Challenges to patient-centred care in a general internal medicine context: findings from an exploratory study

Introduction. If we are to promote more patient-centred approaches in care delivery, we have to better characterize the situations in which being patient-centred is difficult to achieve. Data from professionals in health and social care are important because they are the people charged with operationalizing patient-centred care (PCC) in their daily practice. However, empirical accounts from frontline care providers are still lacking, and it is important to gather experiences not only from doctors but also from the other care providers. Indeed, experiences from different professions can help inform our understanding of patient care, which is expected to be both patient-centred and collaborative. Methods. This study was based on the following research question: What factors make the provision of PCC difficult to achieve? Sample and setting. A purposeful sampling technique was used, allowing for a series of choices about the participants and their professional affiliation. Because patient-centredness is the focus, 3 professions appeared to be of special interest: general internists, nurses and social workers. The study was undertaken in the General Internal Medicine Division of a teaching hospital located in a North American context. Data Collection. To answer the research question, a methodological approach based on a theory called phenomenology was chosen. Accordingly, semi-structured interviews were used since they generate understanding of the meanings different individuals have of their lived world. Interviews with 8 physicians, 10 nurses and 10 social workers were eventually conducted. Data analysis. An inductive thematic analysis was employed to make sense of the interview data. Results. The thematic analysis allowed identifying various types of challenges to PCC. Although most of the challenges were perceived by all three groups of professionals, they were perceived to a different degree across the professions, which likely reflected the scope of practice of each profession. The challenges and their distribution across the professions are illustrated in Table 1. Examples of challenges are provided in Table 2. Discussion. There is a tension between what is supposed to be done - what stands in the philosophy of patient -centredness - and what is currently done - the real life with all the challenges to PCC. According to some participants' accounts, PCC clearly risks becoming a mere illusion for health care professionals on which too great pressures are imposed.

Complete internal audit of a mammography service in a reference institution for breast imaging

Objective Undertaking of a complete audit of the service of mammography, as recommended by BI-RADS®, in a private reference institution for breast cancer diagnosis in the city of São Paulo, SP, Brazil, and comparison of results with those recommended by the literature. Materials and Methods Retrospective, analytical and cross-sectional study including 8,000 patients submitted to mammography in the period between April 2010 and March 2011, whose results were subjected to an internal audit. The patients were followed-up until December 2012. Results The radiological classification of 7,249 screening mammograms, according to BI-RADS, was the following: category 0 (1.43%), 1 (7.82%), 2 (80.76%), 3 (8.35%), 4 (1.46%), 5 (0.15%) and 6 (0.03%). The breast cancer detection ratio was 4.8 cases per 1,000 mammograms. Ductal carcinoma in situ was found in 22.8% of cases. Positive predictive values for categories 3, 4 and 5 were 1.3%, 41.3% and 100%, respectively. In the present study, the sensitivity of the method was 97.1% and specificity, 97.4%. Conclusion The complete internal audit of a service of mammography is essential to evaluate the quality of such service, which reflects on an early breast cancer detection and reduction of mortality rates.

The internal wave field in Sau reservoir : Observation and modeling of a third vertical mode

Water withdrawal from Mediterranean reservoirs in summer is usually very high. Because of this, stratification is often continuous and far from the typical two-layered structure, favoring the excitation of higher vertical modes. The analysis of wind, temperature, and current data from Sau reservoir (Spain) shows that the third vertical mode of the internal seiche (baroclinic mode) dominated the internal wave field at the beginning of September 2003. We used a continuous stratification two-dimensional model to calculate the period and velocity distribution of the various modes of the internal seiche, and we calculated that the period of the third vertical mode is ;24 h, which coincides with the period of the dominating winds. As a result of the resonance between the third mode and the wind, the other oscillation modes were not excited during this period

The seasonal evolution of high vertical–mode internal waves in a deep reservoir

The causal mechanism and seasonal evolution of the internal wave field in a deep, warm, monomictic reservoirare examined through the analysis of field observations and numerical techniques. The study period extends fromthe onset of thermal stratification in the spring until midsummer in 2005. During this time, wind forcing wasperiodic, with a period of 24 h (typical of land–sea breezes), and the thermal structure in the lake wascharacterized by the presence of a shallow surface layer overlying a thick metalimnion, typical of small to mediumsized reservoirs with deep outtakes. Basin-scale internal seiches of high vertical mode (ranging from mode V3 toV5) were observed in the metalimnion. The structure of the dominant modes of oscillation changed asstratification evolved on seasonal timescales, but in all cases, their periods were close to that of the local windforcing (i.e., 24 h), suggesting a resonant response. Nonresonant oscillatory modes of type V1 and V2 becamedominant after large frontal events, which disrupted the diurnal periodicity of the wind forcing

The synthesis of 1,2,3,6,6a,7-hexahydro-7-methyl-5-imino-1H-pyrrolo[1,2-c]imidazolo[5,4-b]indole

N-3-(1-Methylindol-3-yl)propan-N-(2,2,2-trichloroethoxysulfonyl)guanidine was synthesized from 3-formyl-1-methylindole in six steps and subjected to conditions intended to convert the side-chain into a 2-iminotetrahydropyrimidine- containing product, of relevance to a possible synthesis of the aplicyanins. An alternative reaction course was observed, resulting in the formation of a new tetracyclic system.

