Positive aspects and challenges associated with caring for a dying relative at home

Research has consistently shown that family caregivers have a variety of unmet needs, despite comprehensive professional support for caregivers being a central aim of palliative care. This sub-study of a larger randomized controlled trial sought feedback from 47 primary family caregivers of advanced cancer patients who had recently commenced home palliative care. During semi-structured interviews in their homes, family caregivers were asked to comment on the key challenges associated with their role and whether they could identify challenges. These were associated with their own ill health, family circumstances, insufficient skills to manage patient symptoms, limited time for themselves and inadequate support from health professionals. Despite these challenges, 60% of family caregivers were readily able to identify positive aspects of the role. Previous research has tended to focus on the negative impact of caregiving. The extent to which the positive aspects buffer the negative aspects of the role warrants further exploration, as does the long-term impact of the caregiver role on those who are unable to recognize positive elements.

Supporting delivery of the recovery package for people living with and beyond cancer

Survivorship is an important issue in cancer care in the UK. More people are being diagnosed with the disease and many more are living for longer after diagnosis. The National Cancer Survivorship Initiative recommends that patients with cancer have a package of care designed to improve outcomes and support for those living with and beyond the disease. The recovery package consists of a holistic needs assessment, treatment summary, cancer care review and health and wellbeing event. Although these interventions are recommended as a way to improve care, many people do not have access to the combined package, or even some of its components. The Cancer Nursing Partnership (CNP), a collaboration of cancer nursing organisations and communities of influence, has been established to support nurses with delivery of the recovery package in practice. This article describes the package and its components, introduces the CNP and outlines the work it has carried out to date.

Manufacturing at double the speed

The speed of manufacturing processes today depends on a trade-off between the physical processes of production, the wider system that allows these processes to operate and the co-ordination of a supply chain in the pursuit of meeting customer needs. Could the speed of this activity be doubled? This paper explores this hypothetical question, starting with examination of a diverse set of case studies spanning the activities of manufacturing. This reveals that the constraints on increasing manufacturing speed have some common themes, and several of these are examined in more detail, to identify absolute limits to performance. The physical processes of production are constrained by factors such as machine stiffness, actuator acceleration, heat transfer and the delivery of fluids, and for each of these, a simplified model is used to analyse the gap between current and limiting performance. The wider systems of production require the co-ordination of resources and push at the limits of human biophysical and cognitive limits. Evidence about these is explored and related to current practice. Out of this discussion, five promising innovations are explored to show examples of how manufacturing speed is increasing—with line arrays of point actuators, parallel tools, tailored application of precision, hybridisation and task taxonomies. The paper addresses a broad question which could be pursued by a wider community and in greater depth, but even this first examination suggests the possibility of unanticipated innovations in current manufacturing practices.

TCRIO: tecnologia de criatividade relacional inteligente on-line

No âmbito dos contextos de aprendizagem de projeto em Design, nas instituições de Ensino Superior, é cada vez mais frequente a utilização de plataformas de gestão das aprendizagens on-line (LMS) no suporte às atividades curriculares à distância. Contudo estes sistemas apesar de darem um precioso contributo através da gestão de conteúdos, das funcionalidades ligadas à avaliação dos alunos e da comunicação entre pares, respondem de forma ineficiente a outras necessidades específicas de alunos e professores no desenvolvimento de unidades curriculares de Design ligadas à aprendizagem de projeto. Este fato contribuiu para que recorrêssemos às tecnologias móveis e sociais na procura de uma solução que melhor se ajuste à aplicação das novas metodologias de e-learning adaptadas a este tipo de contextos. Partindo dessa constatação desenvolvemos e testámos um modelo tecnológico que julgamos introduzir vantagens bastante significativas na definição de novas metodologias de suporte on-line a contextos de aprendizagem personalizada (PLE) em disciplinas ligadas à aprendizagem colaborativa de projeto em Design. Através do levantamento de necessidades detetadas no terreno e da análise da oferta tecnológica existente, reunimos um conjunto de requisitos que nos permitiu desenvolver o protótipo de um sistema tecnológico que fundamenta a totalidade do modelo teórico que propomos em resposta aos pressupostos equacionados no início deste relatório.

