La pénurie de greffons rénaux a conduit à élargir les prélèvements aux donneurs décédés après mort encéphalique (DME) à critères élargis et aux donneurs décédés après arrêt circulatoire (DDAC). Ces organes sont à risque d'être non greffés ou de présenter des non reprises de fonction primaire et une durée de vie plus limitée. Ces greffons souffrent des mécanismes d'ischémie-reperfusion inhérents au processus de prélèvement-conservation-greffe. Ces donneurs sont soumis à des phénomènes physiopathologiques qui leur sont propres et dont la compréhension pourrait ouvrir de nouvelles pistes thérapeutiques. Un modèle porcin de DME a permis d'établir que la cinétique de passage en mort encéphalique impacte sur la reprise de fonction primaire (RFP) par le biais de la réponse au stress oxydant (voie de SIRT1, PGC1-α, NRF2). La balance NRF2-mTOR pourrait également influencer la genèse de lésions. Le préconditionnement par un analogue de la spermidine améliore les RFP par diminution du stress oxydant, stimulation de PGC1-α et stimulation de l'autophagie par mTOR. Un modèle porcin de DDAC a permis d'établir que le reconditionnement par circulation régionale normothermique passe par la stimulation de l'érythropoïèse et de l'angiogenèse via HIF1-α, de eNOS et de la thrombomoduline avec un temps optimal de 4h. Au-delà une activation de la coagulation par la libération de TF induit une inflammation par stimulation des protease activating receptors. L'utilisation d'une molécule anti-IIa et anti-Xa durant la conservation permet d'améliorer les suites de greffe. La compréhension des principes physiopathologiques propres aux donneurs permet de mettre place des reconditionnements innovants. / The shortage of kidney transplants has led to the expansion of organ procurement to include donors who died after brain death (DBD) with expanded criteria and donors who died after circulatory arrest (DCD). These organs are at risk of not being transplanted or of delayed primary function and a more limited lifespan. These grafts suffer from the ischemia-reperfusion mechanisms inherent in the harvesting, preservation and transplantation process. These donors are subjected to physiopathological phenomena specific to them, the understanding of which could open up new therapeutic pathways. A porcine model of DBD has established that the speed of brain-death occurrence impacts primary graft function (PGR) through oxidative stress response (SIRT1 pathway, PGC1-α, NRF2). The NRF2-mTOR balance could also influence the genesis of graft injury. Preconditioning with a spermidine analogue improves PGR by reducing oxidative stress, stimulating PGC1-α and stimulating autophagy with mTOR. A porcine model of DCD has established that normothermic regional perfusion reconditioning involves stimulating erythropoiesis and angiogenesis via HIF1-α, eNOS and thrombomodulin with an optimal time of 4 hours. Beyond this, an activation of coagulation by the release of TF induces inflammation by stimulating protease activating receptors. The use of an anti-IIa and anti-Xa molecule during storage improves transplant outcomes. Understanding the pathophysiological principles specific to donors allows to implement innovative reconditioning.

