal papers that comprise the thesis body report on findings from a cross-sectional study of cancer patients. Cancer patients were recruited from the radiotherapy treatment waiting rooms of four Australian metropolitan treatment centres during 2010. Radiotherapy outpatients’ perceptions of care were examined across three areas that resonate with the cancer care experience: (1) Life expectancy disclosure (Papers One and Two) (2) Psychosocial well-being and support preferences (Papers Three and Four) (3) Quality of patient-centred care (Paper Five). The thesis discussion provides an overview of the strengths and limitations of this work, and implications of this thesis for future research. The study that forms the basis of this thesis is the first large Australian study in radiotherapy settings to assess cancer outpatients’ preferences and experiences for patient-centred care. Study limitations include the restriction to English-speaking-cancer patients in metropolitan radiotherapy treatment centres, and the use of a cross-sectional design. Future research should move toward developing interventions that could be appropriate for improving patient-centred cancer care for patients receiving radiotherapy.
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Mestre, Catarina Alexandra Jerónimo. "Talk and let talk: Communication is the key: Patients' perspective about oncologic consultations and its implications for quality of cancer care." Master's thesis, 2019. http://hdl.handle.net/10071/19436.
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Background: Quality of cancer care still needs improvement and one of its requirements is a patient-centered care, which englobes several dimensions, such as communication. Even though knowing its importance in cancer settings, and that it impacts both patients and doctors, there is still gaps on understanding patients' perspectives about oncologic consultations.
Aim: To obtain a deeper understanding about how patients evaluate their interactions with oncologists in consultations, using their cognitions and affective states as indicators of the quality of patient cancer care.
Method: We performed a descriptive qualitative study which allowed cancer patients to describe how they felt in oncologic consultations, their thoughts, and how communication occurs with doctors. To address these questions, we conducted semi-structured interviews with twenty-six patients.
Findings: We identified categories and subcategories which highlighted communication as a central piece of doctor-patient encounters. Then, we developed a model which englobes four dimensions of communication. The purpose was to describe patients’ perspectives about each dimension and to help hospital managers to improve the quality of cancer care, by understanding patients' cognitions and affective states.
Conclusion: Communication is essential to cancer patients and it is not always valued by doctors neither adapted to patients' differences, such as gender ones. Considering patients' insights about their experience and interactions with oncologic doctors during consultations, communication skills training should be implemented not only in undergraduate programmes but also during all professional lifetime.<br>Literatura: A qualidade dos cuidados oncológicos requer melhorias e um dos requisitos é um cuidado centrado nos pacientes, que engloba dimensões como a comunicação. A sua importância na oncologia e o impacto para pacientes e médicos são reconhecidos, mas ainda há falhas na compreensão das perspetivas dos pacientes.
Objetivo: Pretende-se um conhecimento aprofundado da avaliação dos pacientes nas interações com os médicos oncologistas, através das suas cognições e estados afetivos como indicadores da qualidade dos cuidados.
Método: Realizámos um estudo qualitativo descritivo para que os pacientes oncológicos descrevessem como se sentem nas consultas oncológicas, os seus pensamentos e como a comunicação ocorre com os médicos. Como tal, conduzimos entrevistas semiestruturadas com vinte e seis pacientes.
Resultados: Identificámos categorias e subcategorias que enfatizaram a comunicação como peça central das interações médico-paciente. Seguidamente, desenvolvemos um modelo com quatro dimensões da comunicação. Este descreve as perspetivas dos doentes sobre cada dimensão e ajuda os hospitais a encontrar formas de melhorar a qualidade dos cuidados, ao perceber as cognições e estados afetivos dos pacientes.
Conclusão: A comunicação é essencial para os doentes oncológicos e nem sempre é valorizada pelos médicos nem adaptada às suas diferenças, como as de género. Considerando as opiniões dos pacientes sobre as suas experiências e interações com os oncologistas durante as consultas, as "skills" de comunicação devem ser ensinadas e implementadas em estudantes de medicina e durante toda a vida profissional.
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HOLANOVÁ, Gabriela. "Změna kvality života žen s diagnostikovaným karcinomem prsu." Master's thesis, 2008. http://www.nusl.cz/ntk/nusl-53233.
