El proyecto se enfoca en brindar apoyo a personas que sufren de insuficiencia renal crónica terminal, a través de un centro especializado en el tratamiento integral del mismo. Brindando espacios de confort con una infraestructura moderna y agradable para el usuario. El objetivo del proyecto es lograr la satisfacción de las necesidades de salud de la población, brindando servicios de salud con calidad, equidad, eficiencia y efectividad, que sumados a la infraestructura ayudará a suplir la carencia de estos centros especializados. / The project focuses on supporting people who suffer from Terminal Chronic Renal Insufficiency; with a specialized integral treatment center that will provide comfort spaces and have a pleasant infrastructure for the user. The aim of the project is to achieve the satisfaction of the population through health needs, and providing high quality services, as well as equity, efficiency and effectiveness; the infrastructure will fill the lack of these specialized treatment centers. / Tesis

Indiana University-Purdue University Indianapolis (IUPUI) / FGF23 is the central regulator for phosphate homeostasis. Both FGF23 and phosphate dysregulation are highly related with the progression of chronic kidney disease (CKD), which is a global health problem. In previous studies, FGF23 was found to be produced in bone and targeting the kidneys to regulate phosphate reabsorption and excretion. In the FGF23 signaling axis, it binds a receptor complex (αKlotho and FGFRs) in the distal convoluted tubules (DCT) and causes its biological effects in the proximal tubules (PT). The mechanism of how the signals passing on from DCT to PT is not clear. In my research, experiments were focused on the FGF23 signaling pathway within the kidney to study the communication steps between tubular cells. HBEGF treatment was given to FGF23 signaling impaired mouse models resulting in significant change of genes regulated by FGF23, indicating that HBEGF was important in the FGF23 signaling axis. Then high quality rabbit anti-mouse HBEGF antibodies were made to better study HBEGF activity in vivo and in vitro. A new cell model was characterized to test FGF23 effects on HBEGF signaling using Western blots and immunofluorescence. Lastly, the location of HBEGF activity was examined in the kidney in vivo. Immunostaining suggested that HBEGF activated the mitogen activated protein kinase (MAPK) pathway. This mapping may provide important information for the molecular relationships between FGF23 and HBEGF.