Made available in DSpace on 2016-08-10T10:32:13Z (GMT). No. of bitstreams: 1 Glauce Sebastiana Andrade de Sousa.pdf: 2035060 bytes, checksum: c0f3e7aea001f1e471a621a0975ae4ec (MD5) Previous issue date: 2014-03-27 / The human being has as its historical fundamental aspect in your build process and permanence, human health, which is a portmanteau of factors such as housing, food, recreation, work, among others and that gives the condition of being, to live and develop this condition, ensured by the Constitution of the Republic of Brazil, 1988, however, unfulfilled by the public health care system that cannot evolve in the proportion required Thus, leaving its users, depending on additional sectors and often of their own family. Thus, the objective of this study is to analyze and reflect on the implications and challenges imposed on families of children and adolescentschronic renal patients that underwent dialysis treatment-related Renal Therapy Service Substitution of Hospital das Clínicas-UFG, and who were referred for kidney transplant outside of the State of Goiás, and are without reference to post-transplant ambulatory attendance by the Sistema Único de Saúde-SUS in the municipality of Goiânia. The methodology used was based on qualitative perspective and consisted of theoretical research, documentary and empirical research, based on a semistructured screenplay, which unfolded the various indicators considered essential and sufficient in topics that contemplated the comprehensiveness of the information expected and which was performed by focusing on two categories of subjects: the families of the children and adolescents met on HC-transplanted and in dialysis treatment. With the study it can be concluded that the aggravation of situations experienced by the Group researched has intensified even further the difficult reality to which they are subjected on a daily basis, due to the illness of one of its members and the lack of efficiency and effectiveness of public policies and universalizadoras integrals. / O ser humano histórico tem como aspecto fundamental no seu processo de construção e permanência, a saúde, que é uma junção de fatores como habitação, alimentação, lazer, trabalho, dentre outros e que lhe dá condição de ser, viver e desenvolver-se. Condição esta, assegurada pela Constituição Federal da República do Brasil, de 1988, porém, não cumprida pelo sistema público de saúde que não consegue evoluir na proporção necessária, deixando, deste modo, seus usuários, na dependência dos setores suplementares e muitas vezes da própria família. Assim, o objetivo deste estudo é analisar e refletir sobre as implicações e os desafios impostos às famílias de crianças e adolescentes - doentes renais crônicos que realizaram tratamento dialítico - vinculados ao Serviço de Terapia Renal Substitutiva do Hospital das Clínicas UFG, e que foram encaminhados para transplante renal fora do Estado de Goiás, e estão sem referência para atendimento ambulatorial póstransplante pelo Sistema Único de Saúde (SUS) no município de Goiânia. A metodologia utilizada baseou-se na perspectiva qualitativa e constituiu-se de pesquisa teórica e pesquisa empírica, baseada num roteiro semi- estruturado, do qual se desdobrou os vários indicadores considerados essenciais e suficientes em tópicos que contemplaram a abrangência das informações esperadas e que foi realizada focando duas categorias de sujeitos: as famílias das crianças e adolescentes atendidas no HC transplantadas e em tratamento dialítico. Com o estudo pode-se concluir que o agravo das situações vivenciadas pelo grupo pesquisado tem intensificado ainda mais a difícil realidade a que são submetidos diariamente, em razão do adoecimento de um de seus membros e da falta de eficácia e efetividade de políticas públicas universalizadoras e integrais.

