Made available in DSpace on 2016-04-28T20:38:05Z (GMT). No. of bitstreams: 1 Luiza de Andrade Braga Farias.pdf: 677617 bytes, checksum: 6999275e80d58d54e7ff7b5257f0e3ae (MD5) Previous issue date: 2012-05-02 / This research aimed to develop a critical analysis of the Brazilian production of the psychologist with patients with chronic renal failure on dialysis, performing literature review on the subject. The analysis seeks to understand how the psychologist is developing its work, if the work is characterized by interdisciplinary and possible interventions related to the impact of dialysis on patients and their families. The literature review consisted of articles on the topic of online journals indexed in SciELO and BVS-Psi, using intersection keyword that addressed the goal, from broader issues for more specific, as in the following examples: Chronic Renal Failure X Psychology; Chronic Renal Failure X X Psychologist Psychology; Chronic Renal Failure Treatment X X Psychology. We used the following criteria for selection of articles: (a) published in journals with review CAPES / Qualis ANPEPP A1, A2, B1, B2, B3 and B4 (b) available online (c) published from 2001 to 2011 (d) produced in Brazil, (e) authoring psychologist(s) or at least a psychologist in coauthoring. The search results indicated that 16 studies were analyzed according to the following categories: identification (of the academic authors, local research institution to which the authors belong, Qualis classification of the journal, year of publication); characteristics of the item (typestudy and method) the psychologist (type of care, focus on the patient or the family health team; dialysis modalities, and most recurring themes). The results indicate that most articles are written by psychologists, focusing on empirical research with patients on hemodialysis. Universities in the Southeast stand out with the highest concentration. The articles are divided into regular assessed Qualis A2 to B4, and most of them concentrated in categories B3 and B4 (total of 11 articles). There was also predominant in the publications of the psychologist during maintenance of the disease and in subjects such as quality of life and treatment compliance.There is a shortage in the scientific production on the theme proposed in this study. It is necessary that the psychologist goes beyond the walls, disclose and publish their work in reputable journals for their work is valued and recognized for their own psychology and other areas, besides helping to constantly improve their work. (Support by CAPES, CNPq) / A presente pesquisa teve como objetivo elaborar uma análise crítica sobre a produção brasileira da atuação do psicólogo junto a pacientes com insuficiência renal crônica em diálise, realizando revisão bibliográfica sobre este tema. A análise busca entender como o psicólogo está desenvolvendo seu trabalho, se a atuação é caracterizada por interdisciplinaridade e possíveis intervenções relacionadas aos impactos da diálise nos pacientes e familiares. A revisão bibliográfica constou de artigos online sobre o tema de periódicos indexados nas bases SciELO e BVS-Psi, utilizando-se cruzamento de palavras-chave que contemplassem o objetivo, a partir de temas mais amplos para os mais específicos, como nos exemplos seguintes: Insuficiência Renal Crônica X Psicologia; Insuficiência Renal Crônica X Psicologia X Psicólogo; Insuficiência Renal Crônica X Psicologia X Tratamento. Foram utilizados os seguintes critérios para a seleção dos artigos: (a) publicados em periódicos com avaliação CAPES/ANPEPP Qualis A1, A2, B1, B2, B3 e B4; (b) disponíveis online; (c) publicados no período de 2001 a 2011; (d) produzidos no Brasil; (e) autoria de psicólogo(s) ou, pelo menos um psicólogo, na coautoria. Os resultados da busca indicaram 16 pesquisas que foram analisadas de acordo com as seguintes categorias: identificação (formação acadêmica dos autores, local da pesquisa, instituição a qual os autores pertencem, classificação Qualis do periódico, ano de publicação); características do artigo (tipo de estudo e método); atuação do psicólogo (tipo de atendimento; foco no paciente, nos familiares ou na equipe de saúde; modalidades de diálise; e temas mais recorrentes). Os resultados indicam que a maioria dos artigos é de autoria de psicólogos, com foco em pesquisas empíricas junto a pacientes em hemodiálise. As universidades