O consentimento do paciente antes do início de qualquer procedimento é uma condição a ser respeitada pelos profissionais da odontologia, sem nenhuma exceção. É necessário que o paciente esteja ciente de seu status de saúde, de suas necessidades específicas, do propósito de cada tratamento, conheça os planejamentos alternativos (incluindo o não tratamento), saiba do seu prognóstico, riscos, consequências, limitações e se conscientize das suas responsabilidades e as do seu cirurgião-dentista, proporcionando o sucesso do tratamento. O termo de consentimento livre e esclarecido (TCLE) visa fortalecer e esclarecer a posição do paciente, estabelecendo os direitos e deveres de ambas as partes paciente e profissional. O conhecimento integral do tratamento diminuirá a ansiedade do paciente e as complicações de tratamento, promoverá maior qualidade dos serviços odontológicos e maior satisfação do dentista e do paciente. Entretanto, no Brasil, poucos artigos são encontrados e existem alguns problemas éticos envolvendo as clínicas odontológicas, no que diz respeito a este documento de esclarecimento para o paciente. Diante disso, este trabalho tem por objetivo realizar uma revisão crítica sobre o tema abordado...

Foi realizado um survey transversal, descritivo e analítico em amostra não-probabilística, prontamente acessível, de tamanho 561, formada por pacientes que procuraram o Pronto-Socorro de Oftalmologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo numa semana considerada típica de atendimento.Os dados foram obtidos através da ficha administrativa e aplicação de questionário semi-estruturado, realizado por meio de entrevistas. O questionário também constava de entrevista com o médico que fez o atendimento. O estudo teve como objetivos, em relação a usuários do pronto-socorro: descrever características sócio-demográficas, razões da procura e da escolha de unidade hospitalar, verificar conhecimentos e condutas referentes a causas e tratamentos do agravo ocular; verificar a adoção de tratamentos oculares prévios ao atendimento, identificar fontes de orientação na adoção de tratamentos, verificar causas de demora na procura de tratamento, identificar percepções sobre diagnóstico e tratamento prescrito. Em relação à instituição: determinar a proporção de atendimentos oculares de urgência e não urgência; disponibilizar informações para subsidiar intervenções educativas e assistenciais de saúde ocular. A análise estatística foi realizada com o uso do programa Stata (versão 9.0). Entre os resultados...

Introdução: O emprego da terapia antirretroviral (TARV) proporcionou dramático impacto na mortalidade por aids e aumento na sobrevida. Entretanto, esse panorama depende da manutenção de altas taxas de adesão ao tratamento medicamentoso. A relevância da adesão tem sido reconhecida pelo Programa Nacional de DST e Aids desde o final dos anos 1990. Em que pese o destaque que o plano propositivo do Programa tem dado para a questão, ainda não dispõe de estudo atualizado sobre o número e tipo das atividades que estão em curso nos serviços. Este estudo teve por objetivo descrever as atividades de adesão em curso nos serviços de HIV/aids do Estado de São Paulo. Métodos: Foi enviado um questionário semi-estruturado para todos os 179 ambulatórios de HIV/aids do Estado, com perguntas sobre o tipo de serviço, pessoas sob TARV, formas e frequências de avaliação de adesão, atividades desenvolvidas (individuais, coletivas e para grupos específicos) e parcerias com organizações não governamentais. Para testar associação entre variáveis categóricas utilizou-se o teste Qui-quadrado de Pearson ou os testes exato de Fisher ou teste da razão de verossimilhanças, no nível de significância de p<0,05. A análise de agrupamento foi utilizada para investigar cada uma das associações de cada resposta com as variáveis: tamanho do município...

OBJECTIVES: This study aimed to determine the magnitude of the barriers to the practice of Atraumatic Restorative Treatment (ART) as perceived by dental practitioners working in pilot dental clinics, and determine the influence of these barriers on the practice of ART. MATERIAL AND METHODS: A validated and tested questionnaire on barriers that may hinder the practice of ART was administered to 20 practitioners working in 13 pilot clinics. Factor analysis was performed to generate barrier factors. These were patient load, management support, cost sharing, ART skills and operator opinion. The pilot clinics kept records of teeth extracted; teeth restored by conventional approach and teeth restored by ART approach. These treatment records were used to compute the percentage of ART restorations to total teeth treated, percentage of ART restorations to total teeth restored and percentage of total restorations to total teeth treated. The mean barrier scores were generated and compared to independent variables, using the t-test. The influence of barriers to ART-related dependent variables was determined using Pearson correlation coefficients. RESULTS: Mean barrier values were low, indicating low influence on ART practice. Female practitioners had higher scores on patient load than male practitioners (p = 0.003). Assistant Dental Officers had higher scores on cost sharing than Dental Therapists (p = 0.024). Practitioners working in urban clinics had higher mean scores on patient load than those who worked in rural clinics (p = 0.0008). All barrier factors were negatively correlated with ART practice indices but all had insignificant association with ART practice indices. CONCLUSION: The barriers studied were of low magnitude...

