Дисертації: "Medicina critica"

1

Tartarini, Chiara <1969&gt. "Quadri di sintomi. Teoria della immagini, storia dell'arte e scienze umane in medicina." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2013. http://amsdottorato.unibo.it/6031/1/Tesi_per_PDF_-_preprint.pdf.

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Lo studio analizza il modo in cui la storia dell’arte e la visual culture vengono utilizzate all’interno delle medical humanities, e cerca di suggerire un metodo più utile rispetto a quelli fin qui proposti. Lo scritto è organizzato in due parti. Nella prima parte sono analizzate alcune teorie e pratiche delle scienze umane in medicina. In particolare, ci concentriamo sulla medicina narrativa e sugli approcci con cui la storia dell’arte viene inclusa nella maggioranza dei programmi di medical humanities. Dopodiché, proponiamo di riconsiderare questi metodi e di implementare il ruolo di un pensiero storico e visivo all’interno di tali insegnamenti. Nella seconda parte, alla luce di quanto emerso nella prima, ci dedichiamo a uno studio di caso: la rappresentazione della melanconia amorosa, o mal d’amore, in una serie di dipinti olandesi del Secolo d’Oro. Colleghiamo queste opere a trattati medico-filosofici dell’epoca che permettano di inquadrare il mal d’amore in un contesto storico; in seguito, analizziamo alcune interpretazioni fornite da studiosi e storici dell’arte a noi contemporanei. In particolare, esaminiamo lo studio pionieristico di Henry Meige, pubblicato sulla “Nouvelle iconographie de la Salpêtrière” nel 1899, da cui emerge la possibilità di un confronto critico sia con le posizioni iconodiagnostiche di Charcot e Richer sia con quelle della prima psicoanalisi.
The research aims to study the way art history and visual culture are utilised in the medical humanities, and to suggest a more profitable approach compared to the usual ones. The text is organised in two parts. In Part I, we examine the main purposes of medical humanities’ theories and practices. In particular, we focus on narrative medicine and on the techniques by which art history has been included in most of their programmes. Then, we propose to review these methods in order to improve the role of a historical and visual thought inside these teachings. In Part II, we consider a series of paintings of the Dutch Golden Age representing the love melancholy, or lovesickness, in view of what shown up in the first part. We connect these images with medico-philosophical treatises of that time, setting the disease in its historical context; then we examine the interpretations some scholars and art historians suggested about them. Above all, we consider the pioneering study by Henry Meige, appeared in the “Nouvelle Iconographie de la Salpêtrière” (1899), that demonstrates the possibility of a critical comparison with the “icono-diagnosis” approach used by Charcot and Richer, and, obviously, with the first works of psychoanalysis.

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2

Tartarini, Chiara <1969&gt. "Quadri di sintomi. Teoria della immagini, storia dell'arte e scienze umane in medicina." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2013. http://amsdottorato.unibo.it/6031/.

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Анотація:

Lo studio analizza il modo in cui la storia dell’arte e la visual culture vengono utilizzate all’interno delle medical humanities, e cerca di suggerire un metodo più utile rispetto a quelli fin qui proposti. Lo scritto è organizzato in due parti. Nella prima parte sono analizzate alcune teorie e pratiche delle scienze umane in medicina. In particolare, ci concentriamo sulla medicina narrativa e sugli approcci con cui la storia dell’arte viene inclusa nella maggioranza dei programmi di medical humanities. Dopodiché, proponiamo di riconsiderare questi metodi e di implementare il ruolo di un pensiero storico e visivo all’interno di tali insegnamenti. Nella seconda parte, alla luce di quanto emerso nella prima, ci dedichiamo a uno studio di caso: la rappresentazione della melanconia amorosa, o mal d’amore, in una serie di dipinti olandesi del Secolo d’Oro. Colleghiamo queste opere a trattati medico-filosofici dell’epoca che permettano di inquadrare il mal d’amore in un contesto storico; in seguito, analizziamo alcune interpretazioni fornite da studiosi e storici dell’arte a noi contemporanei. In particolare, esaminiamo lo studio pionieristico di Henry Meige, pubblicato sulla “Nouvelle iconographie de la Salpêtrière” nel 1899, da cui emerge la possibilità di un confronto critico sia con le posizioni iconodiagnostiche di Charcot e Richer sia con quelle della prima psicoanalisi.
The research aims to study the way art history and visual culture are utilised in the medical humanities, and to suggest a more profitable approach compared to the usual ones. The text is organised in two parts. In Part I, we examine the main purposes of medical humanities’ theories and practices. In particular, we focus on narrative medicine and on the techniques by which art history has been included in most of their programmes. Then, we propose to review these methods in order to improve the role of a historical and visual thought inside these teachings. In Part II, we consider a series of paintings of the Dutch Golden Age representing the love melancholy, or lovesickness, in view of what shown up in the first part. We connect these images with medico-philosophical treatises of that time, setting the disease in its historical context; then we examine the interpretations some scholars and art historians suggested about them. Above all, we consider the pioneering study by Henry Meige, appeared in the “Nouvelle Iconographie de la Salpêtrière” (1899), that demonstrates the possibility of a critical comparison with the “icono-diagnosis” approach used by Charcot and Richer, and, obviously, with the first works of psychoanalysis.

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Souza, Washington Luis. "Da medicina não hospitalar ao hospital médico: uma leitura das análises de Michel Foucault sobre a história da medicina." Pontifícia Universidade Católica de São Paulo, 2008. https://tede2.pucsp.br/handle/handle/11769.

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Made available in DSpace on 2016-04-27T17:27:22Z (GMT). No. of bitstreams: 1 Washington Luis Souza.pdf: 689943 bytes, checksum: ab580f6061104e014a2c9751801dd26b (MD5) Previous issue date: 2008-04-07
Conselho Nacional de Desenvolvimento Científico e Tecnológico
This study aims to present, having Michael Foucault s work as basis, to present the transition from classic medicine (centuries XVII and XVIII) to modern medicine (centuries XIX and XX), as a turning point, opposed to the teleologic evolution thesis proposed by the traditional medical historiography. On institutional basis, we will approach the dichotomy between medical practices and the classic hospital institutions, placing the creation of therapeutic hospital as a fact of modern age. This dissertation tries to show that classic medicine which classifies pathological species was a knowledge based in natural history and reached its top at the end of Classic Age, when the knowledge from biology, such as anatomy and physiology, were applied to the study of pathologies creating the modern empirical medicine. Modern medicine was constituted as a different knowledge with subject, object, concepts and methods completely distinct. However this change hasn´t happened due to the improvement of knowledge and practice, but because of studies that were developed outside the medical field, apart from the medical reason. Therefore it is not justificable to think about the history of medicine in terms of evolutionary continuity, being best described, on the contrary, as a discontinuous and not progressive history
Este estudo tem por objetivo, a partir da leitura da obra de Michel Foucault, apresentar a transição da medicina clássica (séculos XVII e XVIII) à medicina moderna (séculos XIX e XX), como momento de ruptura, em oposição à tese da evolução teleológica proposta pela historiografia médica tradicional. No plano institucional, serão abordadas as dicotomias entre as práticas médicas e as instituições hospitalares clássicas, situando o nascimento do hospital médico terapêutico como um fato próprio da modernidade. Esta dissertação procura explicitar que a medicina clássica classificatória das espécies patológicas, era um saber fundamentado na história natural e chegou ao seu limite no final da Idade Clássica, quando saberes originários da biologia, a exemplo da anatomia e da fisiologia, foram aplicados ao estudo das patologias criando a medicina empírica moderna. A medicina moderna se constituiu como um saber de outra ordem, com sujeito, objeto, conceitos e métodos absolutamente distintos. Contudo, essa mutação não se deu em virtude do aperfeiçoamento dos conhecimentos e das práticas, mas por meio de estudos desenvolvidos fora do campo médico, alheios à intencionalidade da razão médica. Não se justificaria, portanto, pensar a história da medicina em termos de continuidade evolutiva, cabendo descrevê-la, ao contrário, como uma história descontínua e não progressiva

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4

Povoa, Eduardo Conte. "Entre a esculta e a ausculta: uma critica a racionalidade medica ocidental, centrada na medicina baseada em evidencias." Rio de Janeiro : [s.n.], 2002. http://teses.cict.fiocruz.br/pdf/povoaecm.pdf.

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5

Biscaia, Leonardo. "O momento pericial : Ethos pericial e disputa no campo previdenciário." reponame:Repositório Institucional da UFPR, 2016. http://hdl.handle.net/1884/45344.

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Orientador: Profª. Drª. Maria Tarcisa Silva Bega
Tese (doutorado) - Universidade Federal do Paraná, Setor de Ciências Humanas, Programa de Pós-Graduação em Sociologia. Defesa: Curitiba, 09/05/2016
Inclui referências : f. 294-323
Resumo: A tese analisa o habitus da perícia médica previdenciária e a sua inserção no campo previdenciário, bem como as disputas que diferentes agentes coletivos mantêm com a perícia em torno de determinados capitais. Esses objetivos são perseguidos a partir da teoria dos campos de Pierre Bourdieu, estrutura conceitual apropriada para a apreensão das várias dimensões explicativas da ação social do perito médico: o Welfare State, a previdência social brasileira, as diferentes racionalidades burocráticas, as diferenças entre o perito médico e seus pares assistentes. Recupera-se a historiografia tanto da seguridade social brasileira quanto da perícia médica brasileira e procura-se explicar como esta insere-se naquela. Além disso, como a função precípua do perito médico previdenciário é avaliar a capacidade para o trabalho de segurados do regime geral da previdência social, é feita a descrição tanto do cliente do perito médico quanto da sua trajetória desde o adoecimento até a avaliação feita pelo perito médico. A pesquisa contribui pela originalidade do seu objeto de estudo e pelas estratégias de investigação. O habitus e o ethos do perito médico são perscrutados por pesquisa empírica que analisa seus valores e suas posturas sobre a previdência social, sobre os segurados, sobre si mesmos e sobre os outros agentes do campo. Para tentar evidenciar o que há de específico no habitus pericial, deu-se atenção também para os valores dos demais servidores da previdência social brasileira, genericamente denominados "administrativos" em contraposição aos peritos médicos. Os resultados preliminares sugerem que a perícia médica previdenciária busca manter a dignidade e a autonomia do conteúdo de sua prática ao mesmo tempo em que se sujeita à subordinação hierárquica dentro de uma estrutura fortemente centralizada, em que representa apenas uma parte pequena, ainda que indispensável. Tal sujeição implica também o aprendizado de um habitus profundamente diverso daquele assumido pelo médico que intervêm no processo saúde-doença assistindo os pacientes/usuários. Os conflitos com os demais agentes coletivos do campo previdenciário surgem quando há a disputa pelo que Bourdieu chama de capital simbólico (com os servidores administrativos e demais agentes coletivos institucionais do campo) e pela disputa assimétrica pelo capital previdenciário (isto é, a concessão de um benefício por incapacidade) com os usuários do Instituto Nacional do Seguro Social (INSS). PALAVRAS-CHAVE: perícia médica previdenciária; Sociologia das Profissões; Medicina; previdência social; habithus; ethos.
Abstract: inclusion in the social security field, as well as disputes that different collective agents have with the expertise around certain capitals. These goals are pursued from the theory of Pierre Bourdieu fields, appropriate conceptual framework for the understanding of the various explanatory dimensions of the medical expert of social action: the Welfare State, the Brazilian social security, the various bureaucratic rationality, the differences between the expert doctor and his assistants pairs. Recover the history of both the Brazilian social security as the Brazilian medical expertise and seeks to explain how this fits into that. Moreover, as the primary function of the social security medical expert is to evaluate the ability to work from policyholders of the general social security system, the description is made from a medical expert's client and its trajectory from illness to assessment by expert doctor. The research contributes for the originality of its subject matter and the research strategies. The habitus and the medical expert ethos are scrutinized by empirical research that analyzes their values and attitudes on social security, on the insured, about themselves and about the other field agents. To try to highlight what is specific in the expert habitus, also attention was given to the values of other servants of the Brazilian social security, generically called by "administrative", as opposed to medical experts. Preliminary results suggest that the social security medical expertise seeks to maintain the dignity and autonomy of the contents of his practice at the same time is subject to hierarchical subordination within a highly centralized structure, which is only a small part, even indispensable. This subject also involves the learning of a deeply diverse habitus that assumed by the doctor who intervenes disease watching patients / users. Conflicts with other collectives inin ththee hseoacltiha-l security field arise when there is a dispute over what Bourdieu calls symbolic capital (with the administrative staff and other institutional collective agents of the field) and asymmetrical dispute over pension capital (i. e., granting a Incapacity Benefit) with users of the INSS. KEYWORDS: social security medical expertise; Sociology of Professions; Medicine; social insurance; habitus; ethos.