da região Sudeste sobressaem-se com o maior número de produções. Os artigos distribuem-se por periódicos avaliados Qualis A2 a B4, sendo que maioria deles concentra-se nas categorias B3 e B4 (total de 11 artigos). Observou-se, também, predominância nas publicações da atuação do psicólogo durante a manutenção da doença e em temas como: qualidade de vida e aderência ao tratamento. Há uma escassez na produção científica a respeito do tema proposto neste estudo. É preciso que o psicólogo vá além dos muros, divulgue e publique seus trabalhos em revistas bem conceituadas para que sua atuação seja valorizada e reconhecida pela própria Psicologia e por outras áreas, além de ajudar a aprimorar cada vez mais seu trabalho. (Apoio CAPES; CNPq)

Made available in DSpace on 2016-01-26T12:51:32Z (GMT). No. of bitstreams: 1 sabrinaqueirozardito_dissert.pdf: 404181 bytes, checksum: cc58335cbd6ac86952c065cd2a36213e (MD5) Previous issue date: 2011-12-16 / This study aimed at determining the prevalence and the prognostic significance of chronic renal impairment in patients with chronic systolic heart failure secondary to Chagas cardiomyopathy. A total of 245 patients followed at the Cardiomyopathy Outpatient service from January, 2000 to December, 2008 with the diagnosis of chronic systolic heart failure secondary to Chagas cardiomyopathy were included. Chronic renal impairment was diagnosed in 42 (17%) patients. A Cox proportional hazards model was used to evaluate the role of chronic renal impairment as a prognostic index, and a Kaplan-Meier survival curve to study its association with all-cause mortality. Baseline characteristics of patients with and without chronic renal impairment were similar. Beta-Blocker therapy (Hazard ratio=0,42; 95% Confidence Interval 0,27 to 0,63, p value <0,005), left ventricular ejection fraction (Hazard Ratio=0,97; 95% Confidence Interval 0,95 to 0,99; p value=0,005), serum sodium levels (Hazard ratio=0,94; 95% Confidence Interval 0,90 to 0,98; p value=0,004), inotropic support (Hazard Ratio= 1,85; 95% Confidence Interval 1,21 to 2,64; p value= 0,03), and digoxin use (Hazard ratio=2,35; 95% Confidence Interval 1,15 to 4,81; p value=0,02) were independent predictors of all- cause mortality. Survival probability at 12, 24, 36, and 60 months was 74%, 60%, 52%, and 37%, respectively, in patients with chronic renal impairment, and 84%, 70%, 70%, and 35% ,respectively, in patients without (p>0,05). Chronic renal impairment has a low prevalence and no prognostic significance in patients with chronic systolic heart failure secondary to Chagas Cardiomyopathy. / Este estudo tem por objetivo determinar a prevalência e a significância prognóstica da disfunção renal crônica em pacientes com insuficiência cardíaca crônica sistólica secundária à cardiomiopatia chagásica. Duzentos e quarenta e cinco pacientes seguidos no Ambulatório de Cardiomiopatia de Janeiro de 2000 a Dezembro de 2008 com o diagnóstico de insuficiência cardíaca crônica secundária a cardiomiopatia Chagásica foram incluídos no estudo. Disfunção renal crônica foi diagnósticada em 42 (17%) pacientes. Um modelo proporcional de Cox foi usado para avaliar a evolução da disfunção renal crônica como um indice prognóstico, e uma curva de sobrevida de Kaplan-Meier para estudar sua associação com todas as causas de mortalidade. As características basais dos pacientes com e sem disfunção renal crônica foram semelhantes. Terapia com betabloqueador (Razão de Risco=0,42; Intervalo de Confiança 95% de 0,27 a 0,63, p<0,005)], fração de ejeção ventricular esquerda(Razão de Risco=0,97; Intervalo de Confiança 95% de 0,95 a 0,99; p=0,005), nível sérico de sódio(Razão de Risco=0,94; Intervalo de Confiança 95% de 0,90 a 0,98; p=0,004), suporte inotrópico(Razão de risco = 1,85; Intervalo de Confiança 95% de 1,21 a 2,64; p= 0,03) e uso de digoxina(Razão de Risco =2,35; Intervalo de Confiança 95% de 1,15 a 4,81; p=0,02) foram fatores de predição independentes de mortalidade geral. A probabilidade de sobrevida em 12, 24, 36, e 60 meses foi 74%, 60%, 52%, e 37%, respectivamente, em pacientes com disfunção renal crônica e 84%, 70%, 70% e 35%, respectivamente, em pacientes sem disfunção renal crônica(p>0,05). A disfunção renal crônica tem baixa prevalência e não tem significância prognóstica em pacientes com insuficiência cardíaca crônica sistólica secundária a cardiomiopatia chagásica.

