Thesis (Ph.D. )--University of Tennessee Health Science Center, 2008. / Title from title page screen (viewed on May 16, 2008 ). Research advisor: Mona N. Wicks, PhD. Document formatted into pages (vii, 87 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 63-73).

Thesis (Ph. D.)--West Virginia University, 1999. / Title from document title page. Document formatted into pages; contains xvi, 184 p. : ill. Vita. Includes abstract. Includes bibliographical references.

Thesis (M.N.)--Memorial University of Newfoundland, 2003. / Typescript. Bibliography: leaves 176-183. Also available online.

Thesis (M.N.)--Memorial University of Newfoundland, 2004. / Bibliography: leaves 188-195.

Thesis (Ph.D.)--Medical University of Ohio, 2005. / "In partial fulfillment of the requirements for the degree of Doctor of Philosophy in Medical Sciences." Major advisor: Joseph I. Shapiro. Includes abstract. Document formatted into pages: v, 265 p. Title from title page of PDF document. Bibliography: pages 52-59,94-100,129-134,171-176,200-263.

Thesis (M.S.)--University of Toledo, 2006. / "In partial fulfillment of the requirements for the degree of Master of Science in Nursing." Major advisor: Jane C. Evans. Includes abstract. Document formatted into pages: v, 53 p. Title from title page of PDF document. Bibliography: pages 42-43.

Made available in DSpace on 2015-12-06T23:47:55Z (GMT). No. of bitstreams: 0 Previous issue date: 2008 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objetivo: Avaliar a efetividade da Terapia Cognitivo-Comportamental em grupo (TCC) no tratamento de pacientes com Doença Renal Crônica Terminal (DRCT), com diagnóstico de Depressão Maior. Métodos: Pacientes adultos em hemodiálise, com diagnóstico de depressão feito por instrumentos específicos, provenientes de duas unidades de tratamento dialítico da cidade de São José do Rio Preto, foram randomizados para participar de um estudo de intervenção. Os pacientes alocados para o grupo de intervenção receberam tratamento em grupo com TCC, semanalmente, durante três meses, conduzidos por psicólogo especializado; todos os pacientes alocados para o grupo controle receberam tratamento psicológico individualizado, realizado habitualmente na unidade de diálise. Foram aplicados, no momento de entrada no estudo, no final da intervenção (3o mês) e após mais 6 meses de seguimento, a entrevista psiquiátrica Mini International Neuropsychiactric Interview (MINI), o Inventário Beck de Depressão (BDI) e o Kidney Disease and Quality of Life- Short Form (KDQOL-SF). Resultados: Os grupos mostraram-se homogêneos em relação à idade, gênero, etnia, escolaridade e condição sócio-econômica. O grupo intervenção apresentou, quando comparado ao controle, após 3 e 9 meses do início do estudo, melhora estatisticamente significante nas médias das Subescalas cognitiva (p<0,001) e somática do BDI (p<0,001), nas médias do BDI total (p<0,001), do MINI (p<0,001), e nas médias das dimensões de qualidade de vida do KDQOL-SF: Sobrecarga da doença renal (p=0,002), Função cognitiva (p=0,001), Sono (p=0,001), Qualidade da interação social (p<0,001), Saúde total (p<0,001) e Sumário mental (p<0,001). Conclusões: A TCC em grupo mostrou-se efetiva para tratar a depressão em pacientes com DRCT / FAPESP: 04/08710-8 / BV UNIFESP: Teses e dissertações

