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by Szeto, Cheuk Chun. / Thesis (M.D.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (p. 183-206). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

The addition of urea clearance monitoring to the care regimen of renal failure patients provides a dramatic decrease in complications due to improper or inadequate dialysis. Present methods of monitoring urea clearance are computationally complex and expensive to perform, resulting in poor rates of clinical acceptance of this measurement. Dialysate-side urea levels have been shown to relate to traditional measures of dialysis adequacy without the need for complex calculations. The requirements for photometric reagents or electrodes make determination of the urea level expensive and time consuming. This research is focused on the development of an optical measurement system to determine the sample urea level without the need for reagents. An algorithm was developed to predict the urea concentration of the sample from a set of optical transmission parameters recorded from the sample using a specially developed instrument. This instrument records the difference in sample transmission at two different wavelengths. Energy at the first wavelength is absorbed by urea, and the second wavelength is selected such that the matrix of the sample absorbs energy at both wavelengths equally. This effectively nulls out the absorbance of the background matrix, significantly improving the urea detection sensitivity. The algorithm was developed from an analysis of the instrument data and factors causing variations in the data. Calibration, bench study, and clinical protocols were designed, and performed using these protocols. Using a partial least squares approach, the algorithm was fit to a set of training data. The resulting algorithm was used to predict the urea content of patient hemodialysis samples. Compared to a reference standard (Beckman CX7, standard error /dl), the standard error of prediction for this algorithm was 0.47 mg/dl (N = 34 patients). The algorithm was able to predict dialysate urea at clinically relevant levels in samples collected from hemodialysis patients. Qualitative relationships were developed between the sample urea level and the data recorded from the sample. This system has the potential to provide a method that clinicians can use to efficiently and effectively monitor urea removal over the course of a dialysis session.

"Excessive discharge of heavy metals has been one of the major causes of water pollution worldwide. Various traditional methods of heavy metal removal have been devised but certain drawbacks like high cost, high energy requirement, and the production of toxic sludge have limited their use. Hence, biosorption is one of the alternative methodologies. This study combined biosorption and diafiltration in an attempt to optimize Polymer Enhanced Diafiltration to study copper removal from aqueous solutions by the use of a biopolymer, lambda-carrageenan. Lambda-carrageenan was studied as a biosorbent owing to properties such as low cost, good water solubility, non-gelling nature and the presence of sulfate groups which can sequester cations. Conditions for binding such as pH, temperature and concentration of copper and lambda-carrageenan were studied. Equilibrium dialysis experiments were performed to study the metal ion membrane transport kinetics and to determine the metal ion binding capacity and strength of the copper-biopolymer association. Rheological measurements were performed to determine how the viscosity of lambda-carrageenan changes with increase in shear stress and with increase in metal concentration. The solution was found to be shear thinning. However, with increase in metal concentration, viscosity was found to increase when high concentrations of polymer (8 g/L and 12 g/L) were used. Solution viscosity was found to decrease with increase in metal concentration when 4 g/L of polymer was used. Polymer Enhanced Diafiltration studies showed no leakage of the polymer through the membrane and no significant binding elsewhere in the PEDF system. It also showed an impressive retention of copper inspite of a rather high metal ion-polymer dissociation constant suggesting a yet not understood series of events occurring on the membrane of the PEDF system. Lambda-carrageenan is a linear polysaccharide, which might be stacking up on the membrane after forming layers, and not allowing any free metal ion to escape. Other reasons could be the sieving effect, degradation of the polymer due to shear and compaction of molecule on metal binding such that the polymer is not itself escaping through the membrane, but also not allowing the free metal ion to escape. Hence, this study suggests the need for more information on the metal-polymer interactions on the surface of the membrane by designing a direct observation experiment with a mini-tangential flow filtration system."

Patients receiving dialysis treatment experience immense changes in their health and well-being, therefore receiving adequate social support services is an integral aspect of their care plan. Thus, the purpose of this study was to gain an understanding about social support services offered by social workers to patients receiving dialysis care. Furthermore, this study sought to develop awareness about additional services need to assist social workers in providing social, emotional, and physical support to patients. This qualitative study used data from a non-probability snowball sample of 10 social workers that work with patients receiving dialysis care. Findings of this study are significant to social work practice as the analysis provided insight that may enhance current practices in dialysis centers. Furthermore, the qualitative analyses gathered through the one-on-one interviews led to the emergence of seven central themes. Themes anticipated by the researchers included the perception about the ability to provide social, emotional, and physical support, as well as to highlight the role of social workers in this healthcare setting. Additional themes identified during this study focused on reasons for patients lacking social support, the scarcity of resources, and recommendations corroborated with first-hand experiences in the field to better serve patients. Recommendations included increased focus on providing therapeutic services within dialysis, additional transportation options for patients, and greater availability of resources to meet the various needs of patients.