A study of 190 Philippine family planning clinics revealed that certain clinic and physician characteristics were significantly and positively associated with clinic effectiveness, defined in terms of the mean number of monthly acceptors of family planning and the efficacy of the methods selected. Clinics with a high degree of effectiveness were more likely to be staffed by physicians who wanted three or fewer children, who relied more extensively on the IUD (intrauterine device) than physicians in less effective clinics, and who derived more satisfaction from working in family planning than physicians in less effective clinics. Autonomous clinics were more effective than integrated clinics, and clinics staffed by physicians trained by institutions with more experience in family planning were more effective than those staffed by physicians trained by institutions with less experience in this field. The findings regarding the following hypotheses were in the predicted direction: Clinic effectiveness will be greater in clinics staffed by female rather than by male physicians, in urban rather than in rural clinics, in clinics staffed by physicians with a low rather than a high degree of religiosity, and in clinics staffed by physicians with a high rather than a low degree of concern about population growth. The differences in clinic effectiveness...

Health experts and policymakers want people to have access to affordable and high-quality medical care. But in some developing countries, making quality healthcare available may first necessitate ensuring that essential medicines are available, such as anti-malaria pills and antibiotics. The challenge of guaranteeing a steady supply is not only related to the financial side of paying for medicines. Zambia, the World Bank supported a project exploring how to guarantee the availability of essential medicines in often-remote health facilities. Based on the results, clinics in districts that were part of the pilot study are now able to order drugs directly from a central pharmacy. Donors and the Government of Zambia are working together to expand the program to the rest of the country. A pilot program, consisting of two different models for distribution, was initiated to test the best way to overcome the bottleneck at the district level. In Model A, a commodity planner was put in place at the district level. In Model B...

AIM: The article summarises results of a systematic review on the effectiveness of nurse-led clinics for patients with coronary heart disease. The objective was to present the best available evidence related to effective interventions in nurse-led cardiac clinics including patient education, risk factor assessment and continuity of care. METHODS: Following the principles of the Cochrane Collaboration for systematic reviews on effectiveness, this is an update to a previously published review. Thirty databases, relevant journals and hand searching of reference lists were the basis for a comprehensive literature search for the period September 2002 to March 2008. Assessment of methodological quality, data extraction and synthesis was undertaken using a systematic review management tool (JBI-SUMARI). When possible, data was pooled in a meta-analysis. RESULTS: The systematic review is based on seven randomised controlled trials. Inconsistencies of interventions executed in nurse-led clinics and various effects on the outcomes make a comparison difficult. The major nurse-led intervention applied in the clinics consisted of health education, counselling behaviour change and promotion of a healthy lifestyle. There were no harmful effects on patients with coronary heart disease identified when exposed to a nurse-led clinic. A few risk factors were significantly reduced in the short term by attending nurse-led clinics...

This study provides a profile of some of the characteristics of 114 Community Acupuncture Network (CAN) clinics as of June, 2011. Characteristics of clinics that affect their accessibility are examined. Most clinics offered a sliding scale fee structure to patients; the lower end of this scale ranged from 10 to 25 dollars and the higher end ranged from 35 to 45 dollars. On average, CAN clinics were open for 31 hours per week but had limited opening hours during hours at the start and end of weekdays and on Sundays. The typical clinic was operated by 1.48 acupuncturists, 69% of whom were women. Clinics typically had 7.6 chairs/recliners and 0.8 treatment tables (but half of all clinics had no tables). Suggestions are made for increasing clinic accessibility that focus on the number of practitioners, opening hours, and clinic configuration.; American Association of Acupuncture and Oriental Medicine

Health experts and policymakers want people to have access to affordable and high-quality medical care. But in some developing countries, making quality healthcare available may first necessitate ensuring that essential medicines are available, such as anti-malaria pills and antibiotics. The challenge to guaranteeing a steady supply is not only related to the financial side of paying for medicines. Poor roads, limited communications and storage problems can make it difficult to keep medical facilities stocked with what they need to provide children and adults with regular and lifesaving care. The World Bank is working to help countries provide quality medical care, a key part of many of the United Nations Millennium Development eight goals. Recently, in Zambia, the World Bank supported a project exploring how to guarantee the availability of essential medicines in often-remote health facilities. The 12-month study, which covered almost 22 percent of Zambia's rural population, found that streamlining the delivery of medicines directly to health centers and introducing a dedicated staff member to help facilitate and track orders cut down on the rate at which clinics ran out of basic medicines. The focus on just one aspect of good healthcare...