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A doenÃa renal crÃnica (DRC) representa, atualmente, um importante problema de saÃde pÃblica. Em estÃgios mais avanÃados, a doenÃa pode levar à insuficiÃncia renal crÃnica terminal, que requer diÃlise ou transplante. O retardo da progressÃo da DRC depende da efetividade da farmacoterapia das doenÃas de base. A nÃo adesÃo ao tratamento farmacolÃgico prejudica o alcance dos resultados terapÃuticos. O estudo dos fatores associados à nÃo adesÃo à importante para que estratÃgias de intervenÃÃo bem sucedidas possam ser implementadas. O objetivo do presente trabalho à mensurar a prevalÃncia da nÃo adesÃo ao tratamento farmacolÃgico e identificar os fatores associados à nÃo adesÃo em doentes renais crÃnicos. O estudo foi realizado no ambulatÃrio de nefrologia do Hospital UniversitÃrio Walter CantÃdio, em Fortaleza (CE), entre novembro de 2004 e abril de 2005, com delineamento transversal. A amostra foi constituÃda por 130 pacientes com diagnÃstico de DRC, maiores de 18 anos, em uso contÃnuo de algum fÃrmaco anti-hipertensivo ou imunossupressor e que nÃo estivessem sendo submetidos a diÃlise ou transplante renal. A nÃo adesÃo foi medida atravÃs dos mÃtodos da entrevista com questionÃrio, das estimativas feitas pelos mÃdicos e da anÃlise dos resultados terapÃuticos, sendo considerados nÃo aderentes os pacientes assim classificados por, pelo menos, um dos mÃtodos. As variÃveis independentes estudadas estavam relacionadas Ãs caracterÃsticas sociodemogrÃficas, caracterÃsticas e percepÃÃes dos pacientes sobre a DRC, o tratamento e o atendimento oferecido e o nÃvel de informaÃÃo sobre o tratamento farmacolÃgico. O banco de dados e anÃlise bivariada foram feitos atravÃs do EPI-INFO versÃo 6.04d, utilizando o teste do qui-quadrado corrigido por Yates e o teste exato de Fisher. Foi realizada uma anÃlise multivariada por meio de um modelo de regressÃo logÃstica, utilizando-se o programa SPSS for Windows versÃo 10.0. Em todos os testes estatÃsticos adotou-se o nÃvel de significÃncia de p < 0,05 (bicaudal) em relaÃÃo ao erro alfa. A freqÃÃncia de pacientes nÃo aderentes, identificados por pelo menos um dos mÃtodos, foi de 61,3% (IC95% = 52,0 â 70,1%). Na anÃlise multivariada trÃs fatores apresentaram associaÃÃo estatisticamente significante com a nÃo adesÃo: tempo de diagnÃstico da DRC inferior a 5 anos (p = 0,015), relato do paciente sobre reaÃÃo adversa a algum medicamento prescrito (p = 0,015) e baixo nÃvel de informaÃÃo sobre o tratamento farmacolÃgico (p = 0,028). à medida que aumentou o nÃvel de informaÃÃo sobre o tratamento farmacolÃgico diminuiu a prevalÃncia da nÃo adesÃo. A prevalÃncia da nÃo adesÃo ao tratamento farmacolÃgico à alta entre os pacientes estudados. Os fatores que apresentaram associaÃÃo estatisticamente significante com a nÃo adesÃo sÃo possÃveis causas deste comportamento. IntervenÃÃes educativas e motivacionais sÃo necessÃrias para a diminuiÃÃo da magnitude do problema. Os resultados observados estÃo coerentes com outros trabalhos encontrados na literatura, entretanto, mais estudos sÃo necessÃrios para avaliar as causas da nÃo adesÃo ao tratamento farmacolÃgico da DRC e a efetividade das intervenÃÃes propostas. / Chronic kidney disease (CKD) is currently an important public health problem. At more advanced stages CKD can take to end-stage renal disease, that request dialysis or renal transplantation. Retard of the progression of CKD depends on the effectiveness of underlying conditions pharmacotherapy. Medication non-compliance harms reaching therapeutic goals. Non-compliance associated factors study is important so that well happened intervention strategies can be implemented. The objective of the present study is to measure the prevalence of medication noncompliance and to identify medication non-compliance related factors in CKD patients. A cross-sectional study was performed at renal outpatient care unit of the Academical Hospital Walter CantÃdio, in Fortaleza (CE), between 2004 november and 2005 april. The sample was constituted by 130 CKD patients, at least 18 years old, continuously taking some self-administered antihypertensive or immunosuppressive drug and not being submitted to dialysis or renal transplantation. Non-compliance was measured by questionnaire, physician assessment and outcomes methods, being considered non-compliant patients if non-compliance has been detected by any method. Independent variables studied were related to sociodemographic characteristics, characteristics and patientsâ perceptions on CKD, its treatment and offered service and information level about pharmacotherapy. Database and bivariate analysis were performed at EPI-INFO version 6.04d, using Yates corrected chi-square and isherâs exact tests. A multivariate analysis was conducted through a logistic regression model using SPSS for Windows version 10.0. Confidence level for all tests was p < 0,05 (two-tailed). Frequency of non-compliant patients, detected by any method, was 61,3% (95%CI = 52,0 â 70,1%). Multivariate analysis results showed that less than 5 years CKD diagnosis time (p = 0,015), selfreport of adverse drug reaction (p = 0,015) and low information level about pharmacotherapy (p = 0,028) presented statistically significant association with noncompliance. As greater the information level about pharmacotherapy smaller the noncompliance prevalence. Medication non-compliance prevalence is high among studied patients. Factors associated with non-compliance are possible causes of this comportment. Educational and motivational interventions are necessary for decrease problemâs magnitude. Observed results are coherent with literature, however, more studies are necessary to evaluate causes of the medication non-compliance on CKD and effectiveness of the proposed interventions.