Avaliação para as aprendizagens de alunos com necessidades educativas especiais no 1º ciclo de ensino básico : da diversidade da avaliação à avaliação da diversidade

Tese de doutoramento, Educação (Avaliação em Educação), Universidade de Lisboa, Instituto de Educação, 2014

Identification of Predictive Factors of BMI and High Risk Hypertension in Rural Nicaraguan Community

Thesis (Master's)--University of Washington, 2013

Desenvolvimento de software com integração contínua

A integração contínua é uma prática no desenvolvimento de software que já existe há algum tempo mas ainda não é muito conhecida nem usada. Esta prática no desenvolvimento de software surgiu com a programação extrema e tem evoluído ao longo dos últimos anos, adaptando-se às novas tecnologias. O estudo aqui apresentado pretende essencialmente mostrar a real importância e o valor acrescido que a integração contínua pode trazer a um projeto de desenvolvimento de software. O trabalho aqui exposto surge no âmbito de um projeto interno, realizado pelo autor na empresa Konkconsulting, cuja finalidade se prende com o conhecimento mais aprofundado da integração contínua e com o levantamento das necessidades e criação de soluções, de modo a conseguir a sua utilização nos produtos que irão ser desenvolvidos pela empresa. Nesta dissertação, é proposto um conjunto de ferramentas para responder às necessidades imediatas da empresa na implementação de integração contínua num dos seus projetos. Estas ferramentas devem ser de simples e de fácil utilização, de modo a ajudar os programadores durante os desenvolvimentos e responder às necessidades da utilização da integração contínua em um projeto a ser desenvolvido pela empresa, mas ao mesmo tempo, podendo ser facilmente incorporadas em futuros projetos.

Necessidades em cuidados paliativos do doente pós-AVC

Relatório de Prática Clínica apresentado à Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Cuidados Paliativos, realizada sob a orientação científica do Professora Doutora Ana Paula Gonçalves Antunes Sapeta, do Instituto Politécnico de Castelo Branco.

Avaliação de necessidades das pessoas idosas em Medicina Geral e Familiar: um estudo de exequibilidade

RESUMO: Os médicos de família devem participar na detecção precoce dos factores de risco que favorecem o declínio funcional nas pessoas idosas. A avaliação estruturada das suas necessidades poderá contribuir para identificar os problemas de saúde que traduzam deterioração funcional. O objectivo deste trabalho foi avaliar a exequibilidade da implementação de um processo de avaliação de necessidades de cuidados em saúde das pessoas idosas na consulta de MGF.Seleccionou-se uma amostra não aleatória de pacientes com 65 ou mais anos de idade, na consulta médica de uma Unidade de Saúde Familiar da região de Lisboa. A avaliação de necessidades foi realizada, pelos médicos, com cinco itens da entrevista Camberwell Assessment of Need for the Elderly (CANE-5). Avaliou-se a percepção dos médicos e dos pacientes sobre este processo de avaliação de necessidades mediante um questionário escrito e entrevistas individuais, respectivamente. Identificaram-se necessidades em 38 (75%) dos 51 pacientes avaliados. Do total das 83 necessidades identificadas, 17 não estavam cobertas. O sofrimento psicológico foi a necessidade não coberta mais frequente. A comparação das avaliações do médico com as do paciente mostrou concordância razoável ou boa nas cinco áreas avaliadas. Esta avaliação foi bem aceite e considerada útil na perspectiva dos médicos e dos pacientes. A principal dificuldade identificada pelos médicos foi o tempo despendido na avaliação face à duração da consulta. Este estudo aponta para a exequibilidade da utilização da entrevista CANE-5 na prática clínica de MGF. No entanto, será importante alargar este estudo a amostras de maior dimensão e avaliar a utilidade da entrevista em intervenções sobre a funcionalidade dos pacientes idosos.----------ABSTRACT: General practitioners (GP) should participate in the early detection of risk factors for fuctional disability in elderly people. Structured needs assessments may contribute to a better identification of health problems that are linked to functional decline. The aim of this study was to assess the feasibility of a structured assessment of needs in the elderly, in the context of opportunistic screening in primary care. A convenience sample was selected of patients aged 65 years and over with scheduled appointments in one general practice in the Lisbon region. The assessment of needs was done by their GPs, using five items of the Camberwell Assessment of Need for the Elderly (CANE-5). Perceptions of GPs and patients about this process of needs assessment were ev+aluated by means of a written questionnaire and individual interviews, respectively. Needs were identified in 38 (75%) of 51 patients. Seventeen unmet needs were identified, out of a total number of 83 needs. Psychological distress was the most frequent unmet need. GP’s and patients’ assessments showed moderate or good agreement in all five areas. This needs’ assessment process was well accepted and considered useful by both GPs and patients. The main difficulty, according to the views of GPs, was the time consumed in this process, given the length of consultation. This study suggests the feasibility of using the CANE-5 interview in clinical practice in primary care settings. However it is important to replicate this study in larger samples and to evaluate the usefulness of the interview regarding interventions related to functionality in elderly patients.

Business concept design of an innovative product: Partnership between Nmusic and Rovio Entertainment Ltd.