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Reis, Ivoni de Freitas. "A Farmácia e a Medicina Química na Inglaterra Quinhentista: O Caso de R. Bostocke." Pontifícia Universidade Católica de São Paulo, 2006. https://tede2.pucsp.br/handle/handle/13346.

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Made available in DSpace on 2016-04-28T14:16:27Z (GMT). No. of bitstreams: 1 HCS - Ivone de Freitas Reis.pdf: 727469 bytes, checksum: 64f00843d6ea178c15948adf7f5739e4 (MD5) Previous issue date: 2006-10-04
This study aims at an understanding of the pharmacy grounded on chemical medicine introduced in England in the 16th and beginnings of the 17th centuries. Although prefigurated by many others, the main work that introduced Paracelsian ideas on English soil was The Difference the Aucient Phisicke and the Latter Physicke (1585) by R. Bostocke. Nothing is known with certainty on the author, he might have been an English Paracelsian and Parlament member and our study required to research his possible biography. On the other hand, the study of medicines and processes mentioned by Bostocke demanded an understanding of the status of chemical medicine at the time. This was performed through the analysis of related works, such as Paracelsus , Oswald Croll´s, Joseph Duchesne´s and Jean Béguin´s, and the classical medicine of Conrad Gesner. Our study aimed to show that 16th century English chemical pharmacy was much more concerned with the process, purification and dosage of medicines, than with the kind of materials employed. To demonstrate our hypothesis, some remedies mostly metallic were selected and arranged in a way that would show the path followed by iatrochemists to prepare chemical remedies, eventually, in some cases, to attain the most desired one: potable gold
Esse trabalho aborda, principalmente, a farmácia decorrente da medicina química na Inglaterra do Século XVI e início do XVII. Entretanto, obra que introduziu a filosofia paracelsista na Inglaterra, o The Difference the Aucient Phisicke... and the Latter Phisicke (1585), teve por autor R. Bostocke, um paracelsista e parlamentarista inglês sobre o qual quase nada se pode afirmar de concreto. Assim sendo, além de um levantamento de sua magra biografia, fezse necessário buscar a química médica no momento em que foi publicada a sua obra. Assim, para fazer um estudo dos medicamentos e processamentos citados por Bostocke, e tendo por objetivo criar esta ambiência, foram levantados alguns estudiosos deste período. Além do próprio Paracelso, buscou-se avaliar esses medicamentos em Oswald Croll, paracelsista confesso, em dois iatroquímicos, Joseph Duchesne e Jean Béguin, e em adepto da medicina clássica, Conrad Gesner. Tendo como objetivo mostrar que a farmácia dos quimicamente processados na Inglaterra do XVI estava prioritariamente preocupada com o processamento, a purificação e a dosagem, mais do que com o tipo de material utilizado na preparação desses, foi feito um levantamento de alguns medicamentos, em sua maioria metais, dispostos de forma a compreender caminho percorrido por esses estudiosos para desenvolver os quimicamente preparados, bem como, em alguns casos para alcançar aquele que foi o mais cobiçado de todos os medicamentos, o ouro potável

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Schmitt, Vanessa Costa e. Silva. "L'homme de l'art au XVI siècle : la médecine dans l'oeuvre au noir de Marguerite Yourcenar." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2006. http://hdl.handle.net/10183/8721.

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L’objectif du présent mémoire est d’étudier la médecine, longtemps appelée l’art de guérir, en prenant comme point de départ L’OEuvre au Noir, roman de Marguerite Yourcenar, et son protagoniste, Zénon, un médecin brugeois du XVIe siècle. Je commence par présenter quelques informations concernant la vie et l’oeuvre de Marguerite Yourcenar; par ce panorama de sa production littéraire et intellectuelle, il est possible d’accompagner l’évolution de son écriture et d’avoir une meilleure compréhension de l’ouvrage étudié. La présentation du parcours bio-bibliographique de l’auteur est suivie d’une brève étude sur la genèse de L’OEuvre au Noir. Par là on peut voir ce roman comme une oeuvre de la maturité: plus que la retouche d’un texte de jeunesse, L’OEuvre au Noir apparaît comme le résultat d’un long processus d’approfondissement de ses thèmes et de la maîtrise de la langue. Ensuite, je me propose d’apporter quelques éléments d’information sur la Renaissance et particulièrement sur le seizième siècle. Par la peinture de la toile de fond de la période, je prétends permettre au lecteur de L’OEuvre au Noir d’avoir une mise en contexte historique de l’action fictionnelle et lui permettre ainsi de situer l’aventure intellectuelle — l’aventure de l’esprit qui est l’essence de la vie de Zénon — dans le décor de l’époque, lequel est extrêmement bien reconstitué par Marguerite Yourcenar. Puis, je fais une esquisse d’analyse littéraire: en partant du schéma de l’intrigue, j’essaye de voir comment l’étude du temps et de l’espace offre des voies de lecture, de compréhension de l’univers de L’OEuvre au Noir et je suggère une ligne d’interprétation de la signification du roman. Enfin, j’entreprends mon étude sur la médecine dans le roman et au XVIe siècle; elle est divisée en quatre parties: je commence par montrer en quelques pages un panorama de l’histoire de la médecine, de la préhistoire à la Renaissance, afin de mieux comprendre pourquoi certaines conceptions héritées du passé se perpétuaient toujours au XVIe siècle et aussi la raison de l’apparition à cette époque-là de certaines innovations dans la pratique de l’art. Dans les trois parties suivantes, je prends comme point de départ le protagoniste de L’OEuvre au Noir. D’abord, j’expose l’état du monde de la santé et de la maladie au XVIe siècle: les différents types d’établissements d’accueil des malades, les différentes catégories de professionnels des soin, la formation et le statut social des médecins, les disputes corporatives et professionnelles et le rapport entre la médecine et la religion. Dans la partie suivante, je me propose d’analyser l’état de la science et de la pratique médicales au XVIe siècle à partir des branches qui sont tenues à l’époque pour les plus importantes: l’anatomie, la physiologie, la pathologie et la thérapeutique. Enfin, dans la dernière partie, j’esquisse d’abord la routine professionnelle de Zénon à Bruges, puis je passe à ce qui est son dernier acte opératoire: son suicide.
O objetivo desta dissertação é estudar a medicina, conhecida durante muito tempo como a arte de curar, tomando como ponto de partida A Obra em Negro, romance de Marguerite Yourcenar e seu protagonista, Zênon, um médico da cidade de Bruges do século XVI. Começo apresentando algumas informações relativas à vida e à obra de Marguerite Yourcenar; através deste panorama de sua produção literária e intelectual, é possível acompanhar a evolução de sua escrita e ter uma melhor compreensão da obra estudada. À apresentação do percurso bio-bibliográfico da autora, segue-se um breve estudo sobre a gênese da Obra em Negro. Ao estudar a gênese do romance em questão, pode-se vê-lo como uma obra da maturidade: mais que um texto da juventude que foi retrabalhado, A Obra em Negro é o resultado de um longo processo de aprofundamento de seus temas e de domínio da língua. Na seqüência, proponho-me a tratar rapidamente alguns elementos de informação sobre o Renascimento e, particularmente, sobre o século XVI. A redação de um pano de fundo do período visa a permitir ao leitor da Obra em Negro uma contextualização histórica da ação ficcional, de forma que ele possa melhor situar a aventura intelectual — a aventura do espírito que é a essência de vida de Zênon — na acurada reconstituição da época feita por Marguerite Yourcenar. Após, mostro um esboço de análise literária: partindo da intriga, tento compreender como o estudo do tempo e do espaço oferece diferentes vias de leitura e de compreensão do universo de A Obra em Negro e sugiro uma linha de interpretação da significação do romance. Enfim, parto para o estudo da medicina no romance e no século XVI que é dividido em quatro partes: inicio traçando, em algumas páginas, um panorama da história da medicina, da pré-história ao Renascimento, a fim de entender um pouco melhor por que certas concepções herdadas do passado perpetuavam-se durante o século XVI, assim como o porquê do surgimento, naquela época, de certas inovações na prática da arte. Nas três partes que se seguem, tomo como ponto de partida o protagonista da Obra em Negro. Inicialmente, exponho o estado do mundo da doença e da saúde no século XVI: os diferentes tipos de estabelecimentos de cuidados aos doentes, as diferentes categorias de profissionais da saúde, a formação e o status social dos médicos, as disputas corporativas e profissionais e a relação entre medicina e religião. Na parte seguinte, proponho-me a analisar o estado da ciência e da prática médicas no século dezesseis a partir dos ramos tidos à época como os mais importantes: anatomia, fisiologia, patologia e terapêutica. Por fim, na última parte, delineio primeiramente a rotina profissional de Zênon em Bruges para depois passar àquele que é o seu último ato operatório: o suicídio.