Made available in DSpace on 2014-12-17T14:46:53Z (GMT). No. of bitstreams: 1 FernandoSS_DISSERT.pdf: 1401128 bytes, checksum: 9a2239f9c1eca61393a33efa394de31d (MD5) Previous issue date: 2011-12-19 / The therapeutic possibilities for chronic renal failure closely are related to the biological and social condition, and in this perspective the renal transplant is considered the best option, for providing quality of life better. This study it objectified to apprehend, by means of the rescue of the verbal history of life of the kidney transplant patients, the experiences lived since the diagnosis of the renal to the current with the current therapeutic modality. One is about a study of qualitative boarding, exploratory and descriptive, having the verbal history of life as a technique and method. The colony was formed with the ten first kidney transplant patients of the Rio Grande of the North, taken care of in the clinic of the Nephrology in the University Hospital Onofre Lopes-UFRN, located in the city of Christmas-RN. The net was composed for collaborators of both the sex, in the age band between 21 and 56 years of age, submitted it more than has one year to the renal transplant and that, in some cases, together of its familiar ones, they had voluntarily accepted to participate of the study. The first collaborator interviewed for this was excluded not to desire to participate the study more than. After approval for the Committee of Ethics in Search of the UFRN, we carry through the collection of data, by means of a halfstructuralized interview, recorded individually, in environment chosen for the collaborators. We carry through the transcription of the interviews and later we return to the interviewed ones so that the same ones made the conference, what it made possible in them to carry through the transcriation, after consecutive readings. We analyze the stories by means of the analysis of content of Bardin. Guiding the analysis of the stories of the collaborators, we find three axles thematic: Impact in the social relations, Impact in the social condition and Behavior front the illness and treatment. We conclude in this study that the loss of the renal function reed-echo drastically in the life of the collaborators, but that the acceptance of the pathological condition emerged, mainly for the support of the family and in the belief in God. The renal transplant was seen as the chance for a new life, however, so that they reach an improvement in the quality of life, other questions must be optimized, as the guarantee of constitutional laws, the rescue of the citizenship and offer of bigger support of the professionals of the health, family and society for the confrontation of the problems generated for the chronic renal illness and its treatments / As possibilidades terap?uticas para a Insufici?ncia Renal Cr?nica (IRC) est?o intimamente relacionadas ?s condi??es biol?gica e social, e nesta perspectiva o transplante renal ? considerado a melhor op??o, por proporcionar melhor qualidade de vida. Este estudo objetivou apreender, por meio do resgate da hist?ria oral de vida dos pacientes transplantados renais, as experi?ncias vivenciadas desde o diagn?stico da doen?a renal cr?nica ? conviv?ncia com a atual modalidade terap?utica. Trata-se de um estudo de abordagem qualitativa, explorat?rio-descritivo, tendo a hist?ria oral de vida como t?cnica e referencial metodol?gico. A col?nia foi formada pelos dez primeiros pacientes transplantados renais do Rio Grande do Norte, atendidos no ambulat?rio da Nefrologia no Hospital Universit?rio Onofre Lopes-UFRN, localizado na cidade de Natal-RN. A rede foi composta por colaboradores de ambos os sexos, na faixa et?ria entre 21 e 56 anos de idade, submetidos h? mais de um ano ao transplante renal e que, em alguns casos, juntamente de seus familiares, aceitaram, voluntariamente, participar do estudo. Foi exclu?do o primeiro colaborador entrevistado por este n?o desejar participar mais do estudo. Ap?s aprova??o pelo Comit? de ?tica em Pesquisa (CEP) da UFRN, sob o protocolo n. 413/2010, realizamos a coleta de dados, por meio de uma entrevista semi-estruturada, gravada individualmente, em ambiente escolhido pelos colaboradores. Realizamos a transcri??o das entrevistas e posteriormente retornamos aos entrevistados para a contra-prova, ou seja, para que os mesmos conferissem o que nos possibilitou realizar a transcria??o, ap?s leituras consecutivas. Analisamos os relatos por meio da an?lise de conte?do de Bardin. Norteando a an?lise dos relatos dos colaboradores, encontramos tr?s eixos tem?ticos: Impacto nas rela??es sociais, Impacto na condi??o social e Comportamento frente ? doen?a e tratamento. Conclu?mos, neste estudo, que a perda da fun??o renal repercutiu drasticamente na vida dos colaboradores, mas que a aceita??o da condi??o patol?gica emergiu, principalmente, pelo apoio da fam?lia e na cren?a em Deus. O transplante renal foi visto como a oportunidade para uma nova vida, por?m, para que alcancem uma melhoria na qualidade de vida, outras quest?es devem ser otimizadas, como a garantia de direitos constitucionais, o resgate da cidadania e a oferta de maior apoio dos profissionais da sa?de, fam?lia e sociedade para o enfrentamento dos problemas gerados pela doen?a renal cr?nica e seus tratamentos

