Thesis (doctoral)--Lund University, 1995. / Added t.p. with thesis statement inserted.

An experimental study was undertaken to answer the question posed by the problem: "Does a nursing intervention which utilizes a decisionmaking model to assist patients in establishing personal goals for adherence to fluid and potassium restrictions significantly decrease weight gains between dialyses and pre-dialysis serum potassium levels, compared with the values for these variables in a control group which does not have the intervention?" Sixteen chronic hemodialysis patients from one large teaching hospital were selected according to pre-established criteria, and then randomly assigned to either experimental or control conditions. The Experimental group was exposed to the nursing intervention, which was the independent variable. The nursing intervention consisted of an initial interview, during which the patients completed a Balance Sheet Procedure, and established personal goals for weight gain between dialyses and pre-dialysis serum potassium levels. Thereafter, for a period of five weeks, the patients in the Experimental group completed a Well-Being Rating Scale at each dialysis and charted their progress toward their goals on a Progress Sheet. The dependent variables were between dialyses weight gains and pre-dialysis serum potassium levels. Data Pertaining to the dependent variables were collected on both Experimental and Control patients in all three phases of the study: the six month Pre-Intervention Phase, the five week Intervention Phase, and the three week Follow-Up Phase. The Theoretical Framework on which the study was based is Jam's and Mann's Conflict Theory (1968), and their Balance Sheet Procedure, which was used to facilitate personal decision-making and goal setting by patients in relation to between dialyses weight gains and pre-dialysis serum potassium levels. The results indicated that the Experimental group obtained significantly lower pre-dialysis serum potassium levels during the Intervention Phase than the Control group, but there were no significant differences between the two groups in weight gains between dialyses. The Well-Being Rating Scales completed by the Experimental patients indicated that well-being tended to increase slightly over the study period, and was significantly related to the achievement of the goals the patient had established for weight gains and potassium levels. A negative correlation was found between well-being and weight gain. The implications of these findings for the nursing care of hemodialysis patients are discussed, and recommendations for further research are presented. / Applied Science, Faculty of / Nursing, School of / Graduate

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13289号 / 論医博第2187号 / 新制||医||1039(附属図書館) / (主査)教授 中山 健夫, 教授 柳田 素子, 教授 佐藤 俊哉 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 4 uppsatser.

