Elementos de propedêutica médica para o diagnóstico dos transtornos depressivos / The bases of medical semiology diagnosis of depressive desorders

O autor apresenta um panorama do conceito atual das depressöes e dos métodos de exploraçäo diagnóstica que podem ser utilizados pelos clínicos gerais na sua prática clínica. Baseados na experiência internacional de que a maioria dos estados depressivos säo atendidos pelos näo-psiquiatras, säo oferecidas informaçöes técnico-científicas para que os clínicos possam diagnosticar os distúrbios depressivos, enfatizando a importância do diagnóstico diferencial com doenças somáticas associadas a reaçöes afetivas. Por fim apresenta um Roteiro Sistematizado para Identificaçäo de Casos de Depressäo a fim de facilitar a detecçäo das depressöes pelos generalistas

Enriching the doctor-patient relationship by inviting the patient's perspective.

Doctors and patients alike are saddened and angered by the distance that increasingly interferes with their interactions. Two complementary strategies may enhance the human quality of clinical care and improve outcomes. First, the doctor and patient can undertake a systematic "patient's review" that addresses seven dimensions of care: 1) respect for patient's values, preferences, and expressed needs; 2) communication and education; 3) coordination and integration of care; 4) physical comfort; 5) emotional support and alleviation of fears and anxieties; 6) involvement of family and friends; and 7) continuity and transition. Incorporating the "review" into the clinical encounter encourages both patient and doctor to confront individual preferences and values and offers patients an explicit framework for participating actively in their care. Second, using survey instruments designed to solicit focused reports from patients that address each dimension of care, doctors can gather aggregate feedback about their practices. Such reports move beyond anecdote and can serve as screening tests that uncover areas in doctors' practices that merit improvement. In addition, patients can join doctors in developing solutions to problems uncovered by patients' reports.

Atuaçäo do nutricionista em consultório: experiência de oito anos em Fortaleza, CE / Actuation of nutritionist in consultation office: experience of eight years in Fortaleza, CE, Brazil

O presente trabalho relata experiências com uma atividade inovadora do profissional nutricionista em Fortaleza: a prática de consultório. Säo abordados aspectos referentes à caracterizaçäo da clientela atendida, bem como os principais entraves encontrados na operacionalizaçäo da atividade. Apresentam-se sugestöes para minimizaçäo das dificuldades e maior efetivaçäo dessa prática profissional

Purdue stepped approach model: application to pharmacy practice.

The Purdue Stepped Approach Model (PSAM) of service delivery is applied to pharmacy practice. The PSAM offers a method to organize interventions in a systematic and sequential manner according to the amount and type of resources required to achieve optimal patient health status. The model also provides an approach to integrating the expertise of other healthcare professionals into the provision of pharmacy services (e.g., health educators, psychologists, nurse practitioners, exercise physiologists), addresses economic costs and differential modes of reimbursement, and provides suggestions for future research. Examples are included to facilitate application of the PSAM in pharmacy and implications for holistic healthcare or health promotion in pharmacy practice are discussed.

Power for nursing education.

The topic of power and politics is a recurrent theme in the nursing literature, but not, I wish to suggest, in the nursing educational literature. This paper introduces the topic of power as a nursing educational issue. It is divided into three sections: (a) what a concept of power might mean for nursing education; (b) the nature and form of power relationships within nursing education; and (c) the nature, form and efficacy of the current professional strategies to gain power. First, two definitions of power for nursing education are explored: (a) the power inherent in organizational structures; and (b) the notion of practising nursing education as an empowering profession. Next, a theoretical framework is applied to specific examples of power relationships within nursing education. Two views of power and their inter-relationship with decision-making in curriculum matters are described: 'overt conflict' and 'control of the institution's agenda'. It is argued that these still fail to pick up important instances of the strategies to gain power. Finally, examples of strategies used to gain power in colleges of nursing are made explicit. Concurrently, questions are raised in relation to their efficacy and alternative strategies more congruent with the role of professional educator are advocated. It is argued that nursing education's most lasting form of power will rest in the development of pedagogical knowledge expertise and a research basis: in essence, the development of an academic identity in nursing education.

Autonomy of primary nurses: the need to both facilitate and limit autonomy in practice.

This paper explores the concept and implications of autonomy in relation to primary nurses. It explores the need to limit this autonomy to ensure assigned patients receive a consistent and congruent quality of care. Methods that enable primary nurses to demonstrate their pluralistic accountability, currently being used and tested in practice, are described, methods that limit the autonomy of primary nurses without compromising it.

Nursing in transition: an analysis of the state of the art in relation to the conditions of practice and society's expectations.

The discipline of nursing is in a process of rapid transition. In this paper, the developments are discussed that have affected nursing in its advancement to a full-grown profession. Nursing and medicine are the products of Cartesian thinking that has fragmented our perspectives on man and his living world. The consequences of this scientific viewpoint are reflected in all aspects of life. Attention is paid to advances in nursing practice and education, the development of nursing research and the emergence of a nursing science. These aspects are discussed in the context of professionalization and the position of nursing in the health care system and in society. The study findings of the Styles Report Project on the Regulation of Nursing (1985) serve as a framework of analysis. Links are made between the recommendations given in this report and the development of primary health care, the new tomorrow of a modern discipline.