Made available in DSpace on 2016-04-28T20:38:46Z (GMT). No. of bitstreams: 1 Claudia Cassia de Oliveira.pdf: 1310099 bytes, checksum: 4f706e392edb3385a56faf94dcac1a45 (MD5) Previous issue date: 2013-10-10 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / In the epidemiologic transition process in Brazil, we verify the increase of diseases and non-transmissible health problems cardiovascular diseases, chronic respiratory diseases neoplasias, mellitus diabetes, arterial hypertension and chronic renal failure. In 2011, the estimated number of patients in hemodialysis was 91,314 (SBN, 2011). Changes have been occurring in chronic health conditions health systems and care processes, and involve a change in paradigm, from an essentially biological model to a bio psychosocial model. Seeking to understand psychosocial aspects of the life experience of people with Chronic Renal Failure CRF in hemodialysis treatment, we developed this research in a Substitutive Renal Therapy Center, located in Southern Minas Gerais, Brazil. It is a field research with a qualitative approach. In a first stage of the research, we performed periods of daily life observation of the patients who frequented the SRTC. In a second stage, we performed semi structured interviews with ten patients in hemodialysis treatment for at least three years. We adopted an analytical strategy with the data collected from the interviews, the Thematic Analysis, as described from Ezzy (2002). The reports from the patients showed their different life experiences in the different stages of the disease and treatment. The initial confronting of the treatment was marked by the review of their life trajectories, in addition to demanding adaptations to a new life style, with physical, psychological and social wearing, and many losses in their daily life activities. The time elapsed from the diagnosis until the stage in which they were when the interview was conducted seems to have been a soothing, an opportunity of growth, to reorganize life and develop their own manner of resilience. The participation of their family members and of the health team was showed to be relevant for the adaptation process. The hope for a transplant which would release them from hemodialysis is cited by the interviewed in different aspects. Religiosity and family are significant aspects of the patients strength in facing the wearing daily life. Possibilities and gaps in health care with a focus on the transdisciplinary action of the team and on a higher patient autonomy are discussed in the final considerations / ampliação de doenças e agravos não transmissíveis doenças cardiovasculares, doenças respiratórias crônicas, neoplasias, diabetes mellitus, hipertensão arterial e a insuficiência renal crônica. Em 2011, o número estimado de pacientes em hemodiálise foi de 91.314 (SBN, 2011). Mudanças vêm ocorrendo nos sistemas de saúde e nos processos de cuidados às condições crônicas de saúde e envolvem uma mudança de paradigma, de um modelo essencialmente biológico para um modelo biopsicossocial. Em busca de compreender aspectos psicossociais da vivência de pessoas com Insuficiência Renal Crônica-IRC em tratamento hemodialítico desenvolveu-se esta pesquisa, num Centro de Terapia Renal Substitutiva localizado na região sul de Minas Gerais. Trata-se de pesquisa de campo, com abordagem qualitativa. Em uma primeira fase da pesquisa, foram realizados períodos de observação do cotidiano dos pacientes que frequentavam o CTRS. Numa segunda fase foram realizadas entrevistas semiestruturadas com dez pacientes, em tratamento hemodialítico há pelo menos três anos. Adotou-se como estratégia analítica dos dados colhidos nas entrevistas a Análise Temática tal como descrita por Ezzy (2002). Os relatos dos pacientes mostraram serem diferentes as suas vivências nas diferentes etapas do curso do adoecimento e tratamento. O enfrentamento inicial do tratamento revelou-se marcado por uma revisão das suas trajetórias de vida, além de exigir adaptações a um novo cotidiano, com desgaste físico, psíquico e social, e várias perdas nas atividades de suas vidas diárias. O tempo decorrido do diagnóstico até a fase em que se encontravam quando das entrevistas parece ter sido um lenitivo, uma oportunidade para amadurecer, para reorganizar a vida e desenvolver modos próprios de resiliência. A participação de seus familiares e da equipe de saúde mostrou-se relevante para o processo de adaptação. A esperança de realização de um transplante que os libere da hemodiálise é tematizada por todos. A religiosidade e os familiares são aspectos significativos das forças dos pacientes para enfrentamento do cotidiano desgastante. Possibilidades e lacunas do processo de cuidados com foco numa atuação transdisciplinar da equipe e em uma maior autonomia dos pacientes são discutidas nas considerações finais

The purpose of this study was to examine health literacy and treatment adherence among Latinos with end stage renal disease. Health literacy has been overlooked as one of the factors that affects one's ability to comply with the physician's prescribed medical treatment.

Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1628. Advisers: Belinda M. Reininger; Henry S. Brown. Includes bibliographical references.

Darbe atlikta teorinė gyvenimo kokybės sampratos ir lėtiniu inkstų nepakankamumu sergančių pacientų gyvenimo bruožų analizė.Iškelta hipotezė, kad dialize gydomi pacientai blogai vertina visas pagrindines gyvenimo kokybės sritis. Gyvenimo kokybės klausimynu ir interviu pokalbio metodais buvo atliktas tyrimas, kurio tikslas - ištirti dialize gydomų pacientų gyvenimo kokybę. Tyrimo duomenys apdoroti statistinių programų paketu SPSS Statistics 17.0, Microsoft Excel ir turinio (angl. content) analizės metodu. Tyrime dalyvavo 100 dialize gydomų pacientų, iš kurių 5 pacientai dalyvavo interviu pokalbyje. Empirinėje dalyje nagrinėjamas dialize gydomų pacientų pagrindinių gyvenimo sričių (fizinės sveikatos, psichologinės, socialinių santykių, aplinkos sričių) vertinimas ir gyvenimo kokybės ypatumai. / The work carried out in the theoretical concept of quality of life and chronic renal failure patients living traits analyzed.The hypothesis that dialysis patients bad the quality of life of all the key areas.The quality of life questionnaire and interview techniques interview was conducted with the aim - to investigate dialysis patients quality of life. The data processing of the statistical software package SPSS 17.0, Microsoft Excel, and text content analysis.The study included 100 dialysis patients, of which five patients participated in the interview conversation.In the empirical part of dialysis patients major life domains (physical health, psychological, social relationships, environment areas) Assessment of quality of life features.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Background Patients with chronic renal failure must deal not only with the disease itself, but also have to follow a strict dietary regimen. In South Africa there is currently a great demand for new and updated recipes based on the South African Renal Exchange Lists. The focus of this research was the development and testing of recipes commonly used by renal patients following a westernised diet. Objectives The main objectives of the study were to develop and test recipes that meet the nutritional requirements of patients with chronic renal failure. The secondary objectives were to determine the gender and racial differences in participants’ responses during consumer sensory testing. Methodology The study population consisted of patients with chronic renal failure on hemodialysis and continuous ambulatory peritoneal dialysis from Tygerberg Academic Hospital (TAH). Data was collected in three phases, using census sampling: Phase 1 included the development and adaptation of recipes to suit the renal diet. Phase 2 included the consumer sensory testing of the recipes by the dialysis patients, using the 9-point hedonic scale. Phase 3 included the rating of the recipes, the final nutritional analysis and allocation of renal exchanges to one portion of each recipe, as well as the final formatting of the recipe to make it more user-friendly for the renal patient. Results In total, 45 patients took part in the sensory evaluation of 30 recipes. Eighty percent of the subjects were coloured, 4% were white while 16% were black. Fifty-one percent (n=23) were female and 49% (n=22) were male. Of the 30 recipes that were evaluated for overall acceptance, appearance, smell, texture and taste, only 7 were deemed unacceptable. Recipes were unacceptable when less than 80% of the study participants gave a mean overall score of more than 6. Significant differences in the overall acceptability scores were found between the male and female subgroups for the Fish and Vegetable Pie (p=0.031), Chicken Pilaf (p=0.008) and Date Fingers (p=0.002). The females showed a greater preference for these two main meals while the males showed a greater preference for the Date Fingers. Significant differences were found between the black and westernised subgroups for the Rice Salad (p=0.006), Wheat and Mushroom Casserole (p=0.022), Curried Wheat Salad (p=0.043) and the Coconut Ice (p=0.005), with the westernised subgroup showing a greater preference for the dishes than the black subgroup. Conclusion The 23 recipes that were acceptable to the study participants are recommended for inclusion in the RenalSmart Software programme. These recipes are suitable for patients following a westernised diet. It is proposed that recipes suitable for the black and Indian population must be developed in future research. / AFRIKAANSE OPSOMMING: Agtergrond Pasiënte met chroniese nierversaking moet nie net slegs die siektetoestand hanteer nie, maar moet ook ‘n streng dieet regime volg. Daar is huidiglik in Suid-Afrika ‘n groot behoefte vir nuwe en opgedateerde resepte gebasseer op die Suid-Afrikaanse Nier Ruillyste. Die fokus van hierdie navorsing was om resepte te ontwikkel en te toets wat algemeen ingeneem word deur nierversaking pasiënte wat ‘n westerse dieet volg. Doelwitte Die hoof doelwitte van die studie was om resepte te identifiseer en te toets wat voldoen aan die nutrisionele behoeftes van nierpasiënte met kroniese nierversaking. Die