Field Lab in Entrepreneurial Innovative Ventures

How to design and develop There App: A mobile app focused on live video streaming, promoting new social interactions

This work project aims to demonstrate how to design and develop an innovative concept of video streaming app. The project combines technology push and market pull theories into developing a product that is more suitable for the customer needs, with the particularity that there is no other way of seeing any place in the world, live and ondemand. An analysis on the bigger influencers in terms of design-thinking and new product development, as Tim Brown or Paul Trott, lead to a better understanding on how There App should evolve, keeping in mind the customer desires and technical features.

Intervention précoce dans la phase initiale des troubles psychotiques à Lausanne: quels problèmes et quelles solutions [Early intervention for the initial phase of psychotic disorders in Lausanne: what problems and what solutions?]

Schizophrenia has long been considered with pessimism, but the recent interest in the early phase of psychotic disorders has modified this often unjustified perception. Literature has demonstrated the benefit of the development of programs specialised in the treatment of early psychosis, which tend to be developed in many countries. It is however important to match them to local needs as well as to the structure of local health services. This paper reviews elements that justify such a development in Lausanne, Switzerland, and describe its various elements.

Parents living with HIV in a high-income country: do patients need specific support?

The number of HIV-infected persons with children and caregiving duties is likely to increase. From this statement, the present study was designed to establish how HIV infected caregivers organise their parenting routines and to determine their support needs. A further aim was to ascertain caregivers' perception of conspicuous behaviours displayed by their children. Finally, it sought to determine the extent to which the caregivers' assessment of their parenting activity is influenced by the required support and their children's perceived conspicuous behaviours. The study design was observational and cross-sectional. Sampling was based on the 7 HIV Outpatient Clinics associated with the national population-based Swiss HIV Cohort Study. It focused on persons living with HIV who are responsible for raising children below the age of 18. A total of 520 caregivers were approached and 261 participated. An anonymous, standardised, self-administered questionnaire was used for data collection. The data were analysed using descriptive statistical procedures and backward elimination multiple regression analysis. The 261 respondents cared for 406 children and adolescents under 18 years of age; the median age was 10 years. The caregivers' material resources were low. 70% had a net family income in a range below the median of Swiss net family income and 30% were dependent on welfare assistance. 73% were undergoing treatment with 86% reporting no physical impairments. The proportion of single caregivers was 34%. 92% of the children were living with their HIV infected caregivers. 80% of the children attended an institution such as a school or kindergarten during the day. 89% of the caregivers had access to social networks providing support. Nevertheless, caregivers required additional support in performing their parenting duties and indicated a need for assistance on the material level, in connection with legal problems and with participation in the labour market. 46% of the caregivers had observed one or more conspicuous behaviours displayed by their children, which indicates a challenging situation. However, most of these caregivers assessed their parenting activity very favourably. Backward elimination multiple regression analysis indicated that a smaller number of support needs, younger age of the eldest child and fewer physical impairments on the part of the caregiver enhance the caregivers' assessment of their parenting activity. Physicians should speak to caregivers living with HIV about their parenting responsibilities and provide the necessary scope for this subject in their consultation sessions. Physicians are in a position to draw their patients' attention to the services available to them.

Integrating Children with Emotional and Behavioural Disabilities into Community Recreation Programs: A Handbook for Staff

This study examined the process of integrating children with Emotional Behavioural Disorders (EBDs) with their peers into recreation programs. The purpose was to develop a set of recommendations for the development of a handbook to help workers in recreation with the integration process. To this end, a needs assessment was conducted with experienced recreation workers in the form of semistructured interviews. Participants were recruited from two community centers in a large southern Ontario city. Themes were drawn from the analysis of the interview transcripts and combined with findings from the research literature. The results were a set of recommendations on the content and format of a handbook for integrating children with EBDs into recreation programs.

Anxiety in the Primary Classroom: A Handbook for Elementary Educators

This project presents a literature review of pediatric anxiety including the prevalence, etiology, and treatment of anxiety disorders in children, presented along with evidence indicating the short- and long-term effects of anxiety in young children, and the important role of the school in first response regarding the early identification and intervention for these children. A needs assessment was conducted using primary elementary school teachers to identify their level of confidence in their ability to identify and support children suffering with anxiety disorders in their classrooms. Results of the assessment indicated a strong need for a resource that provides both information and support for teachers in their interactions with children with anxiety disorders. The assessment results were used to guide the development of a handbook for elementary educators providing current empirical research detailing information about various forms of anxiety disorders commonly affecting young children in primary grades, as well as a list of available resources, and a series of six sequential lesson plans to be implemented for the entire class. Lesson plans are designed to facilitate increased levels of understanding toward the issues confronted by children suffering from anxiety, and fostering strong peer relations and character-building opportunities. Participants were provided with the handbook for evaluation, which indicated a strong support for the effectiveness and usefulness of the resource.