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Briganti, Carlos Rosario. "O sonho de Descartes: o homem das paixões." Pontifícia Universidade Católica de São Paulo, 2006. https://tede2.pucsp.br/handle/handle/15527.

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This dissertation is an audacious proposal to closely examine the personality of René Descartes which could perhaps, lead us to a theory about his mission in life which is intimately fused with his philosophy. The complexity of his psyche as revealed by his first biographer Baillet is expressed in the progression of his writings. We have chosen our course of direction from one of the higher points selected from the Cartesian philosophical work: the development of a human being incorporating his passions. René Descartes was a man enamored with the truth and for this very reason he merged highly powerful statements, doubts, biases, flights of fantasy and deviations, of which conventional man is incapable. René Descartes was a man who inspired hope: a better future for mankind, without concern merely in relation to his own future. It is impossible to classify René Descartes as an atheist, Catholic, Protestant, libertine or laborer. This classification task is an impossible one because each biographer has imbued his own particular interests in their works at that time. We know all knowledge acquired is linked to a one s own peculiar cause which is also the case in relation to biographers. Descartes himself was to a great extent responsible for these widely disparate viewpoints since his own accomplishments in this world were exactly as he had described his life in his childhood diary, confined within a shrouded world. The period in history was horrifying and all those who dared contradict the Catholic dogmatic order were persecuted. The group of servile yes men and accomplices were by far greater in number and permeated society at the time. This left René Descartes with little choice but to employ masks to enable him to at least continue living. The Catholic dogmas could not be contradicted under threat of punishment by the Inquisition. René Descartes nevertheless conducted his life much like Hegel would write in his definition of the role of the hero and thereby he endeavored and managed to restore philosophy to it rightful place among research, reflection and wisdom. René Descartes wrote his most fundamental text, the Discurse de la Metode (Discourse on Method) in French. This extraordinary event was founded on the right of all people to acquire knowledge, especially women. This uncommon and libertine attitude is just one of the facets of this man, who based on his own freedom to act and think, at no time adhered to any system, school of philosophy or politics; nor did he allow anything to stand in the way of his being truly free. He was very much aware that his attitude would fuel the fires of the moralists from whom anything can be expected or from the cynics who deprive themselves of nothing that is not self serving. His philosophical project in life was enormous; metaphysics comprising the roots of this philosophical tree while the trunk represents physics sucking up the sap running from the roots branching in to the leafy boughs of Mechanics, Medicine and Morals. The project of an integrated human being is intimately connected to Medicine, Ethics and Morals, constituting the Cartesian project. The other project of making nature understandable in the light of reason which edifies science is as he writes in a letter to his friend, Farther Mersenne: Physics dissipates the celestial myths proffered by the poets and painter, which keep God occupied opening and closing the gates to the winds, spilling dew on the flowers and launching lightening bolts against the rocks. Descartes in relation to his reflections and writings in the Discourse of Method, under the fear of its creation, replicates one of the masks, thus writing: do not speak of this to anyone (...) expose the subject as if it were a sample of your philosophy (...) hidden behind the painting to hear to what to say. Our attempt was to endeavor to understand this Cartesian path, conducting hypothetical interpretations about the Descartes´ dream, which according to our fanciful interpretation reveals the paths chosen by Descartes, his fears to be respected, some of the pain he was subjected to but particularly in regard to his defamation. We are aware of and privileged to hold Our interpretation fantasies and leave the texts themselves intact, to survive our comments.
Essa dissertação se propõe a uma ousadia: perscrutar a personalidade de René Descartes que poderá, talvez, nos conduzir a hipóteses sobre seu projeto de vida que é amalgamada com sua filosofia. A complexidade de sua psique revelada desde seu primeiro biógrafo Baillet se expressa na evolução de seus escritos. Escolhemos a direção de um dos vértices que elegemos da obra filosófica cartesiana: a construção de um ser humano integrado às suas paixões. René Descartes foi um homem apaixonado pela verdade, por isso mesmo, misturada a afirmações mais contundentes, a dúvidas, vieses, fugas, desvios, que um homem convencional não seria capaz. René Descartes foi um homem que se lançou a uma esperança: um melhor futuro para a humanidade, não se preocupando somente com o seu próprio futuro. É impossível classificar René Descartes como ateu ou católico ou protestante, libertino ou trabalhador. Essa tarefa classificatória é fugidia uma vez que, cada biógrafo o revestiu de seus particulares interesses daquele momento. Sabemos que toda confissão se encontra atada a uma própria e particular causa, assim também acontece com os biógrafos. Descartes contribuiu e muito para essa controversa forma de visualizado, uma vez que, sua atuação no mundo se deu como ele mesmo escreve em seu diário juvenil, adentrando ao mundo mascarado. Eram tempos terríveis de perseguição a todos aqueles que se atrevessem a contradizer a ordem católica dogmática. O grupo dos aliciadores, cúmplices e servis estavam em maior numero e em toda a sociedade. Restava a René Descartes usar de máscaras a fim de poder, no mínimo, continuar vivo. Os dogmas católicos não podiam, sob pena da Inquisição, serem contrariados. René Descartes desenvolve uma vida como Hegel escreverá, na qualidade de herói, onde tentou e conseguiu restaurar a filosofia ao seu verdadeiro território de pesquisa, reflexão e sabedoria. René Descartes escreverá seu texto fundamental, o Discurso do Método, em francês. Realiza esse extraordinário acontecimento atuando sobre o direito do saber a todos os seres humanos, especialmente as mulheres. Esta atitude incomum e libertaria compõe uma das facetas desse homem, que pela própria liberdade de ação e pensamento nunca aderiu a nenhum sistema ou escola filosófica ou política, jamais permitiu que algo o impedisse de ser verdadeiramente livre. Sabia que sua atitude aqueceria os moralistas, de quem tudo se pode esperar ou dos cínicos que a tudo privilegiam em interesse próprio. Seu projeto filosófico era grande, a metafísica compondo as raízes desta árvore-filosófica, o caule representado a física, e sorvendo da seiva radicular ramifica-se em ramos frondosos: a Mecânica, a Medicina e a Moral. O projeto de um ser humano integrado, a intima interligação entre a Medicina e a Ética ou Moral, constituem o projeto cartesiano. O outro projeto o de tornar a natureza compreensível sob a luz da razão que edifica a ciência, como escreve em carta a seu amigo padre Mersenne: A física dissipa os mitos celestes desenvolvidos pelos poetas e pintores , que ocupam Deus em abrir e fechar as portas dos ventos, em derramar o orvalho sobre as flores, e em lançar o raio sobre os rochedos. . Descartes quando da evolução de suas reflexões e escritos no Discurso do Método, sob o temor de sua produção, reproduz uma das máscaras, assim escrevendo: não falar sobre isso com ninguém (...) exporá o assunto como uma amostra de sua filosofia (...) escondido atrás do quadro para escutar o que disser. Nossa tentativa foi a de tentarmos entender esse percurso cartesiano, efetuando interpretações hipotéticas sobre o sonho de Descartes, que segundo nossa interpretação-fantasia revelava os caminhos eleitos por Descartes, seus temores a serem respeitados, as dores submetidas, entre elas e em particular a calúnia. Sabemos e privilegiamos as Nossas fantasias de interpretação que deixam intactos os próprios textos, que sobrevivem a nossos comentários.

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Rábago, Aguilar María de los Ángeles, and Leythe Enrique Adaya. "Prevalencia de la morbilidad materna en la consulta externa del servicio de medicina critica obstétrica en el hospital materno infantil ISSEMYM en el periodo comprendido del 1° de marzo del 2012 a 28 de febrero del 2013." Tesis de Licenciatura, Medicina-Quimica, 2014. http://ri.uaemex.mx/handle/123456789/14757.

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Vere, Joseph. "Evidence based medicine : a critical analysis." Thesis, University of Sheffield, 2018. http://etheses.whiterose.ac.uk/20659/.

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Evidence based medicine uses hierarchies of evidence to justify knowledge claims that are made. These knowledge claims are important because they dictate which treatment interventions are provided and funded, medicolegal standards and the medical research agenda. It is therefore interesting that different hierarchies can be used as this suggests that knowledge claims can be justified in different ways. This thesis presents a critical analysis of evidence based medicine, using the method of analytical philosophy, to improve understanding of the concept. The thesis is divided into two sections. In the first section a systematic review and thematic analysis of hierarchies of evidence is presented; the arguments used to rank systematic reviews, randomised controlled trials and expert opinion within hierarchies are analysed, and the properties used to rank different study designs are analysed. Five factors, independent of study design, that have influenced the development of hierarchies are then presented and it is argued that a lack of theoretical support for hierarchies has led to their proliferation. In the second section the claims that evidence based medicine is rational, science and a new Kuhnian paradigm are analysed. It is argued that evidence based medicine can be substantively rational but this means that knowledge claims can be both rational and inconsistent dependent upon any value commitments that are held. It is then argued that evidence based medicine cannot be science because it does not use scientific method and it cannot be a new Kuhnian paradigm because it is not science, it was not preceded by a revolutionary crisis and it is not incommensurable with previous versions of medicine. The analysis presented strips evidence based medicine of power and has important implications for the status of knowledge claims that are made.

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Lopes, Mariana do Souto Fontes Antunes. "Preliminary study in vivo of the bone regenerative capacity of hydroxyapatite when associated with omeprazole in critical size defects." Master's thesis, Faculdade de Medicina Dentária da Universidade do Porto, 2009. http://hdl.handle.net/10216/61101.

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Lopes, Mariana do Souto Fontes Antunes. "Preliminary study in vivo of the bone regenerative capacity of hydroxyapatite when associated with omeprazole in critical size defects." Dissertação, Faculdade de Medicina Dentária da Universidade do Porto, 2009. http://hdl.handle.net/10216/61101.

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Papke, Todd Alan. "Personalized audio warning alerts in medicine." Diss., University of Iowa, 2014. https://ir.uiowa.edu/etd/1378.