sekondêre doelwitte was om geslag en ras verskille in die deelnemers se reaksies tydens verbruiker sensoriese evaluering te bepaal. Metodologie Die studie populasie het bestaan uit pasiënte met chroniese nierversaking op hemodialise en aaneenlopende ambulatoriese peritoneale dialise van Tygerberg Akademiese Hospitaal (TAH). Data was versamel in drie fases deur gebruik te maak van sensus steekproeftrekking: Fase 1 het die ontwikkeling en aanpassings van die resepte, om dit toepaslik te maak vir die nier dieet, ingesluit. Fase 2 het die verbruiker sensoriese evaluering van die resepte deur die dialise pasiënte, met behulp van die 9-punt hedoniese skaal, ingesluit. Fase 3 het die klassifisering van die resepte, die finale nutrisionele analise en die toekenning van nier ruile per porsie van elke resep, sowel as die finale formatering om die resep meer gebruikersvriendelik te maak vir die nierpasiënt, ingesluit. Resultate In totaal het 45 pasiënte aan die sensoriese evaluering van die 30 resepte deelgeneem. Tagtig persent van die deelnemers was kleurling, 4% was wit en 16% was swart. Een en vyftig persent (n=23) was vroulik en 49% (n=22) was manlik. Van die 30 resepte wat geevalueer is vir algehele aanvaarding, voorkoms, reuk, tekstuur en smaak, was slegs 7 onaanvaarbaar gevind. Resepte is as onaanvaarbaar beskou indien minder as 80% van die deelnemers ‘n gemiddelde algehele telling van meer as 6 gegee het. Beduidende verskille in die algehele aanvaarbaarheid tellings is gevind tussen die mans en vroue vir die Vis en Groente Pastei (p=0.031), Hoender Pilaf (p=0.008) en Dadelvingers (p=0.002). Die vrouens het ‘n groter voorkeur vir die twee hoofgeregte getoon terwyl die mans ‘n groter voorkeur vir die Dadelvingers getoon het. Beduidende verskille is gevind tussen die swart en westerse sub-groepe vir die Rysslaai (p=0.006), Koring en Sampioen Kasserol (o=0.022), Kerrie Koringslaai (p=0.043) en die Klapperys (p=0.005), met die westerse sub-groep wat ‘n groter voorkeur vir dié geregte toon as die swartes. Gevolgtrekking Die 23 resepte wat aanvaarbaar gevind is sal voorgestel word om ingesluit te word in die RenalSmart Sagteware program. Die resepte is toepaslik vir pasiënte wat ‘n westerse dieet volg. Daar word voorgestel dat resepte toepaslik vir die swart en Indiër populasie ontwikkel word in toekomstige navorsing.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The incidence of people with chronic renal failure has increased significantly, reaching alarming numbers of individuals with kidney failure. This is a disease that affects kidney function and disables the maintenance of internal homeostasis of the organism. Treatment often causes frustration and limitations due to the various dietary restrictions and changes in lifestyle, which requires the patient to participate in their own treatment, determining its autonomy. Thus, this following research aimed to describe how people with chronic renal failure on conservative treatment take care of themselves and identify the possibilities and limits of self-care of people with chronic renal failure undergoing conservative treatment. It is a descriptive qualitative field research, which has taken place in the Uremia Clinic at the University Hospital of Santa Maria. The study included 15 people with chronic renal failure undergoing conservative treatment who attended the clinic. Data collection was performed through narrative interview supplemented by consulting the medical records of patients. The method of analysis of data was through theme analysis, which is a specific form of content analysis proposed by Minayo. All ethical aspects have been respected according to Resolution 196/96 of the National Health Board. The data were organized into two categories, first, the daily life of people with chronic renal failure undergoing conservative treatment as a possibility for self-care, was unveiled on the themes: the experience of self-care of persons with chronic renal failure on conservative treatment, autonomy in self-care of people in the conservative treatment and family support as a possibility of self-care in the conservative treatment. The second category called the limits of self-care of persons with chronic renal failure undergoing conservative treatment, had the following topics: the progress of the disease and care dependency, and the limits and the impact of conservative treatment in chronic renal failure. It is understood that the results of this research might contribute to the care of people with chronic renal failure on conservative treatment and in the manifestation of their autonomy through self-care. It is due to the health team to think and act in promoting the health of those with an eye toward autonomy in health education activities in the pursuit of quality of life. / A incidência de pessoas com insuficiência renal crônica vem aumentando significativamente, atingindo números alarmantes de indivíduos com falência renal. Esta é uma enfermidade que compromete a função renal e incapacita a manutenção da homeostasia interna do organismo. O tratamento geralmente causa frustrações e limitações devido às diversas restrições alimentares e modificações