Hemoglobina fetal mutante : um caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Difference-based meta-analytic procedures for between-participant and/or within-participant designs : a tutorial review for sports and exercise scientists

The aim of this paper is to provide a contemporary summary of statistical and non-statistical meta-analytic procedures that have relevance to the type of experimental designs often used by sport scientists when examining differences/change in dependent measure(s) as a result of one or more independent manipulation(s). Using worked examples from studies on observational learning in the motor behaviour literature, we adopt a random effects model and give a detailed explanation of the statistical procedures for the three types of raw score difference-based analyses applicable to between-participant, within-participant, and mixed-participant designs. Major merits and concerns associated with these quantitative procedures are identified and agreed methods are reported for minimizing biased outcomes, such as those for dealing with multiple dependent measures from single studies, design variation across studies, different metrics (i.e. raw scores and difference scores), and variations in sample size. To complement the worked examples, we summarize the general considerations required when conducting and reporting a meta-analysis, including how to deal with publication bias, what information to present regarding the primary studies, and approaches for dealing with outliers. By bringing together these statistical and non-statistical meta-analytic procedures, we provide the tools required to clarify understanding of key concepts and principles.

Effectiveness of current treatment approaches for benzodiazepine discontinuation : a meta-analysis.

Aims: To assess the effectiveness of current treatment approaches to assist benzodiazepine discontinuation. Methods: A systematic review of approaches to benzodiazepine discontinuation in general practice and out-patient settings was undertaken. Routine care was compared with three treatment approaches: brief interventions, gradual dose reduction (GDR) and psychological interventions. GDR was compared with GDR plus psychological interventions or substitutive pharmacotherapies. Results: Inclusion criteria were met by 24 studies, and a further eight were identified by future search. GDR [odds ratio (OR) = 5.96, confidence interval (CI) = 2.08–17.11] and brief interventions (OR = 4.37, CI = 2.28–8.40) provided superior cessation rates at post-treatment to routine care. Psychological treatment plus GDR were superior to both routine care (OR = 3.38, CI = 1.86–6.12) and GDR alone (OR = 1.82, CI = 1.25–2.67). However, substitutive pharmacotherapies did not add to the impact of GDR (OR = 1.30, CI = 0.97– 1.73), and abrupt substitution of benzodiazepines by other pharmacotherapy was less effective than GDR alone (OR = 0.30, CI = 0.14–0.64). Few studies on any technique had significantly greater benzodiazepine discontinuation than controls at follow-up. Conclusions: Providing an intervention is more effective than routine care. Psychological interventions may improve discontinuation above GDR alone. While some substitutive pharmacotherapies may have promise, current evidence is insufficient to support their use.

Indigenous men's support groups and social and emotional wellbeing : a meta-synthesis of the evidence

Indigenous men’s support groups are designed to empower men to take greater control and responsibility for their health and wellbeing. They provide health education sessions, counselling, men’s health clinics, diversionary programs for men facing criminal charges, cultural activities, drug- and alcohol-free social events, and advocacy for resources. Despite there being ~100 such groups across Australia, there is a dearth of literature on their strategies and outcomes. This paper is based on participatory action research involving two north Queensland groups which were the subject of a series of five ‘phased’ evaluative reports between 2002 and 2007. By applying ‘meta-ethnography’ to the five studies, we identified four themes which provide new interpretations of the data. Self-reported benefits included improved social and emotional wellbeing, modest lifestyle modifications and willingness to change current notions of ‘gendered’ roles within the home, such as sharing housework. Our qualitative research to date suggests that through promoting empowerment, wellbeing and social cohesion for men and their families, men’s support groups may be saving costs through reduced expenditure on health care, welfare, and criminal justice costs, and higher earnings. Future research needs to demonstrate this empirically.

A meta-study of SAP financials in the Queensland Government

This thesis consists of three related studies: an ERP Major Issues Study; an Historical Study of the Queensland Government Financial Management System; and a Meta-Study that integrates these and other related studies conducted under the umbrella of the Cooperative ERP Lifecycle Knowledge Management research program. This research provides a comprehensive view of ERP lifecycle issues encountered in SAP R/3 projects across the Queensland Government. This study follows a preliminary ERP issues study (Chang, 2002) conducted in five Queensland Government agencies. The Major Issues Study aims to achieve the following: (1) identify / explicate major issues in relation to the ES life-cycle in the public sector; (2) rank the importance of these issues; and, (3) highlight areas of consensus and dissent among stakeholder groups. To provide a rich context for this study, this thesis includes an historical recount of the Queensland Government Financial Management System (QGFMS). This recount tells of its inception as a centralised system; the selection of SAP and subsequent decentralisation; and, its eventual recentralisation under the Shared Services Initiative and CorpTech. This historical recount gives an insight into the conditions that affected the selection and ongoing management and support of QGFMS. This research forms part of a program entitled Cooperative ERP Lifecycle Knowledge Management. This thesis provides a concluding report for this research program by summarising related studies conducted in the Queensland Government SAP context: Chan (2003); Vayo et al (2002); Ng (2003); Timbrell et al (2001); Timbrell et al (2002); Chang (2002); Putra (1998); and, Niehus et al (1998). A study of Oracle in the United Arab Emirates by Dhaheri (2002) is also included. The thesis then integrates the findings from these studies in an overarching Meta-Study. The Meta-Study discusses key themes across all of these studies, creating an holistic report for the research program. Themes discussed in the meta-study include common issues found across the related studies; knowledge dynamics of the ERP lifecycle; ERP maintenance and support; and, the relationship between the key players in the ERP lifecycle.