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Modern Electronic Health Record (EHR) systems are now integral to healthcare. Having evolved from hospital billing and laboratory systems in the 80's, EHR systems have grown considerably as we learn to represent more and more aspects of patient encounter, diagnosis and treatment digitally. EHR user interfaces, however, lag considerably behind their consumer-electronics counterparts in usability, most notably with respect to customizability. This limitation is especially evident in the implementation of audible alerts that are coupled to sensors or timing devices in intensive-care settings. The most current standard, (ISO/IEC 60601-1-8) has been designed for alerts that are intended to signal situations of varying priorities: however, it is not universally implemented, and has been criticized for the difficulty that healthcare providers have in discriminating between individual alarms, and for the failure to incorporate prior research with respect to "sense of urgency" as it applies to alarm efficacy. In the present work, however, we consider that there are more effective means to allow a user to identify an alarm correctly than "sense of urgency" response. This thesis focuses on the problem of correct identification of alerts: what happens when a human subject is allowed to create or designate (i.e., personalize) one's own alerts? Given the ubiquity, low costs and commoditization of consumer-electronics devices, we believe that it is just a matter of time before such devices become the norm in critical care and replace existing, special-purpose devices for information delivery at the point of patient care. We built a tool, PASA (Personalized Alert Study Application), that would allow us to capture and edit sounds and orchestrate studies that would contrast any two types of sounds. PASA facilitated a study where study participant's responses to "personalized" sounds were contrasted with sounds that meet the ISO/IEC 60601-1-8:2012 standard. We performed two sub-studies that contrasted responses to two banks of 6-alerts and 10-alerts. The 6-alert study was repeated with the same subjects after two weeks without training to measure recall. We observed that accuracy, reaction time, and retention were significantly improved with the personalized sounds. For example, the median errors for the 6-alert baseline study were 4 for personalized vs. 27 for standard alerts. For the 6-alert repeat study it was 7 vs. 43. The median for the 10-alert study was 1 for personalized vs. 55 for standard alerts. Accuracy for recognition, while remaining constant for personalized alerts, degraded considerably for standardized alerts as the number of alerts increased from 6 to 10. We conclude that personalization of alerts may improve information delivery and reduce cognitive overload on the health care provider. This potential positive effect at the point of patient care merits further studies in a clinical or simulated clinical setting.

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Jonge, Evert de. "Pathophysiology and management of coagulation disorders in critical care medicine." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2000. http://dare.uva.nl/document/56631.

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Laurentiis, Vera Regina Ferraz de. "Aspectos somáticos da conquista do Eu em D. W. Winnicott." Pontifícia Universidade Católica de São Paulo, 2008. https://tede2.pucsp.br/handle/handle/15719.

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The objective of this paper is to explain the somatic aspects inherent to the Winnicottian maturational theory from the initial moment to the so-called I am phase, to assist the psychoanalyst with the comprehension of the clinical phenomena that occur in the soma but are not able to be verbalised. To this end, I have briefly expounded on the theoretical change made by Winnicott and the substitution of the traditional psychoanalytical guidetheory of sexuality by the maturational theory and the Oedipal example for that of the baby on its mother s lap. The distancing from metapsychology and the consolidation of a descriptive language aims to draw closer to the clinical phenomena. Focusing on the interaction between the so-called living body and the human environment, highlighting the imaginative elaboration of the soma and the primary psychosomatic character of Winnicottian theory. Expounding on that which the author denominates as inhabiting the psyche in the soma and the integration of instinct with the self, which is at the foundation of future instinctive dualistic and/or pluralistic relations. Through these propositions, one can understand the author s sense of the I am phase, as that of a moment in which, with the constitution of a body scheme, the baby acquires a place to exist and experience the world
Este trabalho teve por objetivo explicitar os aspectos somáticos inerentes à teoria winnicottiana do amadurecimento, dos momentos iniciais até a etapa denominada eu sou , para instrumentalizar o psicanalista para a compreensão de fenômenos clínicos que têm incidência no soma e não são verbalizáveis. Para tanto, explicitou-se brevemente a mudança teórica operada por Winnicott e a substituição da tradicional teoria-guia psicanalítica da sexualidade pela teoria do amadurecimento e do exemplar edípico para o do bebê no colo da mãe, o afastamento da metapsicologia e a consolidação de uma linguagem descritiva que busca a reaproximação dos fenômenos clínicos. Com o foco nas interações entre o assim chamado corpo vivo e o ambiente humano, destacando-se o teor gestual das primeiras elaborações, elucidou-se o caráter primariamente psicossomático da teoria winnicottiana e explicitaram-se os fundamentos daquilo que o autor denominou alojamento da psique no soma e da integração da instintualidade ao si-mesmo, que estão na base das futuras relações instintuais duais e triádicas. Com essas proposições, pôde-se compreender o sentido do estágio do eu sou para o autor, como um momento em que, com a constituição de um esquema corporal, o bebê conquista um lugar para ser e ter experiências no mundo

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Bandrauk, Natalie. "Futility and the proper goals of medicine : a critical care perspective." Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=78243.

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While the concept of medical futility has existed for as long as medicine has been practiced, it remains a controversial issue that has become more clouded as medicine has advanced. This thesis will explore futility in the most technologically rich and emotionally charged of settings, the intensive care unit. The complex interactions of biology, ethics and the law, with their competing and sometimes conflicting interests will be explored. Disputes between patients, families and health care workers over life-sustaining interventions occur most often in the ICU, and the factors that influence this dynamic, such as lack of communication, time constraints, media-driven misconceptions and value-conflicts, will be examined. Attempts to address futility through advance health directives and conflict resolution policies will be critiqued. But most importantly, this thesis will explain, by appealing to the proper goals of medicine, why limitations should be placed on end-of-life care, and why physicians have an important role to play in making these determinations.

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Masi, Jacopo <1978&gt. "Déclinaisons de la nostalgie dans la poésie européenne de la deuxième moitié du 20e siècle." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2010. http://amsdottorato.unibo.it/2779/1/Masi_Jacopo_TESI.pdf.

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Masi, Jacopo <1978&gt. "Déclinaisons de la nostalgie dans la poésie européenne de la deuxième moitié du 20e siècle." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2010. http://amsdottorato.unibo.it/2779/.

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Trinder, Thomas John. "Splanchnic perfusion in critical illness." Thesis, Queen's University Belfast, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295361.

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Zappa, José Eduardo Bueno 1953. "Por que as exumações? : estudo critico." [s.n.], 1994. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309370.

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Orientador: Fortunato Antonio Badan Palhares
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: É avaliada a razão do número elevado de exumações no Brasil. Oito casos exumados e submetidos à exame necroscópico no Departamento de Medicina Legal da Faculdade de Ciências Médicas da Universidade Estadual de Campinas e Instituto Médico-Legal de Campinas são apresentados como base do trabalho. Laudos, aspectos técnicos e críticos são discutidos e enfatizados no que diz respeito à formação e carreira de Médico-Legista, na estrutura dos Institutos Médico-Legais e formação médica. Conclui que no Brasil, as falhas em laudos são decorrentes de exames necroscópicos mal realizados pois os médicos ¬legistas não têm estrutura, formação e condições de trabalho. Com estes aspectos, a "solução" da Justiça é solicitar exumações às instituições mais estruturadas e tentar solucionar os erros iniciais
Abstract: The reason of the elevated number of exhumations in Brazil is appraised. Eight cases of exhumations that were being submitted to autopsies in the Medicolegal Departament of State University and Medicolegal State lnstitute of Campinas are presented as a hard base of our work. Verdicts, technical and critical aspects are discussed and emphasized in order to review the Forensic Doctor formation and career.It conc1udes that in Brazil, the imperfections in verdicts are the result of some autopsies not well done realized, because Forensic Doctors don't have basic ! structures, solid formation and good conditions to work. Because of these aspects, the "solution" from Justice is' to ask exhumations to institutions that are more prepared and doing this they try to solve the initial mistakes
Doutorado
Medicina Interna
Doutor em Ciências Médicas

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MBWAMBO, EMANUEL PRAYGOD. "Critical analyisis of inventive step and its impact on acceess to Medicine." Thesis, Uppsala universitet, Juridiska institutionen, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-413129.

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Power, Richenda Maeve. "The whole idea of medicine : a critical evaluation of the emergence of 'holistic medicine' in Britain in the early 1980s." Thesis, London South Bank University, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.303989.

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Rodrigues, Andrezza Christina Ferreira. "Drácula, um vampiro vitoriano: o discurso moderno no romance de Bram Stoker." Pontifícia Universidade Católica de São Paulo, 2008. https://tede2.pucsp.br/handle/handle/13074.

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Conselho Nacional de Desenvolvimento Científico e Tecnológico
This work intends to do an analysis of some discourses historically constituted by modernity progress, during the last decades of XIX century, having as reflections main point Bram Stoker s novel Dracula, first published in 1897. Surrounding Stoker s novel, it is possible to glimpse the cultural lines of successful scientism allied health knowledge, especially concerned to blood. At 1880s social Darwinism opened through a biological cover hereditary degeneration theory to English people, reinforcing the sanitary idea developed by Chadwick, which has had its expression through illness control and degeneration by blood connections. The medical theories see blood as gemmules word adopted by Darwin himself to mean granule which has influence on body and mind because of hereditary presence made by ancestors, for example been a worker, been insane, develop promiscuous behavior or became a beggar. In that moment English people has been concerned about this themes, which had been debated by Galton who began the idea of good race for British society
Este trabalho pretende fazer a análise de alguns dos discursos historicamente constituídos pelo avanço da modernidade durante as últimas décadas do século XIX, tendo como eixo norteador das reflexões o livro Dracula de Bram Stoker, publicado em 1897. Através do romance de Stoker é possível vislumbrar traços culturais de um cientificismo triunfante em relação às noções de saúde, em especial no que tange ao sangue. Na década de 1880, o darwinismo social propôs aos ingleses a cobertura biológica para a teoria da degeneração hereditária, reforçando a posição da chamada idéia sanitária desenvolvida por Chadwick, encontrando sua expressão no controle de doenças e na degenerescência através da mistura do sangue. As teorias médicas investem no sangue como condutor dos gemmules termo adotado por Darwin significando grânulos -, que interferem no comportamento do corpo e da mente pela ação hereditária, assim a presença dos antepassados habilitaria o desenvolvimento de características como a disposição para o trabalho, a loucura, a promiscuidade, a mendicância, entre outros. Tema que traz preocupação à sociedade inglesa do período, sendo debatido por estudiosos como Galton, que inauguraria o conceito de boa linhagem para a sociedade britânica