Chronic haemodialysis patients have a high prevalence of Hepatitis B and C virus infections both of which are associated with chronic liver disease and hepatocellular carcinoma Hepatitis B virus (HBV) was identified as a frequent cause of hepatitis during the early years of chronic haemodialysis therapy and strict adherence to infection control measures alone proved inadequate to control the transmission of infection between patients. A policy of regular screening of all patients and blood donations for hepatitis B surface antigen together with isolation of positive patients to separate dialysis units resulted in a significant decline in the incidence of new infections. Hepatitis B vaccination provided an important new means of protection. Despite the finding that haemodialysis patients did not respond to the vaccine as well as normal adults, randomized controlled trials showed significant protection in units with a previously high incidence of infection. Studies have identified both monocyte dysfunction and B cell inhibition by elevated levels of parathyroid hormone (PTH) as possible mechanisms for the reduced response in dialysis patients. Other factors which have been associated with this poor response include increased age, male gender, specific human leukocyte antigens, shorter time on a dialysis programme and poor nutritional status. One study has shown an increased response in patients receiving recombinant human erythropoietin and. there is in vitro evidence that nifedipine improves B cell proliferation in dialysis patients with hyperparathyroidism. Hepatitis C virus (HCV) infection in haemodialysis patients has been associated with blood transfusions in many studies. However, evidence exists that transmission between patients also occurs. There is disagreement as to what measures are necessary to prevent possible nosocomial spread. Some authors recommend isolation of HCV -infected patients to separate dialysis machines or units. There is also concern over the potential of dialyzer reuse to transmit the virus. A protocol for surveillance 0f hepatitis B and C infections was established in the dialysis unit at Groote Schuur Hospital while HCV positive patients were not isolated and reuse of dialyzers was continued for all patients. HBV -infected patients are dialyzed in a separate unit and their dialyzers are not reused. A trial of hepatitis B vaccination of all antibody negative patients was undertaken using four doses of a plasma-derived vaccine given intramuscularly at month 0,1 ,2 and 4.

The pharmacokinetics of orally administered ranitidine were studied in 10 patients with endoscopically proved duodenal ulceration after a single 150 mg dose and after 4 weeks 1 ranitidine treatment (150 mg twice daily), at which time there was endoscopic evidence of complete ulcer healing. After a single dose the median elimination half-life was 135 minutes and the median area under the curve (AUC) was l 844 ng/ml.hr. Although the maximum concentration after a single dose (Cmax = 365 ng/ml) was significantly different from that after continuous treatment (Cmax = 562 ng/ml) (p <0,05) there was no significant difference between the minimum concentrations at 12 hours post-dosing (Cmin = 35 ng/ml and 30 ng/ml respectively) and the median half-lives were identical. No accumulation of ranitidine occurred in these patients after 4 weeks' chronic ranitidine treatment. Five patients received 20 mg ranitidine intravenously. The apparent volume of distribution of the central compartment ranged from 10,5 to 28,4 1 while the elimination rate constant β range from 0,34 to 0,78 h⁻¹ with the t½ ranging from 53 to 122 minutes. The mean oral bioavailability was 51%. The pharmacokinetics of ranitidine were studied in a further 7 patients with chronic duodenal ulceration who showed endoscopic evidence of unhealed ulcers after at least 8 weeks' treatment with ranitidine. There were no significant differences in any of the pharmacokinetic parameters when these patients were compared with the 10 responders above after multiple-dosage except that the disposition rate constant was smaller in non-responders (0,24 h⁻¹ compared with 0,31 h⁻¹, p <0,002). Two patients did, however, have very low plasma concentrations with above average basal and maximal acid output which may have contributed to the lack of response to ranitidine treatment. Single- and multiple-dose pharmacokinetic studies of oral ranitidine were carried out in 6 patients with chronic renal failure (RF) (creatinine clearance <25 ml/min) and compared with those obtained for the 10 patients with chronic duodenal ulceration with normal renal function (creatinine clearance >65 ml/min). There appeared to be no significant differences in absorption rate or amount absorbed but the median elimination rate constant was significantly reduced from 0,31 h⁻¹ in controls to 0,14 h⁻¹ in RF (p <0,002) resulting in a two-fold increase in t½ (312 minutes) after a single dose. Cmax did not differ significantly although Cmin and AUC were significantly larger in RF patients (both p <0,002). It is suggested that the dosage of ranitidine be reduced from 150 mg to 75 mg twice daily in severe renal failure although it was not possible to relate half-life, elimination rate constant or AUC directly to creatinine clearance.