Background: President's Emergency Plan for AIDS Relief (PEPFAR) funding changes have resulted in human immunodeficiency virus (HIV) clinic closures. We evaluated linkage to care following a large-scale patient transfer from a PEPFAR-funded, hospital-based HIV clinic to government-funded, community-based clinics in Durban. Methods: All adults were transferred between March and June 2012. Subjects were surveyed 5–10 months post-transfer to assess self-reported linkage to the target clinic. We validated self-reports by auditing records at 8 clinics. Overall success of transfer was estimated using linkage to care data for both reached and unreached subjects, adjusted for validation results. Results: Of the 3913 transferred patients, 756 (19%) were assigned to validation clinics; 659 (87%) of those patients were reached. Among those reached, 468 (71%) had a validated clinic record visit. Of the 46 who self-reported attending a different validation clinic than originally assigned, 39 (85%) had a validated visit. Of the 97 patients not reached, 59 (61%) had a validated visit at their assigned clinic. Based on the validation rates for reached and unreached patients, the estimated success of transfer for the cohort overall was 82%. Conclusions: Most patients reported successful transfer to a community-based clinic...

BACKGROUND: Specialist outreach clinics in general practice, in which hospital-based specialists hold outpatient clinics in general practitioners' (GPs) surgeries, are one example of a shift in services from secondary to primary care. AIM: To describe specialist outreach clinics held in fundholding general practices in two specialties from the perspective of patients, GPs, and consultants, and to estimate the comparative costs of these outreach clinics and equivalent hospital outpatient clinics. METHOD: Data were collected from single outreach sessions in fundholding practices and single outpatient clinics held by three dermatologists and three orthopaedic surgeons. Patients attending the outreach and outpatient clinics, GPs from practices in which the outreach clinics were held, and the consultants all completed questionnaires. Managers in general practice and hospital finance departments supplied data for the estimation of costs. RESULTS: Initial patient questionnaires were completed by 83 (86%) outreach patients and 81 (75%) outpatients. The specialist outreach clinics sampled provided few opportunities for increased interaction between specialists and GPs. Specialists were concerned about the travelling time resulting from their involvement in outreach clinics. Waiting times for first appointments were shorter in some outreach clinics than in outpatient clinics. However...

OBJECTIVES--To establish the extent and nature of specialist outreach clinics in primary care and to describe specialists' and general practitioners' views on outreach clinics. DESIGN--Telephone interviews with hospital managers. Postal questionnaire surveys of specialists and general practitioners. SETTING--50 hospitals in England and Wales. SUBJECTS--50 hospital managers, all of whom responded. 96 specialists and 88 general practitioners involved in outreach clinics in general practice, of whom 69 (72%) and 46 (52%) respectively completed questionnaires. 122 additional general practitioner fundholders, of whom 72 (59%) completed questionnaires. MAIN OUTCOME MEASURES--Number of specialist outreach clinics; organisation and referral mechanism; waiting times; perceived benefits and problems. RESULTS--28 of the hospitals had a total of 96 outreach clinics, and 32 fundholders identified a further 61 clinics. These clinics covered psychiatry (43), medical specialties (38), and surgical specialties (76). Patients were seen by the consultant in 96% (107) of clinics and general practitioners attended at only six clinics. 61 outreach clinics had shorter waiting times for first outpatient appointment than hospital clinics. The most commonly reported benefits for patients were ease of access and shorter waiting times. CONCLUSIONS--Specialist outreach clinics cover a wide range of specialties and are popular...