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Prado, Pedro Otavio Barretto. "Estudo exploratório da dimensão psicobiológica do método Rolfing de integração estrutural: criação, desenvolvimento e avaliação de questionários." Pontifícia Universidade Católica de São Paulo, 2006. https://tede2.pucsp.br/handle/handle/15517.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Empirical evidence indicates the importance of the Rolfing Method of Structural Integration for the field of Psychology. Ida P. Rolf s work is a holistic approach of organizing the human body structure in the gravitational field by rebalancing the myofascia (connective tissue) through special touch and movement education. The objective of the study described herein is to provide a systematic and consistent method for investigating the psychobiological nature of Rolfing and its intersection with the domain of psychosomatics. The author studied the power of questionnaires that had been developed for clinical research at NAPER (Brazilian Rolfing Association s Center for Clinical Practice, Research and Studies on Rolfing) and at Rolfing schools in Brazil and the United States, where the author had participated in the simultaneous elaboration, application and evaluation of the questionnaires. The questionnaires were used in connection with the Rolfing processes of 874 clients in three groups: 714 at NAPER and 160 in the Rolfing schools (55 in Brazil and 105 in the US). The questionnaire responses were evaluated both within each and among all of these three groups. The responses to closed questions were subjected to an SPSS quantitative analysis, applying statistical tests appropriate to the metrics of the questions and responses themselves. The responses to open questions were qualitatively analyzed with an SPAD.T method: for particular words, the frequencies and contexts of their uses were tabulated; then, words were grouped by conceptual affinity, and the contexts in which they appeared were analyzed. The themes that emerged from the responses, as well as their frequencies, were noted. These analyses of the data gathered in response to the questionnaires demonstrated the presence of a psychobiological dimension of Rolfing and, what s more, demonstrated to be an efficient tool for practitioners and students alike, regardless of cultural milieu. At the schools, clients perceptions concerning their quality of life before and after the Rolfing process were evaluated through the WHO-QOL questionnaire. The results were significant, and corroborated the indications of the NAPER results. The questionnaires also addressed the pre- and post-process intensity and frequency of reported pain; and indicated a significant decrease of both intensity and frequency of pain after the process. This was the case for both recent-onset and chronic pain, regardless of the location of the pain. The author posits that use of the questionnaires is, in and of itself, a mental reflexive activity an activity that makes salient the psychobiological dimension of Rolfing and it s value as a psychosomatic method. What s more, because the questionnaires further clinical, educational and research objectives simultaneously, their use highlights the relationship among those objectives. Based on his review of the evidence, the author sets forth a proposal for a revised questionnaire that comprises two levels, which could be explored independently or jointly. The first level consists of closed questions, which facilitates the collection of data for investigation. The second consists of open questions, which elicits reflection upon the psychobiological dimension of the work. Taken as a whole, this proposed questionnaire is an instrument of both research and teaching
Evidências empíricas apontam o valor do Método Rolfing de Integração Estrutural no Campo da psicologia. O trabalho de Ida P. Rolf é uma proposta holística, de organização da estrutura humana no campo gravitacional, pela reorganização do tecido miofascial, por toques especializados e educação pelo movimento. O objetivo deste trabalho é dar continuidade à investigação da natureza psicobiológica do método Rolfing e sua intersecção com o domínio da psicossomática. Estudou-se o alcance de questionários desenvolvidos em pesquisa-ação no NAPER (Núcleo de Atendimento, Pesquisa e Estudo em Rolfing, São Paulo, Brasil) e nas Escolas de Rolfing, no Brasil e nos Estados Unidos, onde o autor participou de um programa em que a elaboração, aplicação e avaliação dos questionários ocorriam simultaneamente. Os questionários foram usados nos processos de Rolfing de 874 clientes, sendo 714 do serviço de atendimento do NAPER e 160 clientes de classe das Escolas de Rolfing e, destes, 55, no Brasil e, 105, nos Estados Unidos. Foram avaliadas as respostas aos questionários das três amostras, isolada e comparativamente, tendo sido feita uma análise quantitativa das perguntas fechadas, utilizando-se o SPSS, e tendo aplicados testes estatísticos de acordo com o nível de mensuração das amostras. Realizou-se uma análise qualitativa das respostas às perguntas abertas em que se utilizou o SPAD.T, fazendo-se um levantamento das freqüências das palavras utilizadas nas respostas, agrupamentos das palavras por afinidade conceitual, além da busca e da análise do contexto em que foram utilizadas. Também foi feito o levantamento dos temas emergentes nas respostas e suas freqüências. Verificou-se que os questionários trouxeram dados que apresentam a dimensão psicobiológica do método Rolfing em todas as amostras, revelando-se eficientes no uso com profissionais formados, com alunos nas escolas e em diferentes culturas. Foram comparadas a localização, a intensidade e a periodicidade de dores relatadas, e notou-se tendência significativa para a diminuição da intensidade das dores antes e depois do processo, e diminuição na periodicidade tanto de dores recentes como crônicas em todas as localizações descritas. Nas Escolas, foi avaliada a percepção dos clientes quanto à sua Qualidade de Vida pelo WHOQOL-BREF, antes e depois do processo de Rolfing, com resultados significativos, corroborando os resultados apontados pelos questionários. O autor considera que o utilizar questionários representa atividade mental reflexiva, e que o emprego deles serve simultaneamente a propósitos de atendimento, de pesquisa e de educação, sendo o elo metodológico entre estas dimensões do trabalho, permitindo-se, assim, alavancar a percepção da dimensão psicobiológica do Rolfing e seu valor como metodologia em psicossomática. Foi feita uma revisão e uma proposta de uma bateria de questionários que possuem dois níveis: um, de perguntas fechadas e, outro, de perguntas abertas, que podem ser usados independentemente ou acoplados, e que atuam concomitantemente na investigação dos dados e eliciam a reflexão sobre a dimensão psicobiológica: um instrumento ao mesmo tempo de pesquisa e pedagógicos

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25

Gulati, Abha. "Critical molecular events in early skin carcinogenesis." Thesis, Queen Mary, University of London, 2010. http://qmro.qmul.ac.uk/xmlui/handle/123456789/516.

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Background: Cutaneous squamous cell carcinoma (SCC) is the second most common cancer to affect populations of European descent. It is potentially fatal and causes substantial morbidity. Up to 70% of SCC arise from clinically identifiable precancerous lesions, known as actinic keratoses (AK), permitting early diagnosis and intervention. Keratinocyte Intra-epidermal Neoplasia (KIN) are the histological representation of AK. Immunosuppressed organ transplant recipients have 60 – 200 fold higher rates of SCC that are characteristically multiple, aggressive, recurrent and have higher metastatic tendency. The molecular pathogenesis of SCC involves the accumulation of multiple genetic and epigenetic aberrations, but in spite of the magnitude of the problem, the cellular basis for SCC has received little scientific attention compared with other epithelial cancers. Methodology: Skin samples representing sequential keratinocyte carcinogenesis (from non sun-exposed, sun-exposed and AK/KIN skin) were collected from 53 individuals (31 immunosuppressed and 22 immunocompetent), 30 of whom underwent an additional biopsy after prospective treatment with one of three commercially available topical agents. Genome-wide single nucleotide polymorphism (SNP) profiling was performed on all samples and transcriptional profiling was performed on 7 series from each treatment group. Results: The mean number of SNP changes was 3.57 and 3.48 in NSE and SE skin, respectively, increasing to 6.93 in KIN. Several recurrent areas of loss or gain were identified in KIN, specifically deletion at 3p, 9p, 12q, 16q, 18q and X and amplification of 8q, 9p and 17p. Expression profiling identified 428 genes (false discovery rate 0.05) with altered expression in KIN skin compared to paired normal skin. Of these genes, 31% displayed concordant change with regions of copy number change. Several gene networks of interest were identified including F- and -actin, NFB, PPAR and TGF suggesting that they may be key pathways in KIN evolution. Several candidate genes in KIN skin continue to be dysregulated in SCC, some of which, such as ANG, S100A9, ACVR2A, FHL1 and SFN resolve after topical chemoprevention and others, WIF1, CCL27 and LEPR persist. Conclusions: This is the first systematic, in-depth, in vivo study of molecular events characterising KIN and provides a detailed profile of the critical events contributing to malignant progression in keratinocyte neoplasia and the molecular effects of widely used topical chemopreventive agents Together, these data provide clinically relevant insights into cutaneous squamous tumour biology and identify biomarkers with diagnostic, prognostic and therapeutic potential. Acknowledgements

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26

Holt, Jim. "Critical Commentary: Test Ulcers with Culture or PCR." Digital Commons @ East Tennessee State University, 2006. https://dc.etsu.edu/etsu-works/6488.

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27

Karlsson, Sofia, and Annelie Lindberg. "Mobiliseringsmetoder vid en intensivvårdsavdelning- En litteraturstudie." Thesis, Karlstads universitet, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-41186.

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28

Epstein, Jenny. "Acetylation : a critical factor in maintaining intestinal inflammation?" Thesis, Queen Mary, University of London, 2010. http://qmro.qmul.ac.uk/xmlui/handle/123456789/552.

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In inflammatory bowel disease (IBD), both chronic pro-inflammatory pathways and failure of anti-inflammatory (healing) mechanisms sustain disease. The two major anti-inflammatory gut cytokines are transforming growth factor (TGF)-β and interleukin (IL)-10. Acetylation of regulatory proteins may play a role in the activation of both pathways. In IBD there is excess production of pro-inflammatory cytokines such as IL-1β and under-expression of IL-10. Fibroblasts also over-produce matrix metalloproteinases (MMP), mediating tissue destruction. Curcumin, a component of the spice turmeric and a known inhibitor of acetylation, shows clinical benefit in IBD in early trials. Objectives: To assess the anti-inflammatory effects of curcumin in the gut of children and adults with IBD. Methods: Intestinal mucosal tissue biopsies, mononuclear cells and colonic myofibroblasts from children and adults with active IBD were cultured ex vivo with curcumin. p38 MAPK, NF-κB and MMP-3 were measured by immunoblotting. IL-1β, interferon (IFN)-γ and IL-10 were measured by enzyme-linked immunosorbent assay (ELISA). Results: We have shown favourable modulation of the cytokine profile by curcumin, with enhanced IL-10 expression and decreased IL-1β, and we have demonstrated reduced p38 MAPK activation in intestinal mucosal tissue. We have also shown dose-dependent suppression of MMP-3 expression in colonic myofibroblasts (CMF) with curcumin, by a mechanism which appears to be acetylation-dependent. Conclusion: Curcumin, a naturally occurring food substance with no known human toxicity, holds promise as a novel therapy in IBD.

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Pires, Rodrigo Otávio Moretti. "O pensamento crítico social de Paulo Freire sobre humanização e o contexto da formação do enfermeiro, do médico e do odontólogo." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/22/22131/tde-26032008-131633/.

