M.A. / Modern health-care services in general hospital settings are often characterised by mUltidisciplinary and interdisciplinary approaches to patient care. The underlying rationale of these approaches lies in the potential pooling of specialised medical resources from a variety of medical fields. Consequently there is usually an increase in the diagnostic procedures available, theoretically offering a more comprehensive health service. Whilst the above approach is seen to be effective when the health-car~ team specialists subscribe to one encompassing paradigm, it is hypothesised that the existence of other alternative paradigms may affect the efficacy of team work. Using the interface between the Psychology and Renal units of J.G. Strijdom Hospital as an example, this study describes the effect of paradigmatic differences within a team approach on the conceptualisation of problems and treatment choices. The traditional medical approach is contrasted against a systems based psychological approach. The existence of the two approaches within a single team encounters difficulty in the gaining of consensus regarding the level of focus.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

The purpose of this retrospective study was to determine the effectiveness of an innovative unit-wide phosphorus football contest and nutrition education intervention directed at improving the serum phosphorus levels and calcium-phosphorus products of patients undergoing routine hemodialysis. Patients at the Clarian Health Partners dialysis center located at 2140 North Capitol Avenue in Indianapolis, Indiana participated in the "National Fosphorus League Phootball" contest, a theme game that allowed patients to join a team and compete against other teams in the dialysis center over a four month time period from September 2005 to December 2005. Additional nutrition education was also provided to all the hemodialysis patients during the months of the phosphorus football contest. Identical patient information from September 2004 to December 2004 was also collected for baseline comparison of serum phosphorus levels and calcium-phosphorus products when only routine education and instruction was provided.Pearson Chi-Square analyses and a series of three-way ANOVAs were performed on the data collected. Overall, it was determined that patients who participated in the phosphorus football contest and received Vitamin D therapy were potentially two times likely to have serum phosphorus levels and calcium-phosphorus products in the goal ranges. / Department of Family and Consumer Sciences

No description available.