Made available in DSpace on 2015-07-22T20:49:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-05-26 / No paciente receptor de transplante de rim, a infecção do trato urinário é uma das complicações mais comuns podendo levar à rejeição, perda do enxerto, prolongamento do período de internação e aumento de custo. Dentre os fatores de risco estão a utilização da sonda vesical e a duração da cateterização urinária. Todavia, apesar de bastante conhecida a relação entre sonda vesical e infecção, pouco se tem investigado sobre o conhecimento da equipe de enfermagem a respeito da prevenção de infecção do trato urinário associada a sonda vesical. Objetivos: Avaliar a prática e os conhecimentos da equipe de enfermagem sobre os cuidados com sonda vesical e os riscos inerentes ao seu uso; aplicar um programa de intervenções e mensurar o impacto destas intervenções na incidência de infecção do trato urinário no paciente transplantado renal em uso de sonda vesical. Método: Estudo prospectivo, intervencionista, realizado em um hospital especializado em doenças renais, conduzido de 01 de agosto de 2008 a 31 de julho de 2009, dividido em duas fases. Na primeira fase, agosto de 2008 a janeiro de 2009, foram feitas observações da prática da inserção e cuidados com a sonda vesical e aplicação de um questionário para avaliação do conhecimento dos profissionais de saúde quanto à utilização e riscos associados ao uso deste dispositivo. Na segunda fase, 01 de fevereiro a 31 de julho de 2009, foi aplicado um programa de medidas baseadas nas não conformidades observadas e, em seguida, o questionário foi aplicado novamente assim como mais um período de observação da prática com o intuito de avaliar o impacto das intervenções. Resultados: A aferição dos conhecimentos teóricos dos profissionais de enfermagem mostrou que, houve diferença estatisticamente significante, entre as duas fases do estudo em relação a fazer a higiene do meato uretral (p=0,007), freqüência de higiene do meato uretral (p<0,001), conhecimento do produto utilizado na higiene do meato uretral (p<0,001), freqüência de troca da sonda vesical (p<0,001) e ao conhecimento das taxas de infecção do HRIM (p<0,001) apontando uma melhora após a intervenção. A observação da prática mostrou uma melhora da higiene das mãos entre os médicos: 9,1% de conformidade para higiene das mãos antes do procedimento e 68,2% de conformidade após o procedimento. Entre os membros da equipe de enfermagem houve melhora da higiene das mãos em todos os procedimentos, tanto antes (26,7% a 48% de conformidade) como após a sua realização (76% a 86,7% de conformidade); maior adesão aos equipamentos de proteção individual, de 60 a 75% de conformidade na primeira fase para 98% a 100% na segunda fase. Na primeira fase do estudo ocorreram 44 (11,33%) infecções do trato urinário, 26 receptores de doador falecido e 18 de doador vivo, estando 37 (84,09%) associadas à sonda vesical. Na segunda fase a taxa de infecção do trato urinário foi de 14,96% com 62 infecções, 45 receptores de doador falecido e 17 de doador vivo, sendo 44 (70,96%) associadas a sonda vesical. A média de tempo até o diagnóstico de infecção do trato urinário após o transplante foi de 13,5 dias (5 - 30 dias). Em ambos os momentos houve predomínio das infecções bacterianas, sendo os Gram-negativos responsáveis por 97,7% das infecções na primeira fase e 82,25% na segunda fase. E. coli isoladamente foi responsável por 34 (32%) infecções, seguida por K. pneumoniae que causou 18 (16,9%) infecções. Conclusões: Pode-se observar que houve uma melhora significativa da prática e dos conhecimentos teóricos relacionadas ao programa educacional. Observamos que na segunda fase houve melhora de conformidade em todos os procedimentos, com redução da infecção do trato urinário