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A partir do processo de implementação do Sistema Único de Saúde, diversos desafios foram emergindo de um contexto histórico, pautado na exclusão. Diversas estratégias foram utilizadas no sentido de superar os problemas e, entre estas, se destaca o Programa de Saúde da Família, cujos princípios se norteiam pela proximidade do usuário, centralidade na família, trabalho multiprofissional. No entanto, a questão da falta de formação e preparo dos profissionais se apresenta principalmente que se refere ao tratamento humanizado. Neste sentido, o estudo foi construído sob o universo conceitual originado dos trabalhos de Paulo Freire, em particular aos conceitos referentes e articulados a temática da humanização. O presente trabalho objetivou investigar em que medida o modelo pedagógico universitário tem influências na formação do enfermeiro, do médico e do odontólogo com relação à humanização, que no marco teórico freireano significa o bem tratar do paciente, mas também a inserção do profissional como ator social transformador. Para tanto, foram investigados os cursos de Enfermagem, Medicina e Odontologia de uma Universidade Federal da Região Norte do Brasil, pautando-se na perspectiva qualitativa. Como técnicas, foram realizados um encontro de grupo focal para cada curso, com seis acadêmicos do último período. Na etapa seguinte, realizou-se entrevista semiestruturada e individual, com os acadêmicos que participaram dos Grupos focais. Utilizou-se, ainda, da análise documental das matrizes curriculares dos cursos. Os resultados indicam que o ensino em Enfermagem, em Medicina e em Odontologia apresenta talhe tradicional, narrativo e depositário, conforme Freire, direcionamento que implica na vivência desumanizadora do acadêmico durante o curso universitário e que, segundo o referencial teórico, se refletirá na postura futura dos educandos. Os resultados sugerem a premente necessidade de reorientação dos modelos pedagógicos dos cursos estudados, com vistas a formação de enfermeiros, médicos e odontólogos com prática pautada no pensamento histórico-político e crítico reflexivo.
From the process of implementation of the Single Health System, several challenges were emerging from a historical context, guided the exclusion. Several strategies were used to overcome the problems and, among these, are the highlights of the Family Health Program, whose principles are guiding the proximity of the user, centrality in the family, multidisciplinary work. However, the issue of lack of training and preparation of professionals presents mainly regard to the treatment humanized. Therefore, the study was built under the conceptual universe originated the work of Paulo Freire, in particular relating to the concepts articulated in the subject of humanization. This study aimed to investigate the extent to which the pedagogical model university has influence in the training of nurse, doctor and dentist with respect to the humanization, which in the theoretical framework freireano means and treat the patient, but also the inclusion of professional and social actor processor. For both, were investigated the courses of Nursing, Medicine and Dentistry of a Federal University of the north of Brazil, in the qualitative perspective. As techniques were performed a meeting of focus group for each course, with six of the last academic period. In the next stage, held up a semi-structured and individual, with the scholars who participated in focus groups. It was used, in addition, the analysis of the documentary matrices curricula of the courses. The results indicate that education in Nursing, Medicine and Dentistry presents cut traditional, narrative and depositary, as Freire, targeting implies that the experience during the course of the academic university, which, according to the theoretical reference, if reflect on the future posture of the students. The results suggest the urgent need for reorientation of the teaching models of the courses studied, with a view to training for nurses, doctors and dentists with guided practice in the historical-political thinking and critical reflection.

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30

Jordaan, Beatrice. "The protection of indigenous medical knowledge a critical analysis /." Pretoria : [s.n.], 2006. http://upetd.up.ac.za/thesis/available/etd/etd-07132006-120602/.

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31

Reade, Michael Charles. "Characterisation and Novel Treatment of Several Causes of Mortality in Critical Illness." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/15997.

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Three critical care syndromes form the main foci of this thesis: sepsis; delirium; and severe trauma. Research methods used to investigate the pathogenesis and novel treatments of these syndromes include clinical trials, observational studies, and preclinical models. In several instances, a complete research programme is presented. For example: • in the investigation of delirium, in which observational studies and empirical assessments of clinical measurement tools led to a pilot study and then the definitive 15-hospital clinical trial (Dexmedetomidine to Lessen ICU Agitation: DahLIA) comparing dexmedetomidine to placebo as a treatment for this condition; and • in the assessment of a haemodynamic protocol-guided treatment algorithm for septic shock, in which practice surveys and reviews of trial methodologies preceded three harmonised international clinical trials subsequently subjected to definitive meta-analysis. Other research programmes that are still in progress are also presented. For example: • the Cryopreserved vs. Liquid Platelets (CLIP) trial; • a programme that has developed a novel preclinical model of acute traumatic coagulopathy, in parallel with clinical trials of resuscitation in trauma such as the 1400-patient Pre-hospital Anti-fibrinolytics for Traumatic Coagulopathy and Haemorrhage (PATCH) trial; and • a research programme testing a protocolised approach to sedation, including the 4000-patient definitive Sedation Practice in Intensive Care Evaluation (SPICE) trial. A substantial part of this thesis includes collaborative applications of trial and observational methodologies to other critical care topics, including advanced-care planning, nutrition, oxygen delivery, lactate concentration, anaemia, coagulopathy, and the effects of gender and race. Research methodology is constantly evolving, and contributions to this process are outlined along with examples of research translation into practice through both policy and education.

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32

Magri, Dania. "Diminished circulating monocytes after peripheral bypass surgery for critical limb ischemia." [New Haven, Conn. : s.n.], 2008. http://ymtdl.med.yale.edu/theses/available/etd-12092008-133251/.

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33

Gibbons, Patric. "Follow Your Heart: Evaluating Cardiac Function to Predict Outcomes Among ICU Patients with Traumatic Brain Injury." eScholarship@UMMS, 2018. https://escholarship.umassmed.edu/gsbs_diss/977.

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Introduction: Traumatic Brain Injury (TBI) remains a significant public health burden in the United States. Persons afflicted with more severe TBIs are usually admitted to an ICU, where they are at risk for a number of complications throughout their hospitalization. Recent literature has attempted to describe such complications from a cardiovascular perspective as part of a “cardio-cerebral syndrome.” We described the frequency of cardiac complications in the ICU among patients with a TBI and compared patients with and without measured cardiac dysfunction. We investigated the potential impact of cardiac dysfunction on in-hospital mortality. Methods: This was a retrospective review of a prospective cohort study in adult ICU patients with moderate-to-severe TBI (GCS≤12). We measured cardiac dysfunction using initial EKG echocardiography findings and peak serum troponin levels during hospitalization. Primary outcome was in-hospital mortality for patients with and without cardiac dysfunction using multivariable adjusted Cox Proportional Hazards Regression. Secondary outcomes examined the relationship between severity of brain injury and degree of cardiac dysfunction. Results: Ordinal logistic regression showed patients with more indicators of cardiac injury were significantly more likely to have greater brain injury as reflected by lower GCS scores (OR 0.76; 95%CI 0.58-0.99). There was a significantly increased multivariable adjusted risk of dying for each increase in measured cardiac injury (HR 2.41; 95% CI 1.29-4.53). Conclusions: Cardiac dysfunction was frequently observed in patients with TBI and we showed an association between increasing TBI severity and development of cardiac injury. Cardiovascular dysfunction was associated with an increased risk of in-hospital death. Adverse outcomes from TBI could potentially be mediated by cardiac injury, which could be used as a target for therapeutic intervention.

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34

Bowers, Candice Andrea. "Barriers to implementation of evidence-based practices in a critical care unit." Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1013612.

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Over the last three decades there has been a greater need for health care practitioners to base their decision on the best available in order to optimise quality and cost-effective patient care. Evidence-based practice necessitates guideline development, education and review in order to achieve improved patient outcomes. However, initiatives that endeavour to disseminate and implement evidence-based practice have faced barriers and opposition. Barriers that might hamper the implementation of evidence-based practice include characteristics of the evidence itself, personal, institutional or organizational factors. The research study explored and described the barriers to implementation of evidence-based practices in a critical care unit. Based on the data analysis, recommendations were made to enhance the implementation of evidence-based practices in the critical care unit. A quantitative, explorative, descriptive and contextual research design was used to operationalize the research objectives. The target population comprised professional nurses in the critical care unit. Non-probability sampling was used to obtain data by means of a structured self-administered questionnaire. Descriptive data analysis was applied, using a statistical programme and the aid of a statistician. The results are graphically displayed using bar graphs and tables. Recommendations for nursing practice, education and research were made. Ethical principles have been maintained throughout the study.

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Alabdali, Abdullah. "Interfacility critical care transfers in Saudi Arabia : measuring adverse events, mortality comparison and consensus on interventions in adult critical patients transferred by paramedics." Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/98788/.

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Introduction: paramedics conducting interfacility transfer of critically-ill patients is one of the existing models in interfacility transfer. The paramedic model is available in multiple countries, including the Kingdom of Saudi Arabia. Paramedics’ expanded scope of practice has allowed them to transport, monitor and intervene with complex patients. This PhD thesis is designed to evaluate the safety of the paramedic model in Saudi Arabia conducting interfacility transportation of critically-ill patients. Method: the PhD thesis is mixed methods. A systematic literature review was conducted to examine literature on the safety of paramedics in interfacility transfers. A retrospective chart review was conducted to examine the incidence, predictors and pattern of adverse events seen in interfacility transfers by paramedics in Saudi Arabia. Following this, a retrospective chart review of interfacility transfers by physicians to the same institution was conducted to compare in-hospital mortality and 30-days survival in both groups. Finally, an expert survey was conducted to examine the consensus of paramedics’ intervention to adverse events seen in interfacility critical care transfers. Results: the literature showed that the frequency of adverse events seen by paramedics in interfacility transfers ranges from 5.1% to 18%. The rate of adverse events in adult critical patients transferred by paramedics to a tertiary care facility in Saudi Arabia was 13.7%, in-hospital mortality was 30.4% and 30-days survival was 68.1%. There is no significant difference regarding in-hospital mortality or 30-days survival between the paramedic and physician models. The paramedics’ interventions in interfacility adult critically-ill patients were rated appropriate by the majority of the experts in 86.8% of cases; the probability of an intervention to be appropriate was 84.9%. Conclusion: paramedics with appropriate training and skill can safely transfer critical interfacility adult patients. The mortality outcomes in the paramedic model are comparable to the physician model.

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36

Wells, Laurence Gregory. "Master John Hall's little book of cures : a critical edition." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/88160/.

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This thesis presents a critical edition of John Hall’s casebook (composed around 1634-1635) and commentaries on aspects of it. My research involved close reading of Hall’s Latin, and its translation into English. In the process it became apparent that Hall had made considerable use of unattributed borrowings from Latin medical books, making up between thirty and forty per cent of his text. These were mostly identified by detailed word searches of on-line databases. This is a use of medical texts not previously noted, and makes a clear connexion between Latin medical texts and routine medical practice. The thesis is presented in four sections, plus introduction and conclusion. The first section, the Background, gives the history of Hall’s manuscript from its composition in 1634-35 to its acquisition by the British Library. It sets out the reasons for producing a new translation, the editorial principles and practice followed, and some medical themes running through Hall’s case reports. Section two contains the critical edition itself, with parallel Latin and English texts. Footnotes to the Latin text give the sources of all of Hall’s borrowings from and references to medical and other texts. The third section (Chapter 1) analyses the process and results of identifying Hall’s working library, of forty-three authors and sixty titles, from his borrowings. It puts his library in the early modern medical context in terms of its contents and categories of composition. I show that there were changes in the books Hall acquired over time, from those suitable for a student through to his later interests in chymical practice and the diagnosis of scurvy. Despite these changes, he continued to rely on old familiar texts for most of his remedies throughout his life. The fourth section (Chapter 2) examines Hall’s manuscript in the context of casebooks generally. It differs from the majority of casebooks, the differences being explained by its composition as the draft for a book to be published. It shows that a casebook can have an internal structure related to the chronologies of its composition and the cases it draws on. This thesis demonstrates the importance of Latin sources in at least one medical casebook of the early seventeenth century. I show that borrowings such as Hall’s were not unique even if rarer in other texts. The possibility of a Latin textual source should be considered for any Latin text in a casebook of that period.