Fifteen percent of adults in the United States have been diagnosed with chronic kidney disease (CKD). CKD is the slow, progressive, and irreversible loss of kidney function. The most effective means of controlling CKD is by managing dietary phosphorus intake. It is important that staff nurses be educated about effective patient education tools to improve dietary phosphorus management. The purpose of this project was to educate primary care nurses about phosphorus management in CKD patients through the introduction of the phosphorus pyramid as a visual tool. The project sought to understand if an educational intervention regarding phosphorus management in CKD patients could increase the primary care nurse's knowledge. The John Hopkins evidence-based practice model informed the development of this project. Ten primary care nurses participated in a 45-minute education program which focused on the use of the Phosphorus Pyramid. A pre and post-test of knowledge was completed via a Likert scale questionnaire that measured knowledge related to the educational objectives of the program. The posttest scores showed an increase of 15% overall in staff's knowledge regarding dietary phosphorus management, the participants were more likely to correctly answer questions related to the phosphorus content of food and drink. The phosphorus pyramid will serve as a user-friendly tool to assist patients in identifying high phosphorus foods that need to be avoided and low phosphorus foods that are recommended to incorporate in their renal diet. This project supports social change by improving the healthcare team's knowledge regarding dietary recommendations for CKD patients thereby contributing to improved patient outcomes and reduced healthcare costs.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-05-12T13:16:58Z No. of bitstreams: 1 Priscila Garpelli Pássaro.pdf: 2943909 bytes, checksum: b167bb6c81a304736df42a762296232f (MD5) / Made available in DSpace on 2017-05-12T13:16:58Z (GMT). No. of bitstreams: 1 Priscila Garpelli Pássaro.pdf: 2943909 bytes, checksum: b167bb6c81a304736df42a762296232f (MD5) Previous issue date: 2017-05-04 / Introduction: The evolution of patient care should include the complete knowledge about the Adverse Events (AD) of a given procedure. In hemodialysis units there are risk factors that increase the chances of some type of AE occurring, which is why it is important that they are properly identified and recorded. Hemodialysis technicians, who have direct contact with patients in hemodialysis units, should be instructed to recognize and classify AE, in addition to understanding the importance of proper recording. Objectives: 1. Elaborate indicators and mechanisms for the registration of adverse events in hemodialysis patients. 2. To construct an educational program aimed at the training of nursing technicians (students), which allows the understanding of adverse events and aims to adapt the data records. 3. Evaluate the learning before and after the knowledge. Methodology: This was a prospective, longitudinal, descriptive, interventional and quantitative study that was performed at the Dialysis and Renal Transplant Center (CDTR) of Santa Lucinda Hospital, PUC-SP. A table was created for data collection and EA recording during hemodialysis sessions. Any clinical change presented by the patient in a hemodialysis session was considered as an AD. The presentation table and the understanding of the EA and its registration were made through a course, for which a mixed methodology was used, both face-to-face and online, using the Moodle platform for this purpose. In addition to the course itself, individual problems were constructed for each nursing technician, who described the occurrence of AD during the hemodialysis session. The filling in of the EA record models based on these cases served to evaluate online the knowledge of nursing technicians before and after the course. A satisfaction survey of the technicians participating in the course was also made. Results: Of the 16 participating nursing technicians, 9 were female (56%), their mean age was 39 ± 8.9 years and the mean time of experience in the hemodialysis sector was 10 ± 5.9 years. The total number of accesses of the participants to the course through the Moodle platform was 825, with the average access per student, 51.6 ± 21.7 times. In the initial test, the mean score was 3.7 ± 0.3 points and in the final assessment, after the course and using the same pre-course problem, 4.2 ± 0.3 points (p = 0.00002). In the assessment after the course, a different case was also offered than had been answered in the pre-course by each of the students. The mean of these evaluations was similar (4.3 ± 0.3 points, p = 0.26). Satisfaction survey of course participants showed that all students approved the course. Conclusion: The assessment of students before and after a course of presentation of a table developed to improve records of adverse events during hemodialysis showed that students had a low level of understanding of these facts before the course; There was a statistically significant improvement in the evaluation after the course; The students showed a homogeneous behavior in the evaluations; The course provoked interest of the students, and the number of accesses to the course was high / Introdução: A evolução do cuidado ao paciente deve incluir o completo conhecimento sobre os Eventos Adversos (EA) de determinado procedimento. Nas unidades de hemodiálise existem fatores de risco que aumentam as chances de ocorrer algum tipo de EA, motivo pelo qual é importante que eles sejam devidamente identificados e registrados. Os técnicos de hemodiálise, que exercem o contato direto com os pacientes nas unidades de hemodiálise, devem ser orientados a reconhecer e classificar os EA, além de entender a importância de seu adequado registro. Objetivos: 1. Elaborar indicadores e mecanismos para os registros dos eventos adversos em pacientes em hemodiálise. 2. Construir um programa educacional voltado para a capacitação dos técnicos de enfermagem (alunos), que possibilite a compreensão dos eventos adversos e que vise adequar os registros de dados 3. Avaliar a aprendizagem antes e após o conhecimento. Metodologia: Tratou-se de um estudo prospectivo, longitudinal, descritivo, intervencionista e com enfoque quantitativo, que foi realizado no Centro de Diálise e Transplante Renal (CDTR) do Hospital Santa Lucinda da PUC-SP. Foi criada uma tabela para a coleta de dados e registro de EA durante as sessões de hemodiálise. Foram considerados EA qualquer alteração clínica apresentada pelo paciente em uma sessão de hemodiálise. A apresentação da tabela e o entendimento do EA e de seu registro foram feitos através de um curso, para o qual se empregou metodologia mista, presencial e online, utilizando-se para essa finalidade, a plataforma Moodle. Além do curso em si, foram construídas situações de problemas individuais para cada técnico de enfermagem, que descreviam a ocorrência de EA durante a sessão de hemodiálise. O preenchimento dos modelos de registro dos EA baseados nesses casos serviu para avaliação comparativa, online, do conhecimento dos técnicos de enfermagem antes e após o curso. Foi feita ainda uma pesquisa de satisfação dos técnicos participantes do curso. Resultados: Dos 16 técnicos de enfermagem participantes, 9 eram do sexo feminino (56%), sua idade média era de 39± 8,9 anos e a média do tempo de experiência no setor de hemodiálise foi de 10±5,9 anos.O número total de acessos dos participantes ao curso através da plataforma Moodle foi de 825, sendo a média de acesso por aluno, 51,6±21,7 vezes. No teste inicial, a nota média foi 3,7±0,3 pontos e na avaliação final, feita após o curso e utilizando o mesmo problema do pré curso, 4,2± 0,3pontos (p=0,00002). Na avaliação após o curso, também foi oferecido um caso diferente do que havia sido respondido no pré curso por cada um dos alunos. A média dessas avaliações foi semelhante (4,3±0,3 pontos, p=0,26). A pesquisa de satisfação dos participantes do curso mostrou que todos os alunos aprovaram o curso. Conclusão: A avaliação de alunos antes e após um curso de apresentação de uma tabela desenvolvida para melhorar os registros de eventos adversos durante as hemodiálises mostrou que os alunos tinham um baixo nível de compreensão desses fatos antes do curso; houve uma melhora estatisticamente significante na avaliação após o curso; os alunos mostraram um comportamento homogêneo nas avaliações; o curso provocou interesse dos alunos, e o número de acessos ao curso foi elevado

