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Objective: To understand the experiences of the dialysis decision-making process from the perspective of the significant other, specifically their role, influencing factors and the supportive interventions of the interprofessional team. Method: An interpretive description qualitative study was conducted using individual interviews and results were triangulated with decisional conflict and decisional regret quantitative results. Results: Ten participants described their role as advocating, providing a positive outlook, ‘being with’ the patient, learning together, sharing opinions, and communicating about values, preferences, feasibility of options. Environmental factors that influenced decision making included unexpected life change, choosing life, and personal health problems. Factors related to implementation of the treatment modality decision were unanticipated events, relationship changes, recreational travel changes, and the caregiver role. Nursing interventions are required to realign treatment expectations. Relevance: Significant others have an important role in supporting the patient making the dialysis decision and are often instrumental in implementing the decision.

Faculty of Health Sciences, Degree of Master in Medicine. 9713161h / Introduction: Numerous studies have confirmed the association between the delivered dose of haemodialysis and patients outcomes. There is thus some evidence regarding the relationship between dialysis dose and quality of life. Objective: The study was designed to assess dialysis adequacy using urea kinetic modelling parameters and to determine the association between dialysis dose and patient outcomes. Methods: A retrospective review of the demographic and biochemical data of 61 patients on chronic haemodialysis in the year 2003 was performed and a prospective component was added to the study for quality of life and evaluation of cardiovascular comorbidity. Results: The mean delivered dose Kt/V was 1.34 ± 0.25. There was a statistically significant correlation (p<0.05) between dialysis dose and the following parameters: haemoglobin, physical dimension and its 3 scales, the SF-36 overall score, as well as between dialysis dose and sepsis. Conclusion: The dialysis dose correlated with a significant number of parameters including Hb and the physical components of the SF-36; hence, the importance of measuring the delivered dialysis dose of patient on maintenance dialysis in accordance with DOQI guidelines for improved patient outcomes is confirmed.

Hemodialysis induces various symptoms in many patients. However, the type of dialysis symptoms induced and how they contribute to recovery time remains unclear. This study aims to understand patient experiences reporting dialysis recovery time and associated symptoms using three separate novel instruments developed for this study. We conducted a 13-week prospective cohort study in prevalent in-center hemodialysis patients and measured their recovery time using three instruments. Instrument A inquired how long it took to recover from the last dialysis treatment. Instrument B inquired recovery time from last treatment for each of 10 specified symptoms and Instrument C included symptom severity to Instrument B. Each instrument was used for each dialysis treatment for one week. We compared patient response and distribution of recovery time found with each instrument using mixed-effects logistic regression models. 118 participants were recruited from two centres of which 914 (86%) of 1062 expected responses were completed. Recovery time using instrument A resulted in more participants identifying some recovery time from dialysis (83 to 86%) as compared with Instrument B (66 to 80%, p = 0.001) and Instrument C (69 to 73%, p <0.001). The third visit of the week was associated with fewer patients reporting recovery time (p = 0.036). However, Instrument B (p = 0.016) and Instrument C (p < 0.001) showed a longer recovery time compared to the distribution of recovery time of Instrument A. Lack of energy was the most common symptom following dialysis (69 to 77% of all patients). Recovery time with Instrument A was a significant predictor of kidney-specific component scores and mental component score as measured by the Kidney Disease Quality of Life-36 instrument. Recovery time is complex, and includes different symptoms that vary in duration. Attempts to reduce recovery time may impact specific symptoms differentially. / Thesis / Master of Science (MSc)

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 6 uppsatser.

Thesis (doctoral)--University of Uppsala, 1983. / Includes bibliographical references (p. 38-46).

This thesis deals with the processing of a business plan in the health sector . This is a draft business plan strategy for the introduction of outreach services for ambulatory peritoneal dialysis patients in the private health care facilities . The theoretical part is devoted to the characteristics of the services provided, including a description of the current situation and possibilities in the treatment of peritoneal dialysis patients in the home environment in the Czech Republic and abroad. It is also described the concept of strategic management and planning, of which I have in this thesis was based on creating your own business plan. In the practical part , which includes the characteristics of an organization that will provide the service , I made a concrete proposal for a business plan based on identified strategic analysis of the findings . The conclusion is presented feedback from stakeholders, which I used in finalizing the business plan. The aim of the work was to present the methodology of the business plan , which will form the basis for strategic management of development organizations to expand services for patients through the introduction of outreach services for ambulatory peritoneal patients. Key words: business strategy, business plan, dialysis, peritoneal dialysis, assisted...

published_or_final_version / Medicine / Doctoral / Doctor of Philosophy