no estilo de vida, o que exige do paciente a participação no seu próprio tratamento, determinando a sua autonomia. Assim, este estudo teve como objetivos descrever como as pessoas com insuficiência renal crônica em tratamento conservador cuidam de si e identificar as possibilidades e os limites do cuidado de si das pessoas com insuficiência renal crônica em tratamento conservador. Trata-se de uma pesquisa de campo, qualitativa, descritiva, cujo cenário do estudo foi o Ambulatório de Uremia do Hospital Universitário de Santa Maria. Participaram do estudo 15 pessoas com insuficiência renal crônica em tratamento conservador que frequentavam o ambulatório. A coleta dos dados foi realizada por meio da entrevista narrativa complementada pela consulta aos prontuários dos pacientes. O método de análise dos dados foi por meio da análise temática, que é uma modalidade específica da análise de conteúdo proposta por Minayo. Foram respeitados todos os aspectos éticos conforme Resolução nº 196/96 do Conselho Nacional de Saúde. Os dados foram organizados em duas categorias, a primeira, o cotidiano de pessoas com insuficiência renal crônica em tratamento conservador como possibilidade para o cuidado de si, foi desvelada nos temas: a experiência do cuidado de si das pessoas com insuficiência renal crônica no tratamento conservador, a autonomia no cuidado de si das pessoas em tratamento conservador e o apoio da família como possibilidade do cuidado de si no tratamento conservador. A segunda categoria denominada os limites do cuidado de si de pessoas com insuficiência renal crônica em tratamento conservador, teve como temas: o avanço da doença e a dependência de cuidados, e os limites e as repercussões do tratamento conservador na insuficiência renal crônica. Entende-se que os resultados dessa pesquisa possam contribuir no cuidado prestado as pessoas com insuficiência renal crônica em tratamento conservador e na manifestação da sua autonomia através do cuidado de si. Cabe a equipe de saúde pensar e atuar na promoção da saúde dessas pessoas com um olhar voltado a autonomia, nas atividades de educação em saúde, na busca da qualidade de vida.

The issue of chronic renal failure and cannulation of permanent venous accesses in patients treated at haemodialysis centres is a topical and widespread problem of these days. According to generally accessible resources the incidence of terminal stage of renal failure, and thus the necessity to treat a patient by means of elimination methods, is very high, it reaches four individuals per thousand inhabitants according to the statistics. It is obviously a widespread nursing problem. The theoretical part of the thesis is divided into a summary and description of the present situation in chronic renal failure, particularly a brief insight into the chronic renal failure and its causes and syndromes. It also deals with the topic of the present treatment possibilities with stress on patient treatment at nephrologic outpatient clinics and in haemodialysis centres. The next chapter of the thesis describes the development from haemodialysis history up to the present advanced elimination methods. The present elimination methods bring the necessity of functional provision of venous access, particularly cannulation of AV fistulas, it is a very frequent nursing operation provided by nurses treating chronically affected patients at haemodialysis centres. This chapter is concluded by general knowledge of the techniques of cannulation of permanent venous accesses, possible occurrence of complications during the cannula penetration itself in relation to the physical phase of nursing treatment about patients with chronic renal failure. The practical part of the thesis was aimed at discovering or possible confirmation of the hypotheses discussed in the theoretical part. The practical research was based on searching for problems among dialyzed patients related to the permanent venous access, on finding the approach of nurses working at dialysis centres to cannulation of permanent accesses and on mapping the access of patients with permanent venous access to nurses with short time experience at a dialysis centre. Research questions were determined for this purpose and were processed within qualitative research into case reports upon depth interviews with nurses working at the dialysis centres of České Budějovice Hospital, Český Krumlov Hospital and Písek Hospital and their patients. The research data were processed into charts, where responses from patients and those from nurses were assessed separately. Occurrence frequency of the individual answers was particularly monitored in the individual output tables, however the responses were not processed by means of standard statistic methods because of the chosen methodology and thus a low number of respondents, but the output data served for drawing conclusions and preparing recommendations for application of nursing methods. The thesis conclusion summarizes the obtained knowledge and recommends possible procedures of solving the problems of cannulation of permanent venous accesses in patients with chronic renal failure treated at haemodialysis centres.