Made available in DSpace on 2011-05-04T12:36:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / Entre os objetivos da Política Nacional de Medicamentos constam o acesso e o financiamento dos denominados medicamentos de dispensação em caráter excepcional (MDCE). Estes, conhecidos por representarem um gasto governamental relativamente alto, se destinam ao tratamento de doenças em sua maioria, crônicas , que atingem uma pequena parcela da população. Para respaldar sua utilização promovendo adequada alocação dos recursos e o uso racional, o Ministério da Saúde publica protocolos clínicos e diretrizes terapêuticas (PCDT), cujo cumprimento é pré-requisito para o acesso dos pacientes a esses medicamentos pelo programa governamental. A adesão dos prescritores aos protocolos é fator imprescindível ao sucesso desta estratégia. O presente estudo busca verificar, mediante critérios objetivos, o grau de cumprimento pelos prescritores dos procedimentos-chave eleitos a partir do PDCT selecionado. Realizado estudo transversal descritivo com prontuário como fonte de dados e sua revisão como estratégia. Tratamento da anemia em pacientes portadores de Insuficiência Renal Crônica (IRC) com o medicamento eritropoetina humana recombinante (EPO) foi eleita como situação traçadora. Escolhidas três unidades de saúde, sendo critérios o número de pacientes acompanhados e a natureza da organização. No banco de dados da Secretaria de Estado de Saúde do Rio de Janeiro, destinado ao acompanhamento da dispensação dos MDCE identificou-se universo de 411 pacientes com CID principal registrado para autorização de dispensação N18.0 e N18.8, que retiraram o medicamento em algum momento entre janeiro de 2004 a dezembro de 2005. Elegidos procedimentos chave do fluxograma de tratamento do PCDT para a condição traçadora como critérios de verificação. Foram revisados prontuários de 202 pacientes renais crônicos que receberam o medicamento por um período de até dois anos de acompanhamento. Quanto ao grau de adesão ao PDCT, 38,1% foram classificados como adequados, 48,5% como regular, 10,4% como insuficiente e 3% como inadequado. Os critérios mais seguidos foram: critério de inclusão valor do hematócrito ou da hemoglobina, realização inicial de hemograma completo e de contagem de plaquetas e exame de monitorização desses últimos. Os menos seguidos foram: dose inicial e suspensão temporária. No geral, há uma boa adesão, porém essa pode ser melhorada. A análise de possíveis barreiras a adesão faz-se mister. / One of the National Medicines Policy goals is to guarantee the access and funding of the group of drugs called medicines of dispensation in exceptional character (MDEC). These expensive drugs are intended for the treatment of diseases - most of them, chronic - that affect a small portion of the population. In this way, they are know to represent high cost to the public service in Brazil. To support the appropriate allocation of resources and rational use, the Health Ministry develops and public the Clinical protocols and standard treatment guidelines (CPSTG) which is essential for the patient access to the governmental program. To perceive this benefits physicians adherence is necessary. The study aims to evaluate, by objective criteria, the degree of physicians’ adherence to CPSTG. A descriptive cross-sectional study was conducted, using medical records review. CPSTG for the treatment of anemia in chronic renal patients with recombinant human erythropoietin (EPO) was chose to evaluation the adherence. Three units of health were chosen to participate due to number of patients and nature of the organization. The population was picked out from the database of the Secretary of State of Health of Rio de Janeiro, which monitor the distribution of MDEC. The universe was 411 patients with principal ICD registered N18.0 and N18.8, which withdrew the drug at some time between January 2004 to December 2005. To verify the adherence to statements from CPSTG was elected key procedures from CPSTG the treatment of anemia in patients with Chronic Renal Failure (CRF) using EPO flowchart. 202 chronic renal patients medical records were reviewed who received the drug for up to two years of monitoring. The characteristics of patients in the study were similar to the patients described in the 2008 Brazilian Census of Dialysis. Among the comorbidities presented by patients, 76.24% had hypertension and 7.42% ischemic heart disease or congestive heart failure. Regarding adherence, 38.1% were classified as adequate, 48.5% regular, 10.4% insufficient and 3% as inadequate. The most followed criterias were: criterion for inclusion of the value of hematocrit or hemoglobin, achieving initial complete blood platelet count monitoring and examination of these latter. The least followed were: initial dose and temporary. It follows that a good adherence was obtained from the study, but this can be improved. It is indispensable the analysis of possible barriers to adherence.

Text in English with abstracts in English and isiZulu / Poor adherence to their prescribed diet, medications and treatment contributes to increased mortality and morbidity in patients with end-stage renal disease. These patients must change their diet when receiving dialysis treatment, but cultural beliefs and practices can affect their adherence to the prescribed diet. The purpose of this qualitative, descriptive, exploratory study was to improve health education on prescribed diet adherence to patients living on haemodialysis at a haemodialysis unit in eThekwini Municipality. Data from a sample of 20 patients was collected using semi-structured interviews and analysed using qualitative content analysis. The findings revealed that haemodialysis patients’ prescribed diet adherence was influenced by cultural and religious views, and by family support. Food availability, patients’ geographical location and patients’ financial means hindered their adherence to their prescribed diet. A multi-disciplinary health care team including nurses, should be sensitive to patients’ different cultural beliefs and practices when providing health education. / Ukungabambeleli endleleni emisiwe yokudla, amakhambi nasekwelashweni kunomthelela ekwandiseni izimpawu zesifo sezinso esingapheli (ESRD) futhi kwandisa isibalo sabantu ababulawa yilesisifo. Iziguli ezinalesisifo zidinga ukushitsha indlela yokuphila, iziphuzo kanye nokulandela indlela emisiwe yokudla kakhulukazi mabe ngaphansi kokwelashwa ngokuhlanzwa kwegazi ngomshini (dialysis). Izinkolelo zamasiko nendlela zokuphila ezihambisana namasiko kwenze imfundiso nge ezempilo maqondana nendlela emisiwe yokudla yaba lukhuni. Inhloso yalolucwaningo bekuwukwandisa ulwazi nemfundiso ngezempilo mayelana nokulandela indlela emisiwe yokudla kwiziguli izithola ukulashwa ngokuhlanzwa kwegazi ngomshini (haemodialysis) esikhungweni esikuMasipala weTheku. Kusetshenziwe indlela yokwenza ucwaningo esezingeni elifanele, Imininingwano eqoqiwe eqembini (sample) leziguli ezingamashumi amabili (20) ezithola ukwelashwange haemodialyisis. Imininigwane iqoqwe kusetshenziswa izingxoxo ezihleliwe. Imigomo elawula ukuhlaziya ilandeliwe yonke ngenkathi kwenziwe lolucwaningo. Lolucwaningo luveze ukuthi indlela yokudla emisiwe yeziguli ezikwi dialysis iphazanyiswa imobono yamasiko, inkolo kanye nokusekelwa nokuzimbandakanya kwamalungu omndeni. Izinselelo ezinjengokutholakala, indawo isiguli esihlala kuyo nezinkinga zemali zivimbela ukubambelela endleleni emisiwe yokudla. Abasebenzi bezempilo kumele banakekele indima edlalwa izinkolelo namasiko uma befundisa ngezempilo ezigulini eziphethwe izinso. / Nursing Science / M.A. (Nursing Science)