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Deuchar, Graeme Alexander. "Development of pulmonary hypertension in left ventricular dysfunction : role of critical vasoactive factors." Thesis, University of Glasgow, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.250067.

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38

McPeake, Joanne. "The health and social consequences of alcohol related admission to critical care." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/6967/.

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Introduction: Alcohol related admissions to critical care are increasing. However, there is uncertainty about the impact of excessive alcohol use on the intensive care stay and recovery from critical illness. Aim: The aim of this study was to understand the impact of alcohol use disorders on the critically ill patient's journey. Settings & participants: The setting for this study was a 20 bed mixed ICU, in a large teaching hospital in Scotland. On admission patients were allocated to one of three alcohol groups: low risk; harmful/hazardous or alcohol dependency. Methods: This was a mixed methods study. An 18 month prospective observational cohort study was undertaken. In addition, 21 in depth, semi structured interviews were undertaken with patients with and without alcohol use disorders, three to seven months after discharge from critical care. Results: 580 ICU patients were screened for the presence of alcohol use disorders during the study period. 34.4% of patients were admitted with a background of alcohol misuse. ICU stay was significantly different between the three study groups, with those in the alcohol dependency group having a longer stay (p=0.01). After adjustment for all lifestyle factors which were significantly different between the groups, alcohol dependence was associated with more than a twofold increased odds of ICU mortality (OR 2.28; 95% CI 1.2-4.69, p=0.01). Four themes which impacted on recovery from ICU were identified in this patient group: psychological resilience; impact and support for activities of daily living; social support and cohesion; and the impact of alcohol use disorders on recovery. Conclusions: Alcohol related admissions account for a significant proportion of admissions to critical care and alcohol dependency is independently associated with ICU outcome. A more targeted rehabilitation pathway for all patients leaving critical care, with specific emphasis on alcohol misuse if appropriate, needs to be generated.

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39

Miles, Mary Alice, and n/a. "A critical analysis of the relationships between nursing, medicine and the government in New Zealand 1984-2001." University of Otago. Faculty of Education, 2006. http://adt.otago.ac.nz./public/adt-NZDU20061024.145605.

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This thesis concerns an investigation of the tripartite arrangements between the government, the nursing and the medical sectors in New Zealand over the period 1984 to 2001 with a particular focus on primary health care. The start point is the commencement of the health reforms instituted by the Fourth New Zealand Labour Government of 1984. The thesis falls within a framework of critical inquiry, specifically, the methodology of depth hermeneutics (Thompson, 1990), a development of critical theory. The effects of political and economic policies and the methodologies of neo-liberal market reform are examined together with the concept of collaboration as an ideological symbolic form, typical of enterprise culture. The limitations of economic models such as public choice theory, agency theory and managerialism are examined from the point of view of government strategies and their effects on the relationships between the nursing and medical professions. The influence of American health care policies and their partial introduction into primary health care in New Zealand is traversed in some detail, together with the experiences of health reform in several other countries. Post election 1999, the thesis considers the effect of change of political direction consequent upon the election of a Labour Coalition government and concludes that the removal of the neo-liberal ethic by Labour may terminate entrepreneurial opportunities in the nursing profession. The thesis considers the effects of a change to Third Way political direction on national health care policy and on the medical and nursing professions. The data is derived from various texts and transcripts of interviews with 12 health professionals and health commentators. The histories and current relationships between the nursing and medical professions are examined in relation to their claims to be scientific discourses and it is argued that the issue of lack of recognition as a scientific discourse is at the root of nursing�s perceived inferiority to medicine. This is further expanded in a discussion at the end of the thesis where the structure of the two professions is compared and critiqued. A conclusion is drawn that a potential for action exists to remedy the deficient structure of nursing. The thesis argues that this is the major issue which maintains nursing in the primary sector in a perceived position of inferiority to medicine. The thesis also concludes that the role of government in this triangular relationship is one of manipulation to bring about necessary fundamental change in the delivery of health services at the lowest possible cost without materially strengthening the autonomy of the nursing or the medical professions.

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40

Hall, Dana L. "Shifting the paradigm of trauma medicine to positively influence critical mortality rates following a mass casualty event." Thesis, Monterey, Calif. : Naval Postgraduate School, 2009. http://edocs.nps.edu/npspubs/scholarly/theses/2009/Jun/09Jun%5FHall%5FDana.pdf.

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Thesis (M.A. in Security Studies (Homeland Security and Defense))--Naval Postgraduate School, June 2009.
Thesis Advisor(s): Richter, Anke. "June 2009." Description based on title screen as viewed on July 13, 2009. Author(s) subject terms: Critical mortality, triage accuracy, definitive care, damage control, regional preparedness, standard of care, mass casualty event, trauma medicine, rationing, Spain, Israel, United Kingdom, Tactical Combat Casualty Care, TCCC. Includes bibliographical references (p. 73-78). Also available in print.

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41

Martin, Kristy Ann. "The effect of earplugs on perceived sleep quality of acute care patients." Thesis, Montana State University, 2008. http://etd.lib.montana.edu/etd/2008/martin/MartinK0508.pdf.

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The purpose of this study was to evaluate the use of earplugs to improve perceived sleep quality in hospitalized patients. Sleep disruption is a common problem for hospitalized patients and has been shown to lead to physical and emotional complications. A variety of factors such as pain, illness, stress, worry, noise, lights and patient care activities contribute to disturbed sleep. Studies on sound in hospitals have shown that levels exceed recommendations by the Environmental Protection Agency. Limited research has shown that earplugs are a cost-effective, nonpharmacologic intervention with clinical usefulness to improve sleep quality. The study design was a quasi-experimental pilot study using a pre-test and post-test with the participants serving as their own control. Participants were recruited from a telemetry unit at St. Vincent Healthcare in Billings, Montana. The Verran and Snyder-Halpern Sleep Scales were selected to measure sleep quality. Ten participants were able to complete the two nights of study. The proposed hypothesis was supported for the sleep characteristic, soundness of sleep, with an improvement greater than 15 mm on the night with the ear plugs. Subjective findings identified positive comments with only one participant unable to tolerate the earplugs. The improvement in sleep was clinically significant for these participants. Hospitals should consider creating a sleep promotion policy and re-evaluating their night care practices. Earplugs could be included as an option for patients, and patients experiencing sleep difficulties should be encouraged to try earplugs. Further research is needed with a variety of populations and a large sample size. Research should also be done on nurses\' knowledge and beliefs regarding sleep and sleep interventions. This information could provide useful information on areas where additional education is needed.

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Henderson, Alan. "Some ethical problems in adult intensive care : a physician's approach to ethical problems at the bedside /." [St. Lucia, Qld. : s.n.], 2002. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16635.pdf.

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43

Hunter, George Joseph Stephen. "Digital radiology : a critical appraisal of cardiovascular subtraction angiography and measurement of blood flow." Thesis, University College London (University of London), 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271161.

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44

Hodkinson, Peter William. "Developing a patient-centred care pathway for paediatric critical care in the Western Cape." Doctoral thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/17259.

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Includes bibliographical references
Background: Emergency care of critically ill or injured children requires prompt identification, high quality treatment and rapid referral. This study examines the critical care pathways in a health system to identify preventable care failures by evaluating the entire pathway to care, the quality of care at each step along the referral pathway, and the impact on patient outcomes. Methods: A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation until paediatric intensive care unit admission or emergency centre death, using a modified confidential enquiry process of expert panel review and caregiver interview. Outcomes were expert panel assessment of quality of care, avoidability of death or PICU admission and severity at PICU admission, identification of modifiable factors, adherence to consensus standards of care, as well as time delays and objective measures of severity and outcome. Results: The study enrolled 282 children: 85% medical and 15% trauma cases (252 emergency admissions, and 30 children who died at referring health facilities). Global quality of care was graded poor in 57(20%) of all cases and 141(50%) had at least one major impact modifiable factor. Key modifiable factors related to access and identification of the critically ill, assessment of severity, inadequate resuscitation, delays in decision making and referral, and access to paediatric intensive care. Standards compliance increased with increasing level of healthcare facility, as did caregiver satisfaction. Children presented primarily to primary health care (54%), largely after hours (65%), and were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 74% of children, indicating room for improvement. Conclusions and Relevance: The study presents a novel methodology, examining the quality of paediatric critical care across a health system in a middle income country. The findings highlight the complexity of the care pathway and focus attention on specific issues, many amenable to suggested interventions that could reduce mortality and morbidity, and optimize scarce critical care resources; as well as demonstrating the importance of continuity and quality of care throughout the referral pathway.

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Sharir, R. B. "A critical evaluation of biomechanical risk factors for ACL injuries during dynamic activities." Thesis, Liverpool John Moores University, 2018. http://researchonline.ljmu.ac.uk/8822/.

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For injury screening to effectively identify individuals with at-risk behaviours, risk factors should be identified and validated carefully through appropriate prospective study designs. In the context of injury prevention in sport, the main aim of screening is to draw a line between those who are at risk of getting injured and those who are not. In order to effectively screen for anterior cruciate ligament (ACL) injury risk, injury screening should not be based on a singular observation in a single task as it is unlikely to effectively identify those who are at risk with acceptable sensitivity and specificity. Observations of ACL injury could be evaluated through a more mechanism-informed risk factors as this may provide a better justification of an individual’s movement pattern. If an individual who is at risk would demonstrate a particular behaviour across different tasks, this collection of variables characterising an individuals’ at-risk behaviours across tasks could form an individual’s “movement signature”. This thesis therefore aimed to critically evaluate the biomechanical risk factors for non-contact ACL injury during dynamic sporting activities and to explore some novel approaches to characterising movement characteristics for screening. Through a systematic review, the first study in this thesis critically evaluated the current research trends on the in vivo biomechanical risk factors of the ACL injury in dynamic activities and identified a lack of high quality (level 1), prospective evidence. Only one prospective cohort study was identified; therefore, more prospective cohort studies are required as research since the time of this systematic review did not provide further prospective evidence. Study two sought to develop more prospective evidence but unfortunately no ACL injuries were observed therefore, no new biomechanical risk factors for ACL injury could be identified. Utilizing the data collected from the prospective cohort, study three led to the development of a novel approach of injury screening by verifying the existence of individual movement signatures. The task-invariant movement signatures were also able to identify at-risk movement behaviour. Further exploration of mechanism informed multi-planar variables in study four showed that task-invariant movement signatures also exist in multi-planar variables, and may better inform at-risk behaviours. This thesis has furthered the understanding of biomechanical risk factors and moved towards the development of more effective injury screening tools.