Introdução: A hemodiálise é um procedimento invasivo, para pacientes em falência renal onde se realiza a filtração do sangue continuamente, utilizando-se circulação extracorpórea em um filtro hemodialisador. No Brasil, a prática do reuso de hemodialisadores atinge quase 100% nos serviços de diálise. Uma das justificativas para o reuso são os limitados recursos para a assistência à saúde. No entanto, esta prática, causa questionamentos relacionados à segurança. Erros técnicos no reprocessamento, qualidade da água e alteração da integridade da membrana do hemodiliasador podem afetar a qualidade do processamento expondo os pacientes ao risco de bacteriemia e sepse. Objetivo: Avaliar a contaminação microbiana dos hemodialisadores após o número máximo de reusos permitidos, comparando os resultados conforme tipo de processamento: manual e automatizado. Método: Esta pesquisa caracterizou-se como estudo de campo, transversal, de caráter exploratório comparativo em dois serviços de diálise. A composição da amostra foi por conveniência conforme a disponibilidade destas, pelas instituições doadoras, sendo os grupos experimentais compostos por 11 hemodialisadores processados pelo método automatizado e quatro hemodialisadores processados manualmente. As amostras foram coletadas após o processamento obedecendo ao número máximo de reusos permitidos pela RDC ANVISA nº 11/2014, sendo 12 reusos para processamento manual e 20 reusos para processamento automatizado. Em Cabine de Proteção Biológica a solução salina e dialisadora foram drenadas dos compartimentos de sangue e dialisato, respectivamente, e injetados 150 mL de meio de cultura Tioglicolato de Sódio Fluido em cada compartimento. As amostras foram incubadas em estufa microbiológica por 14 dias, a temperatura de 35 ºC ±2ºC. Após esse período alíquotas do meio de cultura foram semeadas em meios de ágar sangue, anaerinsol e sabouraud, capazes de recuperar a maioria dos microrganismos aeróbios, anaeróbios, bolores e leveduras. As placas foram incubadas por 48 horas a 35 ºC ±2ºC, e procedida a identificação de gênero dos micorganismos. Realizados controles positivos com hemodialisadores contaminados intencionalmente e controles negativos, com novos esterilizados. Resultados: Das amostras submetidas ao processamento automatizado três amostras (3/11-27,3%) apresentaram crescimento microbiano no compartimento de sangue, sendo identificados dois diferentes microrganismos: de Sphingomonas paucimobilis (66,67%) e de Penicillium sp. (33,33%). Todas as amostras 11/11 (100%) apresentaram crescimento microbiano no compartimento de dialisato, sendo identificados 5 diferentes microrganismos: Sphingomonas paucimobilis (43,75%), Strenotrophomonas maltophilia (25%), Pseudomonas aeruginosa (18,75%), Acinectobacter baumannii (6,25%) e Candida sp (6,25%). Dos quatro hemodialisadores submetidos ao processamento manual, uma amostra (25%) apresentou crescimento de bacilo Gram-positivo no compartimento de sangue e uma amostra (25%) apresentou crescimento no compartimento do dialisato contaminados por três microrganismos distintos: de Bacillus sp, Rhizobium radiobacter, Burkholderia sp. Comparando os resultados da contaminação microbiana segundo os dois métodos de processamento analisados não houve diferença estatisticamente significante (p=1) para o compartimento de sangue. Para o compartimento do dialisato o método automatizado apresentou maior número amostras positivas em relação ao manual (p=0,008791). Conclusão: Os resultados demonstraram que o reuso dos hemodialisadores não é uma prática recomendada, podendo causar bacteriemia e sepse em pacientes em tratamento hemodialítico. Ressalta-se que a pesquisa foi conduzida no pior cenário após o número máximo de reusos permitidos sem determinar em qual número de reusos a contaminação aconteceu. / Introduction: Hemodialysis is an invasive procedure for patients with kidney failure in which blood is continuously filtered using a dialyzer filter through extracorporeal blood flow. In Brazil dialyzers are nearly 100% reused in dialysis facilities. One of the main justifications to reuse dialyzers is economical. However, this practice often leads to concerns related to patient safety. Technical errors in reprocessing, water quality and the membrane dialyzer degradation may lead to different risks including bacteremia and sepsis. Objective: To evaluate dialyzers regarding microbiological contamination after maximal number of reuses, comparing results in accordance with the type of reprocessing: manual and automated. Method: This research was characterized as a transversal, exploratory and comparative in two dialysis facilities. The sample was composed as convenience according to the availability of the facilities which donated the samples. The experimental groups were composed of 11 automated reprocessed dialyzers and four manually reprocessed dialyzers. The samples were collected after reprocessing in dialysis facilities according to the maximal number of reuses permited by law (12 in manual reprocessing and 20 in automated reprocessing) and prepared in Biosafety Cabinets. Saline Solution and dialysate solution were drained from both the blood and the dialysate chambers, respectively, by applying suction and filled with 150 mL of culture medium sodium thioglicolato fluid in each chamber and they were incubated at a temperature of 35 º C + or -2 ° C for 14 days. After this period, the samples were cultured in medium adequate for the growth of aerobic and anaerobic organisms as well as fungi and yeasts.The samples were incubated for 48 hours at 35 º C + or -2 ° C and identification of microorganisms was carried. Results: The analyzed samples which were automated reprocessed, 3/11(27.3%) showed microbiological growth in the blood chamber, of this total, we identified two different microorganisms: S.paucimobilis (66,67%) and Penicillium sp. (33,33%). In the dialysate chamber 11/11 (100%) of microbiological growth was identified, of this total we identified five different microorganisms: S.paucimobilis (43,75%) , S. maltophilia (25%) , P. aeruginosa (18,75%) , A. baumannii (6,25%) and Candida sp. (6,25%). The four analyzed samples which were manually reprocessed, 1/4(25%) showed microbiological growth in the blood chamber. One sample with Gram-positive Bacillus was identified in the dialysate chamber and contaminated by Bacillus sp, R. Radiobacter and Burkholderia sp. Comparing the results related to microbiological growth according to the two methods in the blood chamber, we concluded that there was no statistically significant difference (p=1) and in the dialysate chamber, there was a higher number of positive samples among those which were automated reprocessed compared to manually reprocessed (p = 0.008791) Conclusion: The results showed that dialyzers reuse is not a recommended practice and may cause bacteremia and sepsis for patients with chronical kidney disease. We highlight that this study was carried out considering the worst case scenario ,i.e. after the maximal number of reuses permitted by law, without specifying in which number of reuses the contamination occurred.

by Wing-cheung Pang. / Thesis (M.Sc.)--Chinese University of Hong Kong, 1988. / Bibliography: leaves 45-56.

Thematic paper (M.C.T.M. (Clinical Tropical Medicine))--Mahidol University, 2006. / LICL has E-Thesis 0012 ; please contact computer services. LIRV has E-Thesis 0012 ; please contact circulation services.

Thesis (M.S.)--University of Wisconsin--Madison, 1981. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 97-106).

Thesis (M.S.)--University of Wisconsin-Madison. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 56-61).