L'intériorité se redéfinissant par l'expérience de la maladie somatique chronique et de ses thérapeutiques, une des formes de travail psychique que nous nous proposons d'étudier est celui de l'hypocondrie. Après avoir proposé l’hypothèse générale d’un travail de l’hypocondrie-signal d’alarme, nous avons affiné trois hypothèses : face à la mort, le travail de l’hypocondrie permet de lutter pour la vie ; face aux traumatismes, le travail de l’hypocondrie permet une surveillance de l’état traumatique et une défense contre l’état traumatique ; enfin, face à l’innommable et le non figurable de la mort, le travail de l’hypocondrie permet un travail de figurabilité et du négatif. Cinq cas cliniques de psychothérapies de sujets en insuffisance rénale chronique d’origine héréditaire, pendant leurs temps d’hémodialyse, se situent aux sources de ces réflexions. Cette clinique nous a conduits à discuter du travail de l’hypocondrie chez l’insuffisant rénal chronique hémodialysé en lien aux traumatismes cumulatifs, aux deuils infinis et aux figures de cruauté, telles que la sur-vivance, le vampirisme, l’hématophilie, l’identification cadavérique et l’introjection cannibalique. Nous avons ensuite interrogé la question du mythe transgénérationnel et des scènes primitives notamment lorsque la maladie était d’origine génétique et héréditaire. Cette discussion nous a amené à rappeler la recherche d’un corps pour rêver en lien à la réserve de l’incréable. Ce travail de rêve des plaintes, du corps et de l’hypocondrie permet une resexualisation des images crues du corps malade somatiquement, chroniquement voire génétiquement et héréditairement. Il leur (re)donne de la chair, une chair psychique. Ainsi ce travail psychique favorise une ré-animation, une ré-humanisation, et une ré-objectalisation du sujet par ce retour à un travail de mentalisation, jusqu’à l’auto-scopie du soi-cadavre, il re-substantifique le sujet. / The way the interiority of the body define itself is changing with the experiment of a somatic and chronic disease and its therapeutics. In this thesis, we propose to study the work of hypochondria. After we proposed to consider the general hypothesis of the work of hypochondria as an alarm signal, we proposed three hypothesis: dealing with death, the work of hypochondria is a fight for life; dealing with traumatisms, the work of hypochondria is a watch of the traumatic state of mind, a defense against it; finally, dealing with the unspeakable and the non figurability of death, the work of hypochondria furthers a work of psychic figurability and a work of the negative. In psychotherapy during their time of hemodialysis, five subjects with hereditary chronic renal failure are the heart of this reflections. Those clinical cases conduce us to discuss the work of hypochondria related to cumulative traumatisms, about infinite work of mourning and cruelty, as out-live, vampirism, haematophilia, corpse’s identification and corpses’ introjection. Then we worked the question of transgenerational myths and primitives scenes, especially when the chronic renal failure provide from a genetic and hereditary way. This discussion conduced us to remind us the need of a body for dreaming, related to the reserve of the uncreatable. The dreamwork of the complaints, the body and the hypochondria resexualizes the cruel images of a ill body. This brings (back) flesh, a psychic flesh. This psychic work furthers a re-animation, a re-humanization, a re-objectalisation of the subject by a way back to a work of mentalization.