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Professional treatises and articles in commercial media having breast carcinoma in the heading characterize it mostly as an epidemiologically serious phenomenon. This fact cannot be doubted regarding to occurrence of this carcinoma disorder of women (in minimal cases of men). At present the patients become co-coordinators of the treatment in far bigger rate than they used to. Studies and practical experience in this context show that only quantitative aspects of life like the length are not the determined ones for the patient, but more and more patients prefer quality of the survival. Traditional medicine under the pressure of such findings tends to modify treatment procedures in relation with keeping certain quality of life of oncological patients. That is the reason why traditional medicine in the objectives of psychooncology specialization maps the rate of such level, searches preferences of the patients in context of type of the carcinoma, the stage of the disease, individual emotional attitudes etc. Psychooncology becomes an equal partner to radiology, surgery, pathology, oncology and psychology itself in terms of help patients. The possibility to provide psychooncological investigation in the centre of diagnosis and treatment of breast carcinoma of women Mamografie Nemocnice Písek a.s. and to process the data by the form of diploma work seemed purposeful in this case. In the theoretical part initial conditions of breast carcinoma by traditional medicine were defined {--} diagnosis, cure and consecutive treatment. Common emotional maps while facing cancer diagnosis were defined. Methods of determination quality of life of patients in historical and contemporary trends were mentioned. The selected methodology was described by the form of partially anonymous questionnaires and investigative file of 128 women was characterized. The aim of this work was to search the women with diagnosis of breast carcinoma and development of their partnerships, relationships in extended family, inter - personal relationships at work and to compare quantifiable parameters with the time before setting the diagnosis. Mapping somatic (tiredness, pain, insomnia, digestive problems) and psychosomatic factors determining quality of life of sick women was the major axis of searching and investigation. These aims were applied to defined hypotheses which dealt with goals mentioned in the context of contemporary state of comprehension to help people with oncological diagnosis: breast carcinoma is not only serious somatic problem but also psychosocial issue although psychooncology is not the specialization systematically incorporated into the complex oncological solution of patients at the moment. Dates result in the fact that the factors which contribute most to the quality of life concerning to somatic influences are negatively felt tiredness followed by pain afterwards. The dominant psychical influences include depression, anxiety and insomnia. In psychosocial sphere social support is unambiguously dominantly important for quality of life and according to the literature it can contribute even to the length of survival. Following the data, lucid absence of psychooncological help in early stages after detected disorder and during contingent recovery seemed insufficient. The diploma work was not purposeless. There was a deep interest and support of all medical staff of the mammography centre. If we succeed to include psychooncological intervention into a set of conditions asserted in the horizon of treatment of breast cancer, then the data will daily contribute to help of sick women. By generalization it is possible to outline the way in understanding the complex treatment and solving further oncological diagnoses and procedures.
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Bilodeau, Karine. "La description de la pratique interprofessionnelle centrée sur le patient au cours de la trajectoire de soins en oncologie." Thèse, 2014. http://hdl.handle.net/1866/11269.
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Les orientations ministérielles du Québec encouragent une pratique interprofessionnelle centrée sur le patient (ICP), au cours de la trajectoire de soins, pour soutenir les patients diagnostiqués d’un cancer. Cette pratique assure une meilleure communication entre les professionnels et la sécurité des patients, et améliore les soins et l'accès aux services (Santé Canada, 2010). Cependant, les études rapportent généralement les perceptions des professionnels en regard des soins et des services et informent sur les facteurs organisationnels, procéduraux et relationnels liés à cette pratique. Considérant l’importance de celle-ci, il semble nécessaire de la documenter selon les perceptions de patients, de proches et de professionnels dans un contexte réel de soins. L’étude avait pour but de décrire la pratique ICP au cours de la trajectoire de soins en oncologie. Pour soutenir cette description, l’adaptation du cadre de référence Person centred nursing framework (PCNF) de McCormack et McCance (2010) a été réalisée en incluant l’interprofessionnalité, telle que définie par Couturier (2009) et utilisée.