associada à sonda vesical (p=0,674), porém sem impacto positivo na incidência de infecção do trato urinário. / The urinary tract infection is one of the most ordinary complications after a renal transplant and it may lead to rejection, donor kidney failure, long hospital stay period and increased cost. Although the use of a urinary catheter as its period of stay is considered a risk factor, little has been studied about the nursing staff knowledge to prevent urinary tract infection due to a urinary catheter. Objectives: Evaluate the nursing staff practice and knowledge related to the maintenance of a urinary catheter as the risks of its use, implement an intervention guide and measure its impact on the incidence of urinary tract infection and also on the nursing assistance to patients undergoing renal transplantation. Method: A prospective interventional study was performed in a hospital in São Paulo, from August first 2008 to July 31st 2009, and divided into two phases. In the first phase, which occurred from August 2008 to January 2009, the urinary catheter insertion and the procedures for its safe maintenance were observed and a questionnaire to access the nurses’ information about the subject was applied as well. In the second phase, from February first to July 31st 2009, a group of new actions based on data collected from the first round were implemented, the same questionnaire was applied once more followed by another period of observation which the main purpose was to verify the effect and changes caused by the new guide developed. Results: The nursing professionals’ theoretical knowledge assessment showed a meaningful statistical difference between the distinct study phases such as urethral meatus hygiene procedure (p=0,007), hygiene frequency urethral meatus (p<0.001), the cleaning product used in the hygiene of the urethral meatus (p<0,001), the catheter exchange frequency (p<0,001) and HRIM infection rates (p<0,001) awareness indicating an improvement after the intervention. The practice observation also showed a hand hygiene improvement among physicians: 9,1% of frequency before procedure and 68,2% after the procedure. Among the nursing staff members again positive results were noticed: 26,7% to 48% of hand washing before procedure and 76% to 86,7% after procedure. Better adherence to the use of personal protective equipment comparing 60 to 75% in the first round against 98% to 100% in the second. There were 44 (11,33%) cases of urinary tract infection in the first phase of the study, 26 deceaseddonor while 17 living-donor, which 37 (84,09%) due to urinary catheter presence. The average time between the urinary tract infection diagnosis and the kidney transplant was 13,5 days (5 to 30 days). In both phases, there was a bacterial infection predominance being the gram-negatives responsible for 97,7% of the infections in the first round against 82,25% in the second. E. coli itself was responsible for 34 (32%) cases of infection, followed by K. pneumoniae which caused 18 (16,9%) cases of infection. Conclusions: A meaningful practice and theoretical knowledge improvement can be noticed due to the educational program. Despite all the better results achieved in the second phase of this study, with reduction of urinary tract infection associated with vesical catheter (p=0,674), any impact on decreasing urinary tract infections could be demonstrated. / TEDE / BV UNIFESP: Teses e dissertações

INTRODUÇÃO: A avaliação da Qualidade de Vida tem se destacado de modo crescente em pesquisas clínicas de pacientes com transplante renal. O WHOQOLAbreviado é um dos instrumentos usados para avaliar a Qualidade de Vida em várias populações. O objetivo deste estudo foi avaliar e comparar a Qualidade de Vida nos pacientes transplantados renais submetidos à ampliação vesical e transplantados renais utilizando o WHOQOL-Abreviado e verificar a co-interferência de outros fatores sua Qualidade de Vida desses grupos. MÉTODOS: este é um estudo caso-controle e foi realizado na Unidade de Transplante Renal da Divisão de Clínica Urológica do Instituto Central da Faculdade de Medicina da Universidade de São Paulo, de julho a novembro de 2007. Foram incluídos no estudo todos os pacientes transplantados renais submetidos à Ampliação Vesical entre 1972 e 2004 com