BACKGROUND: Encouraged by the increased purchasing power of general practitioners (GPs), specialist-run clinics in general practice and community health care settings (known as specialist outreach clinics) have increased rapidly across England. The activities of local commissioning schemes within primary care groups are likely to accelerate this trend. AIM: To evaluate the costs, processes, and benefits of specialists' outreach clinics held in GPs' surgeries, compared with hospital outpatient clinics. DESIGN OF STUDY: A case-referent (comparative) study comparing the characteristics of outreach clinics (cases) with matched outpatient control clinics. SETTING: Thirty-eight outreach clinics, compared with 38 matched outpatient clinics as controls, covering 14 hospital trust areas across England. METHOD: Self-administered questionnaires were given to patients in both clinic settings. These covered processes, satisfaction, personal costs, and health status, with postal follow-up at six months to assess health outcomes. Self-administered questionnaires were also given to the specialists and GPs whose clinics were included in the study (individual patient clinical sheet and an attitude questionnaire), practice managers, and trust accountants (process and costs questionnaire). Evaluation of the costs...

OBJECTIVE: The objective of this study was to compare quality of care for patients with sexually transmitted diseases (STDs) in specialized vs. general clinics. METHODS: The authors conducted a retrospective chart review evaluating compliance with a set of STD-related process of care quality indicators for adult patients seen in six Los Angeles County clinics (two STD specialized clinics and four general medical clinics). RESULTS: Thirty-two quality indicators were selected using a modified Delphi process. From March 1, 1996, to June 31, 1996, there were 205 STD-related visits to the two specialized STD clinics and 373 STD-related visits to the four general medical clinics. For patients with "classic" STDs (those for which sexual contact is the primary means of transmission), STD clinics achieved greater compliance than general medical clinics on 14 quality indicators, while general medical clinics achieved greater compliance on 4 indicators. CONCLUSION: STD clinics provide better overall STD care than general medical clinics. Possible explanations include differences in clinician experience with STD patients and greater use of standardized protocol sheets.

OBJECTIVES: The wider study aimed to evaluate specialists' outreach clinics in relation to their costs, processes, and effectiveness, including patients' and professionals' attitudes. The data on processes and attitudes are presented here. DESIGN: Self administered questionnaires were drawn up for patients, their general practitioners (GPs) and specialists, and managers in the practice. Information was sought from hospital trusts. The study formed a pilot phase prior to a wider evaluation. SETTING: Nine outreach clinics in general practices in England, each with a hospital outpatient department as a control clinic were studied. SUBJECTS: The specialties included were ear, nose, and throat surgery; rheumatology; and gynaecology. The subjects were the patients who attended either the outreach clinics or hospital outpatients clinics during the study period, the outreach patients' GPs, the outreach patients' and outpatients' specialists, the managers in the practices, and the NHS trusts which employed the specialists. MAIN OUTCOME MEASURES: Process items included waiting lists, waiting times in clinics, number of follow up visits, investigations and procedures performed, treatment, health status, patients' and specialists' travelling times...

Objectiu: Descriure les característiques demogràfiques i clíniques dels pacients inclosos als assaigs clínics que avaluen l’eficàcia dels fàrmacs inhibidors del sistema renina-angiotensina (ISRA). Metodologia: Revisió sistemàtica dels assaigs clínics que avaluen l’eficàcia dels ISRA, a partir de la base de dades bibliogràfica Cochrane Plus. A partir dels 143 articles identificats, es van recollir els criteris de selecció i les característiques demogràfiques i clíniques dels pacients tractats amb ISRA. Resultats: El criteri d’inclusió més freqüent dels pacients va ser la hipertensió arterial (111 assaigs) i el d’exclusió l’alteració de la funció renal (68 assaigs). Dels 64.038 pacients inclosos, 38.106 van rebre tractament amb ISRA. Les dades disponibles dels pacients tractats amb ISRA van ser: edat (68,5%), sexe (88,7%), pes (16,2%), pressió arterial sistòlica i diastòlica (67,7%), creatinina (22,8%). L’edat (SD) mitjana dels pacients va ser de 53,1 (7) anys, el 38,1% van ser dones i la concentració de creatinina (SD) mitjana dels pacients va ser d’1,2 (0,3) mg/dl. Conclusió: Hi ha poca informació sobre les característiques demogràfiques i clíniques dels pacients en les publicacions dels assaigs clínics que avaluen l’eficàcia dels ISRA. Els pacients inclosos tenen una edat mitjana d’uns 50 anys...