This study was conducted to assess the effect of nutrition education utilizing computerized dietary analysis on nutrition knowledge, dietary compliance, nutrition status, and quality of life in hemodialysis patients. Twenty patients of the Bonneville Dialysis Center in Ogden, Utah voluntarily agreed to participate in this six-month study. All participants completed quality of life assessments, the Beck Depression Inventory© (BDI), and a nutrition knowledge assessment pre- and post-study. Patients in the treatment group (n=12) completed monthly 3-day food records which were analyzed by Computrition® nutrient analysis software. Results were discussed with the patients during one-on-one education sessions. Control patients (n=8) completed 3-day food records pre- and poststudy. Monitoring parameters included: nutrition-related laboratory data, kinetic modeling data, weights, and percent body fat, using Futrex® near infrared interactance. Dietary components followed were: protein, calories, sodium, potassium, calcium, and phosphorus. Multivariant analysis of variance was used for statistical comparisons. Weight and percent body fat were relatively stable throughout the study period for both groups. The treatment group's nutrition knowledge improved as measured by pre- and post-study test scores. Nutrient intakes showed no significant changes except for calorie intake, which decreased in the treatment group. The treatment group's intake of other analyzed nutrients showed declining trends, which were not statistically significant. Serum albumin and total protein increased in both groups. Average serum cholesterol levels decreased in the treatment group. Serum potassium levels did not change significantly. Serum phosphorus increased in the treatment group. However, this did not appear to be caused by increased dietary phosphorus intake. Kinetic modeling data showed a significant increase in protein catabolic rate of experimental subjects. Protein catabolic rates (PCR) are an indicator of dietary protein intakes in maintenance hemodialysis patients. The treatment group showed improvement in the alertness behavior area of the Sickness Impact Profile© (SIP). The control group declined in the recreation and pastimes area of the SIP. No significant changes were observed in the BDI. These results indicate that computerized dietary analysis is an effective instruction tool, is helpful in improving dietary protein intake as measured by PCR, and may contribute to improved quality of life of hemodialysis patients.