enxerto funcionante (Grupo Caso) e seus respectivos pares (Grupo Controle). Participaram 15 pacientes no Grupo Caso e 27 no Grupo Controle. Através do prontuário médico e de uma ficha de caracterização foram coletados os dados demográficos, sociais e econômicos. A Qualidade de Vida foi avaliada apenas uma vez durante a entrevista com a pesquisadora. RESULTADOS: Os grupos foram muito semelhantes entre si na maioria das variáveis analisadas. No Grupo Caso observou-se menor renda pessoal (p=0,013) e menor IMC (p=0,022). A avaliação da Qualidade de Vida foi semelhante em quase todos os domínios do WHOQOLAbreviado, a única diferença ocorreu no Domínio Relações Sociais, onde o Grupo Caso teve um escore menor que o Grupo Controle (p=0,058). Houve uma integração significativa entre o Domínio Relações Sociais e a faceta suporte (apoio) social (r=0,703; p=0,004). CONCLUSÃO: A Qualidade de Vida foi muito semelhante entre os dois grupos de transplantados renais. O Grupo Caso apresentou menor resultado no Domínio Relações Sociais, sendo que esse resultado parece estar diretamente ligado à particularidade da patologia urológica do grupo / The evaluation of health-related Quality of Life is fundamental when searching for better treatment in renal transplantation. The WHOQOL-Bref is used questionnaire to assessment for many population. The purpose of this study was evaluated and compared the Quality of Life of renal transplant patients with bladder augmentation using WHOQOL-Bref and check the co-interference of other factors their Quality of Life of these groups. METHODS: This is case-control study, performed in a Unit of Renal Transplant of the Division of Urology of the Central Institute of the Hospital of the Clinics of the College of Medicine of the University of São Paulo. Were included in the study all patients of the renal transplant with bladder augmentation between 1972 and 2004 with functioning graft (Case Group) and their peers (Control Group). Fifteen Case Group and 27 Control Group patients were enrolled. Through the medical records and a form of characterization data were collected demographic, social and economic. The Quality of Life was assessed once an interview with one of the authors. RESULTS: Both groups were very similar in most of the analyzed domains. In Case Group if it was observed lower personal income (p = 0,013) and lower BMI (p = 0,022). The assessment of Quality of Life was similar in almost all areas of WHOQOL-Bref, the only difference occurred in Social Relations Domains, where the Case Group if had a score lower than the Control Group (p=0,058). There was a significant integration between the Social Relations Domains facet support social (r = 0,703 and p = 0,004). CONCLUSION: The Quality of Life was very similar between the two groups of renal transplant. The Case Group presented result in lower Social Relations Domains, and that outcome appears to be directly connected to the peculiarity of urological pathology of the group

Univerzita Karlova v Praze 1. lékařská fakulta Doktorský studijní program Studijní obor: Experimentální chirurgie MUDr. Filip Thieme Název závěrečné práce Chirurgické modely studia proinflamačního vlivu tukové tkáně v rozvoji aterosklerózy Title Surgical models of the study of the pro-inflammatory effect of adipose tissue in the development of atherosclerosis Typ závěrečné práce Disertační Školitel: doc. MUDr. Jiří Froněk, Ph.D., FRSC Konzultant doc. MUDr. Libor Janoušek, Ph.D. Klinika transplantační chirurgie, IKEM Praha, 2021 Abstract Background: Atherosclerosis is a serious inflammatory systemic disease. Surgery mainly addresses its vascular complications. Conversely, surgery may also lead to the development and acceleration of atherosclerosis, e.g., in a living kidney donor. This would especially be the case in a donor who meets internationally recognized donation criteria but suffers from metabolic syndrome. The effort to refine assessments of living kidney donors in terms of eliminating the risk of developing atherosclerosis is a long-term project. Our aim is to determine risk factors for living kidney donors and to prevent long-term complications after donation. Collecting tissue from a living donor involves not oly subcutaneous tissue (SCAT) but also visceral (VAT) and perivascular tissue (PVAT),...