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Sim, Malcolm A. B. "The development and application of novel intelligent scoring systems in critical illness." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/6512/.

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Scoring systems in medicine are not a new concept. There are examples from the early 1950s, from around the same time as the polio epidemic in Copenhagen resulted in the birth of modern Intensive Care. Many scores have subsequently been developed specifically for Intensive Care patients. The majority summarise the overall physiological state of the patient in a variety of different ways. A clinical interest in ascertaining whether haemodialysis causes cardiovascular instability in Intensive Care patients led to an initial simple experiment examining stability using a small number of cardiovascular parameters. It became apparent that to answer the question properly a physiologically based score which could be calculated automatically in real time, and which took into account the level of physiological or pharmacological support the patient was receiving would have to be developed, to counter or to mitigate the drawbacks of the main scoring systems in common use at the time. This thesis describes the development and first stage in the validation of a novel physiologically based scoring system for Intensive Care patients which overcomes some of the major disadvantages of existing scores. The score was then used to investigate other clinical questions. Myocardial damage in Intensive Care is common and associated with a poor outcome. Aspects of the developed score were used to ascertain if it is possible to detect and predict myocardial damage occurring in Intensive Care patients based on physiological disturbance rather than a rise in biomarkers. The score was subsequently used to examine Intensive Care patient outcomes. The introductory chapter describes the history of Intensive Care, the mechanism of data collection for patients in Scottish Intensive Care Units and its analysis to enable comparison of different units. Reviewing currently available scoring systems places this work in context and highlights the need for a new score. An overview of renal replacement therapy modalities follows, as an interest in cardiovascular stability during haemodialysis led to the idea for a new scoring system. Myocardial damage in Intensive Care patients is common and indicative of poorer outcomes. This is reviewed, as the developed score was used to detect and then predict where myocardial damage was occurring in critically ill patients, based on physiological disturbance rather than on raised biomarkers. In Chapter 2, data from dialysis sessions in critically ill patients was collected, prc-processed, and analysed for cardiovascular instability. Using an arbitrary definition of instability as a 20% change in mean arterial pressure or heart rate in either direction, 65% of dialysis sessions were stable and 35% unstable. This simple experiment suggested that haemodialysis is less cardiovascularly destabilising than previously believed. However a major deficiency was the lack of consideration of the level of physiological support required during dialysis. To investigate this and other clinical problems better, it became apparent that a new score would have to be developed. Chapter 3 describes the development of a novel quantitative score which takes into account the amount of physiological and pharmacological support a patient is receiving. Physiological parameters were separated into those recorded regularly and those recorded intermittently. They were subsequently divided into ranges, scoring increasing points depending upon the degree of derangement. Ranges were based on an extensive literature search, currently available scores, and clinical opinion. Two key parameters viz. mean arterial pressure and oxygen saturation, were then weighted against a range of factors which can either increase or decrease their value. A score of instability could then be calculated by adding points for the weighted and unweighted parameters. After reflection using common clinical scenarios, some of the points scored in different ranges and weightings were revised to give the final quantitative score. In Chapter 4, the quantitative score was tested against data sets from actual Intensive Care patients to produce graphs of overall cardiovascular stability against time. Although this approach did capture improvements and deteriorations it had several disadvantages. It captured the expertise of a single clinician only, gave an arbitrary number which could be difficult to interpret, and the emphasis given by the clinician to the relative importance of different physiological or pharmacological parameters would not be obvious to others. Clinical reflection led to a new approach to the problem, viz. the development of the 5 point qualitative scale described in Chapter 5. Chapter 5 describes the development of a 5 point qualitative score for cardiovascular instability, underpinned by complex physiological rules, and capturing the expertise of several senior Intensive Care Clinicians. This is the Intensive Care Unit - Patient Scoring System (ICU-PSS). I scored data sets comprising thousands of predominantly hourly commonly recorded physiological and pharmacological parameters on a 5 point scale of cardiovascular stability (A to E). I also described rules in the form of different parameter ranges to indicate why I had scored time points as stable (A) through to unstable (E). These rules were incorporated into a computer programme which scored unseen data sets which I also then scored. The computer’s predicted A to E score based on these rules and my own score were compared in a confusion matrix. Mismatches with the computer prediction (based on my initial rules) were analysed and I either rescored the data if I considered that I had not assigned the correct level of instability, or modified the rule base. Through this process clinical expertise was better captured. This process was repeated with two other clinicians using my rules as a starting point. This led to further refinements of the rule base. The result was a sophisticated set of rules underpinning a 5 point, easily understandable scale of cardiovascular stability crystallising the expertise of 3 senior Intensive Care clinicians. The ICU-PSS was tested in a discrimination experiment to ascertain if clinicians could agree with the score moving in a one step and two step change. This is the first stage in full validation of the score In Chapter 6, the first stage in the validation of the ICU-PSS is described, using 10 clinicians from a city teaching and a district general hospital. It was hypothesised that if they were shown two consecutive hourly time points of physiological data from real patients and asked whether they were improving or deteriorating, they should agree with the ICU-PSS score in more than 50% of cases (random chance). In two discrimination experiments the consultants were, in random order, shown 4 examples of each type of two step improvement or deterioration in the score, e.g. A to C, and 4 examples of each type of one step change, e.g. E to D. In the two step experiment there was 92.9% agreement with the score, and in the one step change experiment, 90.9% agreement. Both were highly statistically significant. Chapter 7 describes the first of the applications of the validated score. Myocardial damage is common in Intensive Care patients and is an independent risk factor for both short and long term mortality. The mechanism in Intensive Care patients is likely to be the so-called type II damage caused by extremes of physiological derangement leading to a myocardial oxygen supply and demand imbalance. I hypothesised that it should be possible to use aspects of the score to confirm and subsequently predict where this damage is occurs based on physiological disturbance alone rather than on a rise in cardiac biomarkers.

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BARTZ, CLAUDIA CAROL. "NURSE-PATIENT COMMUNICATION DURING CRITICAL ILLNESS EVENTS." Diss., The University of Arizona, 1986. http://hdl.handle.net/10150/183833.

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The purpose of this study was to explore and describe nurse-patient communication during critical illness events. The theoretical structure of the study was drawn from communication, sociolinguistic, and nursing theory. Data were collected in a 374-bed private hospital in the Southwest. The sample consisted of six registered nurses and nine patients experiencing cardiac surgery. Nine observed and audiotaped nurse-patient interactions, and fourteen audiotaped partcipant interviews provided the data base for analysis. Content analysis was used to organize the data. Findings were presented in terms of language, paralanguage, and nonverbal expression, and in terms of content, process, and product of nurse-patient communication. Participants used biomedical-technical language and casual-everyday language during the interactions. Nurses talked about what patients would experience while patients talked about themselves as a way of establishing their credibility within the biomedical setting. Nurses viewed nurse-patient communication as variable depending on the patients' needs and responses. Patients viewed nurse-patient communication as straightforward, not requiring adjustment for the needs of the participants. Products of communication for patients involved increased knowledge, reassurance, and increased confidence. Products of communication for nurses involved relieving the patients' anxieties, considering the patients' remembering, and increasing the nursing staff's knowledge about the patient while helping the patient to know the goals of the nursing staff. The introduction and closure segments of the six nurse-patient interactions for preoperative preparation of the patient were analyzed. Nurses began the introductions by assuming that the patients needed relief from anxiety but the patients demonstrated politeness more than anxiety. Nurses used strategies of questioning, starting the physical assessment, topic persistence, and self-monitoring to control the closure segments. Patients used narratives and humor as control strategies. The study findings suggest conceptual areas relevant to nurse-patient communication which may ground theoretical model development for nurse-patient communication. Nurses in clinical settings can compare their patient communication experiences with the findings of the study in order to increase their understanding of expression, form, and function of nurse-patient communication.

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Cilliers, Liezel. "Critical success factors for user acceptance of telemedicine in South Africa." Thesis, University of Fort Hare, 2010. http://hdl.handle.net/10353/384.

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The World Health Organization has recommended Telemedicine to improve health care in developing countries. The objective of this study was to produce Critical Success Factors that will investigate and identify factors that influence the acceptance and continued use of Telemedicine in the Eastern Cape Department of Health, and to suggest ways to sustain this technology from initial adoption (the pilot programme) to full adoption. Sub questions investigated which other facilitating factors, such as management support or previous Information Technology exposure must be present in order for the technology to be adopted successfully. The study made use of a questionnaire to investigate the user acceptance and behaviour of health care workers. A return rate of 76% was achieved. The data was analysed making use of Statistical Package for the Social Sciences (SPSS), specifically the Chi Square test. From these results Critical Success Factors where then formulated to address the problems identified. The Critical Success Factors that were identified include: Implement and disseminate best practice within a legislative framework; Find a champion; Change management strategies; Training; Sustainable finance; Technical issues and Project management principles If these CSFs are addressed before and during the implementation of Telemedicine it will increase the acceptance and use of the technology among health care workers. Critical Success Factors for User Acceptance of Telemedicine in South Africa.

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Madelon, Myrlene. "Systematic Review of Sedation Management in the Pediatric Critical Care Unit." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4743.

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Nurse-driven guidelines existed for the management of sedation in adult population; however, there is a lack of guidelines for the critically ill children. Nurses play significant roles in the management of sedation for mechanically ventilated patients in the Pediatric Intensive Care Unit (PICU), nonetheless, comprehensive guidelines for the management of sedation does not exist. The purpose of this systematic literature review was to evaluate and synthesize evidence-based research that can be used to adapt a pediatric clinical guideline for sedation management. The ACE star model and the evidence-based practice model were used as a framework to guide this review. The practice question focused on investigating the available best practices that can be used to support the nursing management practice of sedated patients in the PICU. This is important because inadequate sedation management can lead to multiple adverse outcomes for patients. The design of this project was a systematic literature review method. The sources of the data were gathered from Medline, PubMed, CINAHL, Joanna Briggs institute and Google Scholar. This review included 17 studies, of which 84.2% showed improvement with positive patient outcomes such as decreased sedation use, decreased length of stay, and improved nursing practice. The results also support recommendations for evidence-based practice guidelines in the clinical nursing practice setting. In conclusion, despite the recommendation for the use of sedation guidelines, this systematic review found that there are few studies comprehensively evaluating the impact of nurse-driven sedation management in the PICU. The social implication of this review is that more studies involving pediatric patients utilizing nurse-driven sedation protocol is needed, before it can be adopted in the PICU.

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Summers, Ronald. "A methodology for the design, implementation and evaluation of intelligent systems with an application to critical care medicine." Thesis, City University London, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.332618.

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