The synthesis of 1,2,3,6,6a,7-hexahydro-7-methyl-5-imino-1H-pyrrolo[1,2-c]imidazolo[5,4-b]indole

N-3-(1-Methylindol-3-yl)propan-N-(2,2,2-trichloroethoxysulfonyl)guanidine was synthesized from 3-formyl-1-methylindole in six steps and subjected to conditions intended to convert the side-chain into a 2-iminotetrahydropyrimidine- containing product, of relevance to a possible synthesis of the aplicyanins. An alternative reaction course was observed, resulting in the formation of a new tetracyclic system.

Developing A Knowledge Management Process Model for Internal IT Organization, Case: Stora Enso Oyj, Corporate IT

The objectives of this Master’s Thesis were to find out what kind of knowledge management strategy would fit best an IT organization that uses ITIL (Information Technology Infrastructure Library) framework for IT Service Management and to create a knowledge management process model to support chosen strategy. The empirical material for this research was collected through qualitative semi-structured interviews of a case organization Stora Enso Corporate IT. The results of the qualitative interviews indicate that codification knowledge management strategy would fit best for the case organization. The knowledge management process model was created based on earlier studies and a literature of knowledge management. The model was evaluated in the interview research and the results showed that the created process model is realistic, useful, and it responds to a real life phenomenon.

Ácidos ciclopentênicos do óleo da sapucainha (Carpotroche brasiliensis Endl, Flacourtiaceae): o primeiro antileprótico usado no Brasil

The chaoolmugra oil is one of the oldest medicines used for leprosy until the development of sulfas. In Brazil, it is known as sapucainha oil that is obtained from Carpotroche brasilienesis seeds (Flacourtiaceae). Chemical and medicinal studies of sapucainha oil were introduced in Brazil by Peckolt, Cole and Cardoso which showed that major ciclopentenyl fatty acids as chaulmoogric, hydnocarpic and gorlic were responsible for its bactericidal activity. In this work, a method for quantification of sapucainha oil acidic fraction by HRGC was established using methyl n-heptadecanoate as internal standard. The oil chemical stability was investigated by the use of GC-MS, IR, ¹H and 13C NMR and showed that the main degradation products belong to the cyclopentenyl moiety oxidation.

El juego y su estructura interna en relación con el trabajo de la condición física en primaria = Games and their internal structure in relation to the work of physical condition in Primary Education

One of the methodological resources that teachers use in a generalised way in Physical Education classes is the game. Inthis article we define the concept of game and analyse the characteristics of their internal structure. On the other hand welook at the concepts of physical condition and conditional skills and describe the objectives of its work in Primary Education.Finally, we relate these concepts and propose two practical examples of modifying the internal structure of the game so asto produce variations in the implied conditional skills

Preparation and characterization oF Ru-Sn/Al2O3 catalysts for the hydrogenation of fatty acid methyl esters

Ru-Sn/Al2O3 catalysts with different Sn loadings were prepared by the coimpregnation method. Several characterization techniques such as TPR, pyridine TPD and catalytic tests for dehydrogenation and hydrogenolysis were used to evaluate and compare such catalysts. TPR results indicate that Sn is deposited both onto the support and as species strongly interacting with Ru. Such non selective deposition modifies the acid and metallic functions of the catalysts. Both total acidity and acid strength distribution are affected: total acidity decreases and new sites of lower acid strength are created. Both dehydrogenating and hydrogenolytic activities are strongly diminished by the addition of Sn. Results of catalytic tests for methyl oleate hydrogenation indicate that methyl stearate is the main product, with only minute amounts of oleyl alcohol produced, and that the addition of Sn diminishes the hydrogenation activity.

Determinação do teor de ésteres graxos em biodiesel metílico de soja por cromatografia gasosa utilizando oleato de etila como padrão interno

A method for ester content determination in soybean methyl biodiesel was studied, using ethyl oleate as internal standard. A biodiesel sample was analyzed and had its purity estimated as 92.8%. Method accuracy was evaluated by comparison with the result obtained via EN14103, with a relative difference of 0.1%. Repetitivity and intermediate precision were estimated as 2 and 1.5%, respectively.

Internal standard versus external standard calibration: an uncertainty case study of a liquid chromatography analysis

Traditionally, in the cigarettes industry, the determination of ammonium ion in the mainstream smoke is performed by ion chromatography. This work studies this determination and compares the results of this technique with the use of external and internal standard calibration. A reference cigarette sample presented measurement uncertainty of 2.0 μg/cigarette and 1.5 μg/cigarette, with external and internal standard, respectively. It is observed that the greatest source of uncertainty is the bias correction factor and that it is even more significant when using external standard, confirming thus the importance of internal standardization for this correction.

Poly(ethylene-co-methyl acrylate)/poly(caprolactone) triol blends for drug delivery systems: characterization and drug release

Poly(ethylene-co-methyl acrylate) (EMA) and poly (caprolactone) triol (PCL-T) blends, a biodegradable aliphatic polyester with low molecular weight and moderate water solubility containing diltiazem hydrochloride (DZ) were studied in terms of the thermal and morphological properties, and drug release mechanism. An increase in the PCL-T content in the EMA/PCL-T/DZ films decreased the degree of DZ crystallinity. Drug release from these films is temperature-dependent, and it is possible to modify the drug release rate by adjusting the EMA/PCL-T composition of the blends. The mechanism of drug release is governed by PCL-T melting and PCL-T leaching from EMA matrix.