Le polyomavirus BK est un virus très prévalent qui demeure normalement en phase de latence dans l’uroépithélium sans entrainer de complications. Chez les greffés rénaux, il peut cependant se réactiver et mener à une néphropathie pouvant nuire à la survie du greffon. L’immunité du receveur est la pierre angulaire de la prévention et du traitement de cette néphropathie, puisque le seul traitement démontré efficace est une diminution de l’immunosuppression. Cependant, une augmentation non spécifique de l’immunité augmente également le risque de rejet. Notre objectif était donc d’adapter et de valider un protocole transférable en clinique d’immunothérapie adoptive antivirale nous permettant de produire des lignées de lymphocytes T BKvirus spécifiques à partir du sang de patients greffés virémiques, afin de prévenir et traiter ces néphropathies. Nous avons tout d’abord comparé les lignées cellulaires produites à partir de donneurs sains à celles de patients immunosupprimés soumis à une immunosuppression chronique. Par la suite, nous avons adapté le protocole en ajoutant une stimulation à l’aide de cellules dendritiques afin de maximiser l’expansion cellulaire, le statut de différentiation et la spécificité. Bien que les lignées étaient polyclonales, elles n’ont pas démontré de potentiel alloréactif in vivo et in vitro, et ce, malgré une persistance et une prolifération in vivo. Nous avons donc élaboré un protocole qui est prêt à être transféré en étude clinique de phase I/II et qui pourrait nous permettre de prévenir et traiter la néphropathie associée au polyomavirus BK, sans augmenter le risque de rejet. / More than 75% of the population has been exposed to BK polyomavirus and carries latent virus in the uroepithelium without any complications. However, it can reactivates in kidney transplant recipients (KTR) and lead to a nephropathy affecting graft survival. Recipient anti-viral immunity is the cornerstone of BK-virus associated nephropathy prevention and treatment and thus, reduction of immunosuppression is the only well-accepted treatment. Adoptive immunotherapy is a promising solution to this problem, allowing a specific T cell mediated response against this virus without the alloreactive risk. It was demonstrated efficacious for other viral infections in immunocompromised hosts but it has not been used in this specific context. Our objective was to adapt and validate a clinical-compliant protocol to obtain BK-specific T cell lines from viremic KTR and to compare their expansion, differentiation and specificity to ones obtained from healthy donors. Although comparable specificity and differentiation status, cell expansions form KTR were not systematically sufficient for a therapeutic dose. The addition of a stimulation with dendritic cells improved cell expansion in addition to favors a central memory phenotype and refined BKspecificity. Despite polyclonality, T cell lines didn’t demonstrated alloreactivity in a chromium release assay and in vivo. Furthermore, T cell lines could persist and proliferates in vivo. This protocol is ready for a phase I/II clinical trial. This opens the possibility to solve the current conundrum and treat PVAN without increasing rejection risk.

Quand elle est possible, la greffe de rein est le meilleur traitement de l’insuffisance rénale chronique terminale. La qualité de vie des patients joue un rôle essentiel dans la réussite de la transplantation. Dans ce contexte, notre objectif était d’analyser la qualité de vie dans une cohorte de patients transplantés rénaux en France. Dans un premier temps, nous avons analysé la qualité de vie des patients au moment de leur inclusion dans l’étude dans le but de déterminer les facteurs associés à la qualité de vie. Nous avons retrouvé des caractéristiques socio-démographiques et cliniques connues dans la littérature et de nouvelles variables psycho-sociales ont été identifiées. Ce travail nous a ensuite amené à analyser le profil des patients qui utilisent l’Internet et les réseaux sociaux : près de 80% de patients utilisent Internet et la plupart d’entre eux ont besoin de soutien informatif. Nous avons pu montrer, dans un deuxième temps, une faible concordance de l’évolution de l’état de santé du patient du point de vue du patient et du médecin. Enfin, pour interpréter les scores de qualité de vie dans cette cohorte, nous avons calculé la différence minimale cliniquement significative par la méthode des courbes ROC, en utilisant le changement d’état de santé du point de vue du patient comme critère de changement (anchor). Cette analyse a montré que l’évolution de la qualité de vie de ces patients n’est pas liée au changement d’état de santé des patients. Cette thèse fournit une analyse approfondie sur la qualité de vie des patients transplantés rénaux francophones. / Kidney transplant is the best treatment for chronic end-stage renal failure. The quality of life of the patient plays a vital role in the success of the transplantation. In this context, our objective was to analyze the quality of life in a cohort of kidney transplanted patients in France. As a first step, we analyzed the quality of life of patients at the time of their inclusion in the study in order to determine the factors associated with the quality of life. Socio-demographic and clinical characteristics known in literature were found and new psycho-social variables were identified. This work then led us to analyze the profile of patients using the Internet and social networks: nearly 80% of the patients use Internet and the majority need an informative support. We were able to show, in a second time, a weak concordance of the evolution of the state of health of the patient from the patient and the doctor point of view. Finally, to interpret the quality of life scores in this cohort, we calculated the minimal clinically significant difference, by the ROC curve method and using the change in health status from the patient's point of view as a criteria for change. This analysis showed that the quality of life of these patients is not related to the patient's state of health, and no clinical changes could be detected for the quality of life scores of the two questionnaires. This thesis provides an in-depth analysis of the quality of life of French kidney transplanted patients.