Une étude qualitative de cas multiples a été réalisée auprès de deux équipes interprofessionnelles d’un centre hospitalier universitaire de la région de Montréal. L’échantillon (N=31) était composé de 8 patients, 3 proches, 18 professionnels et 2 gestionnaires. Vingt-huit entrevues ont été réalisées ainsi que 57,6 heures d’observation d’activités cliniques auxquelles participait le patient (ex., rendez-vous, traitement). Les résultats suggèrent que la pratique ICP des équipes est empreinte d’un dualisme de cultures (culture centrée sur le traitement versus culture davantage centrée sur le patient). De plus, les équipes étudiées ont présenté une pratique ICP fluctuante en raison de l’influence de nombreux facteurs tels le « fonctionnement de l’équipe », l’« environnement physique » et le « positionnement » des patients et des professionnels. Les résultats ont aussi suggéré que le déploiement des équipes de soins se fait à intensité variable au cours de la trajectoire. Il a été soulevé que les patients ont pu faire l’expérience d’une pratique ICP changeante, de bris dans la continuité des soins et de transition difficile entre les différentes périodes de la trajectoire. De plus, la description d’une pratique ICP souhaitée par les patients, leurs proches et les professionnels propose un accompagnement respectant le rythme du patient, sans prédominance des valeurs du professionnel ainsi qu’une assiduité dans la collaboration des membres de l’équipe.
Cette étude suggère que les sciences infirmières peuvent ajouter aux connaissances interprofessionnelles actuelles en utilisant une perspective centrée sur le patient, perspective cohérente avec ses valeurs disciplinaires. De plus, de nombreuses pistes de réflexion sont proposées pour la pratique, la recherche, la gestion et la formation.<br>The ministerial orientations drawn up by the Quebec government promote the concept of interprofessional patient-centred practice (IPPC) throughout the care trajectory to support patients who have been diagnosed with cancer. That form of practice improves communication between professionals and patients’ sense of security, as well as improving care and access to services (Health Canada, 2010). However, studies generally report professionals’ perceptions of care and services and provide information on organizational, procedural and relationship factors connected to that practice. It is necessary to document this important practice based on the perceptions of patients, family members and professionals in a real context of care. This study was designed to describe IPPC practice throughout the trajectory of oncology care. The Person Centred Nursing Framework (PCNF) of McCormack and McCance (2010) was adapted by integrating interprofessionality, as defined by Couturier (2009), and used to support that description.
A qualitative study of multiple cases was conducted with two interprofessional teams at a teaching hospital in the Montreal region. The sampling (N=31) consisted of 8 patients, 3 family members, 18 professionals and 2 managers. Twenty-eight interviews were conducted, as well as 57.6 hours of observation of clinical activities in which patients were participating (e.g. appointments, treatments). The results suggest that the teams’ IPPC practice reflected a duality of cultures (treatment-centred culture versus patient-centred culture). In addition, the IPPC practice of teams in the study fluctuated due to the influence of many factors, such as “how the team works,” “the physical environment” and the “stance” of patients and professionals. The results further suggested that the deployment of healthcare teams varied in intensity over the trajectory. The point was raised that patients experienced a variable IPPC practice, breakdowns in continuity of care, and difficult transitions between different periods in the trajectory. In addition, the description of the IPPC practice that patients, their family members and professionals would like to see suggests a form of accompaniment that would follow the patient’s own pace, without imposing professionals’ values, with assiduous collaboration from members of the team.
This study suggests that nursing could advance current interprofessional knowledge by taking a patient-centred perspective, a perspective consistent with values in this discipline. In addition, many avenues for further reflection are put forward in terms of practice, research, management and training.
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Stasko, Carly. "A Pedagogy of Holistic Media Literacy: Reflections on Culture Jamming as Transformative Learning and Healing." Thesis, 2009. http://hdl.handle.net/1807/18109.
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This qualitative study uses narrative inquiry (Connelly & Clandinin, 1988, 1990, 2001) and self-study to investigate ways to further understand and facilitate the integration of holistic philosophies of education with media literacy pedagogies. As founder and director of the Youth Media Literacy Project and a self-titled Imagitator (one who agitates imagination), I have spent over 10 years teaching media literacy in various high schools, universities, and community centres across North America. This study will focus on my own personal practical knowledge (Connelly & Clandinin, 1982) as a culture jammer, educator and cancer survivor to illustrate my original vision of a ‘holistic media literacy pedagogy’. This research reflects on the emergence and impact of holistic media literacy in my personal and professional life and also draws from relevant interdisciplinary literature to challenge and synthesize current insights and theories of media literacy, holistic education and culture jamming.