No description available.

Made available in DSpace on 2017-06-01T18:08:40Z (GMT). No. of bitstreams: 1 tarciana_elias_cavalcante.pdf: 38526651 bytes, checksum: 37ad713d9c0721d8254c5f4679ad3438 (MD5) Previous issue date: 2012-05-02 / The present study had the aim to understand repercussions of chronic renal patient s illness and hemodialysis treatment in the lives of main caregivers, with the goal to elaborate and implement a psychological-educational intervention. A qualitative research was conducted using Thematic Content Analysis technique. This study is composed by three papers: one theoretical approach and two empirical ones. In order to carry out the second and third studies, ten relatives of people with chronic renal disease in hemodialysis treatment were recruited. The first paper refers to a literature review on Chronic Renal Failure, with focus on its concept, main causes, characteristics, treatment and the history of hemodialysis. Consulted literature highlights that despite the technological evolution of hemodialysis treatment, which brought up better quality of life to chronic renal patients, it also brought up physical, emotional, social, economic and cultural implications to them and their families. The second paper is on caring and its repercussions in the family, especially regarding the main caregiver. Data analysis of the interviews showed that chronic renal disease and hemodialysis treatment require the family to adapt to a new routine and that caregivers also need caring. In the third paper, the elaboration and implementation of an intervention proposal for this group of relatives is described. Lipp's Inventory of Stress Symptoms in Adults was used to assess the level of stress in caregivers before and after the intervention. The need for relatives of patients in hemodialysis treatment to be assisted in a space that can facilitate the creation, reinvention and/or strengthening of coping mechanisms was observed. / O presente estudo teve como objetivo compreender as repercussões da doença renal crônica e do tratamento de hemodiálise na vida dos cuidadores principais, com o intuito de elaborar e implementar uma intervenção psicoeducativa. Foi realizada uma pesquisa de campo de caráter qualitativo, em que se utilizou como técnica a Análise de Conteúdo Temática. Este trabalho compreende três artigos: um teórico e dois empíricos. Para o segundo e o terceiro artigo, participaram dez cuidadores familiares dos doentes renais crônicos. O primeiro artigo fez uma revisão de literatura sobre o cenário da doença renal crônica, enfatizando conceitos, características, causas, tratamentos e a trajetória histórica da hemodiálise. A literatura consultada ressalta que apesar de o tratamento de hemodiálise ter evoluído tecnologicamente ao longo da história, trazendo uma melhor qualidade de vida aos pacientes renais crônicos, também trouxe implicações físicas, emocionais, sociais, econômicas e culturais para o paciente e para a sua família. O segundo artigo fez uma explanação acerca do cuidado e de suas ressonâncias na família, mais especificamente, no cuidador principal. A avaliação do material obtido através das entrevistas mostram que a doença renal crônica e o tratamento de hemodiálise requerem adaptações da família a uma nova rotina e que os que cuidam também necessitam ser cuidados. No terceiro artigo, descreve-se a elaboração e implementação de uma proposta de intervenção em grupo com estes familiares. Para avaliar o nível de estresse dos cuidadores, antes e após a intervenção, aplicou-se o Inventário de Sintomas de Stress para Adultos de Lipp. Foi observado o quanto se faz necessário que a família do paciente em hemodiálise também tenha um espaço que a possibilite criar, recriar e/ou fortalecer mecanismos de enfrentamento.