The main criteria for managing good postoperative care include the effective and appropriate choice of pain therapy. Experiencing pain is a purely individual feeling for each of us, so it is very important to have adequate and sufficient analgesia during this period. Modern management of post-operative pain therapy uses preparations of various pharmacological groups that potentiate and thereby more effectively reduce pain. By this mechanism, we can reduce the total dose of analgesics given, and more particularly, reduce the dose of opioids that have a higher risk of side effects. In this project i want to show how the analgesic catheter could be useful as alternative possibility in algorithm therapy of postoperative pain. Analgesic catheter enable continual local anesthetics administration, exactly 0,5% bupivacaine, which is operating in surgical wound. Main goal of the study is to find out and verify if analgesic catheter is method which provides continual analgesia strong enough to results in lower use of opioids. The research data will be determined by quantitative research using a questionnaire survey. Non standardized self-production questionnaire. will be given in a paper form to non-medical healthcare staff, who perform nursing activities The spectrum of patients is very specific; they are...

Bakgrund: Idag är det drygt 700 personer som väntar på en njurtransplantation i Sverige. Njurtransplantationen är en räddning från döden för många patienter som genomgår dialys behandling eller andra former av interventioner för att kunna leva ett ”normalt liv”. För att kunna erbjuda den bästa omvårdnaden bör sjuksköterskan ha en god kunskap om patienters upplevelser. Syfte: Avsikten med litteraturstudien var att belysa patienters upplevelser av att vänta på en njurtransplantation. Metod: Litteraturstudien bygger på tio vetenskapliga studier med kvalitativ metod. Kvalitetsgranskning av artiklarna och sammanställning av resultat genomfördes. Resultat: Resultaten presenteras genom två tema som omfattar patienternas upplevelser av att vänta på en njurtransplantation. Teman som valdes ut är:Osäkerhet i väntan på en njurtransplantation; Behovet av stöd från omgivningen. Slutsats: Att få en njurtransplantation innebär en chans till ett nytt liv. Den komplexa processen som en transplantation innebar framkallade många upplevelser hos patienter med njursjukdom. Vårdens insatser bör vara inriktade på att utveckla strategier och vara mer fokuserade på patienternas behov av information och kunskapsutveckling för att kunna hantera upplevelserna vid väntan på en njurtransplantation. / Background: There are currently around 700 people waiting for a kidney transplant in Sweden. Kidney transplantation is a lifesaver for many patients undergoing dialysis or other previous interventions to be able to live a “norma llife”. In order to be able to offer the best care, the nurse should have a good knowledge of patients' experiences. Aim: The purpose of the literature study was to shed light on patients´ experiences of waiting for a kidney transplant. Method: The literature study is based on ten scientific studies with a qualitative method. Quality review of the articles and compilation of results was carried out. Results: The results are presented through two themes that include patients´experiences of waiting for a kidney transplant. Themes selected are: Uncertaintyin waiting for a kidney transplant; The need for support from the environment. Conclusion: Getting a kidney transplant means a chance at a new life. The complex process involved in a transplant evoked many experiences in patients with kidney disease. Healthcare efforts should develop their strategies and be more focused on the patients´ needs for information and knowledge development in order to be able to manage the experiences while waiting for a kidney transplant.