Submitted in fulfillment of the Master of Technology : Biomedical and Clinical Technology, Durban University of Technology, 2014. / INTRODUCTION End stage renal disease (ESRD) occurs once 90 % of the kidney function is lost. Patients with ESRD must either undergo medical treatments, like haemodialysis, that substitute the function of the kidney, or they must have a kidney transplant. In the 1970s, haemodialysis treatment took 8 to 12 hours, three times per week. As technology advanced, dialyzers were able to handle more dialysate and higher blood flow rates hence treatment times were shortened to between three and five hours per treatment which has remained the norm until present day. One clinic in Tassin, France remained on the longer dialysis program and noticed advantages for patients who were on extended dialysis times. One of the major problems with dialysis done in the traditional sense is that it tries to provide a lot of therapy in a short period of time, and it is difficult to clear toxins and fluid in that time, Nocturnal dialysis provides a greater amount of toxin removal over a long period of time. AIMS AND OBJECTIVES The main aim of this study was to determine if nocturnal dialysis resulted in improved dialysis clearance, better overall patient health and a better quality of life. The primary objective of this study was to compare the clearance of small molecules (for example, urea, phosphate, creatinine and potassium) and large retention products (for example Parathyroid Hormone (PTH) and 2-Microglobulin) between the two haemodialysis procedures. The secondary objective was to compare the quality of life and survival of patients on both nocturnal and daytime dialysis. METHODOLOGY Thirty patients with End Stage Renal Disease (ESRD) presenting to the Sunninghill Hospital Dialysis Unit for treatment, who met the inclusion criteria, were recruited to participate in this study. Blood samples were taken for each participant at a baseline, 3 month and 6 month interval. The Kidney Disease Quality of Life Survey Questionnaire (KDQOL: SF- 36TM) was also given to each participant to complete. This survey consisted of three parts: 1) Physical Component Summary 2) Mental Component Summary and 3) Burden of Kidney Disease. This survey helped to predict the quality of life of the patients in each group. RESULTS In this study, non-significant effects of treatment were found for all small solutes individually. This study showed that there was a statistically significant increase in both dialysis adequacy and the clearance of large molecules (Parathyroid Hormone and Beta-2-Microglobulin) in the nocturnal haemodialysis group. The results of the KDQOL: SF-36 survey showed that the nocturnal dialysis patients scored higher in both the Physical Component Summary and the Mental Component Summary which means that they felt they were in better physical and mental health. The survey also showed that the nocturnal dialysis patients felt the burden of kidney disease less than those patients dialyzing during the day. CONCLUSION Firstly, dialysis adequacy as defined by the formula Kt/V, increased in the nocturnal group while it levelled off in the diurnal group. Secondly, both the Parathyroid Hormone levels and Beta-2-Microglobulin levels decreased more in the nocturnal group therefore resulting in statistically significant effects of treatment. The third and final conclusion drawn was that nocturnal haemodialysis resulted in better physical health, better mental health and a lower burden of kidney disease was felt by patients undergoing nocturnal haemodialysis.

This research examines the relationship between health literacy among End Stage Renal Disease (ESRD) patients and its relevance for communication between patients and providers. The study was conducted among dialysis services providers at the Good Samaritan Dialysis Center and dialysis patients receiving care at the Center. Data collection techniques included individual interviews, surveys, and the Short Test of Functional Health Literacy in Adults (S-TOFHLA), which measured the health literacy level of the participants. The results of the study show that a large majority of the patients have "adequate" health literacy, which contradicts the provider's perceptions of the patient's ability to comprehend health information. Provider's perspectives are shaped by their training and work environment. The study suggests that structural barriers and communication issues impede effective patient-provider interactions. This issue is especially serious for those chronic disease patients who have limited self-management skills. / Graduation date: 2012

Made available in DSpace on 2016-03-22T17:26:40Z (GMT). No. of bitstreams: 1 juliana roth.pdf: 240395 bytes, checksum: 9b92834586cbce747f4f0d4faa4c67e9 (MD5) Previous issue date: 2005-06-30 / Patients with renal chronic disease have an increased incidence of cancer. It is well known that long periods of hemodialysis treatment are linked to DNA damage due to the oxidative stress. This genotoxic effect may cause loss of chromosome fragments, or even entire chromosomes, which form micronucleus (MN) after cell division, and can be detected by the micronucleus test. In the present case-control study we evaluated the genotoxic effect of hemodialysis treatment in 20 patients undergoing hemodialysis (HD), and 20 subjected to peritoneal dialysis (DP), matched for sex and age with 40 controls. Genetic damage was assessed by examining the frequency of micronuclei in 2,000 exfoliated buccal cells per individual. Our results revealed that patients undergoing hemodialysis treatment have a significantly higher frequency of micronucleated cells (5.60±5.31 MNC) compared to control subjects (1.50±2.01 MNC, p<0.01). Interestingly, the same was not observed for the peritoneal dialysis patients, who presented no significant differences in MNC (2.85±2.96) frequency compared to control individuals (3.25±3.85). In addition, we evaluated the possible association between creatine levels, smoking, alcoholic intake, age, time of treatment, incomes of the individuals (separately analyzed according to their gender) and the frequency of micronuclei. The results reported here indicate that the period of treatment is the only factor associated with increased MNC frequency among HD patients (Spearman coefficient 0.414, p=0.01). The number of MN cells found in individuals under six years or less of treatment was significantly lower (2.91±2.74 MN) compared to patients under seven or more years of treatment (8.89±5.96 MN, p<0.05). Overall, peritoneal dialysis may be a safer choice of treatment, but further studies need to be performed to investigate the risks and benefits of both treatments. / n