A qualidade de vida relacionada à saúde tem aparecido, com frequência, entre as metas dos estudos clínicos destinados ao desenvolvimento de novos tratamentos para a hipertensão arterial pulmonar (HAP). Embora os novos tratamentos melhorem o desempenho ao exercício na fase inicial de 12 - 16 semanas, não se sabe se existe associação entre tolerância ao exercício e qualidade de vida (QV), sobretudo em médio e longo prazo. Os objetivos do estudo foram: a) verificar, em pacientes com HAP, a existência ou não de correlação entre a QV e desempenho físico; b) verificar como as possíveis associações entre QV e desempenho ao exercício se comporta ao longo de um ano de observação sob tratamento medicamentoso específico; c) verificar se a aplicação de um protocolo de orientação de enfermagem, especificamente planejado para pacientes com HAP, poderia exercer impacto sobre a QV e o desempenho físico. Foram incluídos 34 pacientes no estudo, adolescentes ou adultos com o diagnóstico de HAP idiopática, hereditária ou associada a cardiopatias congênitas. Para o comprimento do terceiro objetivo, os pacientes foram organizados em pares, seguindo-se randomização para o tipo de seguimento a que seriam submetidos: apenas orientação médica ou orientação médica seguida de consulta de enfermagem. O acompanhamento constou de cinco visitas...
Tese de doutoramento em Medicina (área de
especialização em Medicina); Asthma is a common condition in general practice but is frequently under-diagnosed. There is
wide variation in the reported incidence and prevalence rates of asthma but these rates are
believed to be increasing. Research on the magnitude of this problem has met with
methodological obstacles because it has been difficult to define and diagnose asthma in
There is evidence that the control of asthma involving self-assessment by patients and a stronger
doctor-patient relationship can improve compliance to therapeutic plans and lead to better
outcomes for patients. Evidence is lacking on the influence of the level of patient empowerment
on the quality of life and level of control of asthma. The objectives of the three studies in the
present thesis were to assess how physicians in a sentinel practice network perform using
standardized diagnostic criteria, to estimate the true prevalence of asthma by gender and age
groups in the population of the area covered by one urban Health Centre in Portugal, to assess
the severity of asthma, medication use, asthma control, the level of patient enablement and the
quality of life in a population of asthmatic patients treated in primary care...
This thesis contributes to our understanding of the moral dimensions of using self-management technologies in general practice. Through qualitative interviews with general practitioners (GPs) and patients with experience in home blood pressure monitoring (HBPM) utilization, it examines the influences of HBPM on the general practitioner-patient relationship, patient responsibility for their health and patient autonomy. The first part of this thesis provides an account of the ethical implications of self-management technologies and their related practices for the doctor-patient relationship (DPR), patients’ responsibility for their health and patient autonomy. This account is contrasted with models of the DPR drawn from the bioethics and clinical literature, and with the conceptions of patient responsibility and patient autonomy that inform these models. Self-management technologies and their related practices have the potential to be more ethically robust than ordinary care. They may be able to influence patients’ health agency by promoting their cognitive and emotional abilities and, through this, change health outcomes for chronically-ill patients. However, there are a number of pertinent ethical issues concerning mutual trust in the DPR...
In this article I review of the bioethics and clinical models of doctor-patient relationship and analyze them with ethical lens. It has two parts. First I review the bioethics models of DPR and argue that they are normative and prescriptive in nature being derived from various ethical and social theories. Although they describe various processes through which they may promote either patients' autonomy or beneficence, these processes are not assessed empirically and therefore. it is not clear whether their implementation at the level of health systems may rich their goals. Second I review the clinical models of DPR and show that similar to the bioethics models of DPR they are normative and prescriptive in nature. In addition, similar to the bioethics models of DPR, they are instrumental for beneficence and patients' autonomy. However, the processes through which these models aim at promoting beneficence were comprehensively assessed from an empirical point of view. I outline this research and argue that there is evidence that the relationship centered care model of DPR may promote beneficence and patients' autonomy if implemented Finally, I compare the processes in the clinical models of DPR with those in the bioethics models and argue that the contractual models of DPR are likely to promote less beneficence and patients' autonomy as compared with relational models of DPR.
Le système de santé d'aujourd'hui fait appel à de nombreuses technologies de l'information nommées TIS (Technologies de l’Information en Santé). Celles-ci ont donné naissance à de nouvelles formes d’interaction médecin-patient et ont complexifié l'approche thérapeutique dite « centrée sur le patient ». Les TIS promettent une plus grande efficacité et l’augmentation de la satisfaction des patients par le biais d’une meilleure compréhension de la maladie pour le patient. Or, elles peuvent également devenir des sources de conflit pour le professionnel de la santé, étant donné leur utilisation en dehors des rencontres cliniques ainsi que leur tendance à agir comme des barrières communicationnelles lors des consultations. Cette recherche vise a étudier les critères de design nécessaires à la conception d’un TIS pouvant améliorer la relation médecin-patient et donc, faciliter la communication et améliorer l’alliance thérapeutique. L’étude utilise une approche centrée sur l’utilisateur et vise donc à comprendre les besoins et les attentes des médecins et des patients.
En étudiant les nouvelles approches en santé et les TIS, il a été possible de comprendre le contexte et les besoins des utilisateurs en terme de communication. Ces derniers sont primordiaux au processus dit centré sur l’utilisateur. Le faible taux de rétention du discours du médecin devient une barrière communicationnelle importante...
Background and Objectives: Psychooncology research and practice has grown exponentially in recent years. We review the evidence-based accomplishments of psychooncology in key areas that inform clinical practice. Methods: We reviewed the following computerized databases: PubMed, Embase, Cochrane, Ovid Medline and Psychinfo for studies on predetermined areas of interest representing the continuum of current psychooncology, focusing on meta-analyses and controlled studies. Results: Cancer related psychological distress occurs in one third of patients. Psychological factors are of importance in cancer prevention such as the relationship of smoking to depression. The association between personality styles and cancer vulnerability is not strong, but social support is a well-established prognostic factor. Existential distress may manifest as demoralization; meaning and dignity-based therapies have been designed to assuage existential angst in the cancer setting. Psychotherapy is efficacious in ameliorating cancer related distress, anxiety and depression, with newer models focusing on meaning and adaptive coping. Although there is not a strong evidence-base for the impact of psychooncology on survival, psychological factors clearly impact on adherence to cancer treatment. Most survivors do well overall...