OBJECTIVES: This study aimed to determine the magnitude of the barriers to the practice of Atraumatic Restorative Treatment (ART) as perceived by dental practitioners working in pilot dental clinics, and determine the influence of these barriers on the practice of ART. MATERIAL AND METHODS: A validated and tested questionnaire on barriers that may hinder the practice of ART was administered to 20 practitioners working in 13 pilot clinics. Factor analysis was performed to generate barrier factors. These were patient load, management support, cost sharing, ART skills and operator opinion. The pilot clinics kept records of teeth extracted; teeth restored by conventional approach and teeth restored by ART approach. These treatment records were used to compute the percentage of ART restorations to total teeth treated, percentage of ART restorations to total teeth restored and percentage of total restorations to total teeth treated. The mean barrier scores were generated and compared to independent variables, using the t-test. The influence of barriers to ART-related dependent variables was determined using Pearson correlation coefficients. RESULTS: Mean barrier values were low, indicating low influence on ART practice. Female practitioners had higher scores on patient load than male practitioners (p = 0.003). Assistant Dental Officers had higher scores on cost sharing than Dental Therapists (p = 0.024). Practitioners working in urban clinics had higher mean scores on patient load than those who worked in rural clinics (p = 0.0008). All barrier factors were negatively correlated with ART practice indices but all had insignificant association with ART practice indices. CONCLUSION: The barriers studied were of low magnitude...

Work is a subject matter that several psychological approaches share, each one driven by specific epistemological, theoretical, methodological and deontological assumptions. Generally speaking, the realm of Organizational and Work Psychology (OWP) involves three main focuses: cognitive, social and, more recently, clinical. This article, of a theoretical nature, attempts to outline the characteristics of work clinics. We analyze their main affiliations and theoretical roots, the assumptions made and shared by their representative approaches, and their main subjects of research and intervention. We conclude with a proposal to locate work clinics using as reference a broader paradigm analysis taking account of coexisting neo-positivist and comprehensive (non-positivist) OWP paradigms. We propose that locating them close to comprehensive paradigms may lead to certain stresses and challenges, with significant consequences for the actions of (clinics) work psychologists.; O trabalho é um objeto de estudo compartilhado por diversas abordagens da psicologia, cada qual orientada por pressupostos epistemológicos, teóricos, metodológicos e deontológicos específicos. Em uma avaliação geral, três grandes ênfases são observadas no domínio da Psicologia Organizacional e do Trabalho (POT): cognitiva...

Foi apresentado plano de reformulação da assistência ambulatorial prestada pelo Instituto Nacional de Previdência Social a seus segurados e respectivos dependentes, na cidade de São Paulo, salientando, que uma avaliação desse tipo assume importância considerável, diante da carência de leitos hospitalares disponíveis. A primeira etapa do plano consistiu no levantamento da situação atual, o qual compreendeu três aspectos: quantitativos de pessoal, dimensionamento das instalações, localização em relação à área urbana. O resultado demonstrou deficiências em todos os Postos de Assistência, sob os três pontos de vista analisados. Foi elaborado plano de reformulação da rede ambulatorial, tomando por base a população previdenciária da cidade de São Paulo, a qual é de cerca de 4.500.000 pessoas. Esse plano funda-se em quatro premissas fundamentais: 1. dimensionamento adequado de unidades a serem construídas e definição das que deverão ser mantidas, de acordo com as necessidades das diferentes zonas da cidade; 2. localização adequada das novas unidades; 3. implantação de sistemas de unidades periféricas resultantes da integração de unidades da Secretaria da Saúde do Estado de São Paulo; 4. definição de retaguarda hospitalar adequada. O total de atendimentos capazes de serem oferecidos pela rede de Postos de Assistência...

This article intends to establish the theoretical and clinical coordinates of the research group in psychoanalysis at a Federal University. Therefore, we present the concepts which are considered crucial for the structuring of the psychoanalytic theory and clinics – namely, the way they can be the source to research in various important themes to psychoanalytic research, and its importance in establishing the scientific field of psychoanalysis as well as its interaction with other fields of knowledge. The article concludes with the demonstration of the detours that psychoanalysis may face if it does not follow strict concepts which structure its experience.   Keywords: psychoanalysis; clinics; research.; O presente artigo pretende estabelecer as coordenadas teórico-clínicas do grupo de pesquisa em psicanálise dentro de uma universidade federal. Apresentamos, por esta razão, os conceitos que são considerados fundamentais para estruturação da teoria e clínica psicanalítica, a maneira pela qual eles podem servir de matriz para pesquisa em diversos temas relevantes para a pesquisa psicanalítica e a sua importância tanto para estabelecer o campo específico da psicanálise quanto a interação dela com outros campos do saber.O artigo termina com a demonstração dos desvios que a psicanálise pode sofrer caso não siga com rigor os conceitos que estruturam sua experiência. Palavras-chave: psicanálise; clínica; pesquisa.