ASSOCIATION OF AGE, GENDER AND RACE IN CHRONIC KIDNEY DISEASE PATIENTS WITH AND WITHOUT DIALYSIS 1Busayo Adeyemi Onatolu, 2Hemang Panchal, 3Edward Francis Leinaar, 1*Shimin Zheng, 2Timir K. Paul 1Department of Biostatistics and Epidemiology, College of Public Health, ETSU, Johnson City, TN 37614 2Department of Internal Medicine, Quillen College of Medicine, ETSU, Johnson City, TN, 37614 3Department of Health Services Management and Policy, CPH, ETSU, Johnson City, TN 37614 *Sponsoring faculty Introduction: Studies have shown that chronic kidney disease (CKD) is common among adults in the United States. The Centers for Disease Control and Prevention (CDC) states that 30 million people, or 15% of US adults, are estimated to have CKD. Forty-eight percent of those with severely reduced kidney function are not aware of having CKD, and therefore do not receive hemodialysis (HD). Methods: A nationwide inpatient sample database from 2012-2014 was used to identify all patients admitted to the hospital using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes (n= 534,845). Patients with dialysis dependent CKD (n=8,100) and CKD without dialysis (n=51,285) were compared to non-CKD patients (n=475,460). Hierarchical logistic regression was performed and p Results: Of the 534,845 patients, 88.9% were without CKD and 9.59% had CKD without HD and 1.51% had CKD with HD. Among patients with CKD, 13.64% were on HD and 86.34% were non-HD patients. The result shows that a higher proportion of patients with CKD without HD in the ≥ 80 years age group (≥ 80 = 37.84%, 65-79 = 36.94%, 50-64 = 20.80%, 35-49 = 4.12% and 18-34 = 0.30%) and a higher proportion of patients with CKD with HD in the 65-79 years age (≥ 80 = 16.30%, 65-79 = 41.79%, 50-64 = 33.09%, 35-64 = 8.09% and 18-34 = 1.29%). The OR of age group 18-34 compared to ≥ 80 is 5.690, 95% CI: 4.202,7.705, OR 35-49 is 4.552, 95% CI: 4.552, 95% CI: 4.103, 5.050, OR of 50-64 is 3.693, 95% CI: 3.444, 3.961 and OR 65-79 is 2.626, 95% CI: 2.457, 2.807. Males had higher rates of CKD than females, without HD (Male= 63.12%, female= 36.88%, p Conclusion: From this study, males had higher rates of CKD with and without HD than females, the age group ≥ 80 years had higher proportion of CKD without HD and those between 65-79 years had higher number of CKD with HD. Whites had higher rates of CKD with and without HD than other races.

Thesis (M. Soc. Sc.)--University of Hong Kong, 2003.

Stress within healthcare environments can be the result of uncertainty, illness, or the environment itself. In order to promote better health outcomes for dialysis users, scientific literature advocates stress reduction within healthcare environments. Dialysis patients are subject to numerous stressors, including the threat of potential losses and lifestyle change. Studies have revealed that patients who suffer from chronic illness perceive different levels of quality of life than those who are considered healthy and because of these lifestyle changes they employ various coping mechanisms when dealing with stress. There is a rising movement to mitigate stress through the use of holistic healing, an approach that addresses a person’s mental, emotional, physical, and spiritual elements to create a total healing environment. In accordance with this growing movement, the intent of this practicum is to create an outpatient centre for Manitoba’s dialysis patients that increases their perceived quality of life. The inquiry process began by questioning dialysis patients and conducting observational research at the Winnipeg Health Sciences Centre. Literature and precedent reviews were conducted, and the design programme was developed. The result of this research-based design proposal is an outpatient hemodialysis centre located within the Winnipeg Health Sciences Centre that helps mitigate stress while patients attempt to cope with lifestyle changes. The resulting design is one that is warm, welcoming, home-like and comfortable, which is supported by the theories explained in the literature review. This environment provides a greater sense of control, creates positive distractions and allows spiritually evoking opportunities to take place for all users of this new facility. / February 2009

Sammanfattning Syftet med denna studie var att beskriva hur hemodialyspatienter uppfattar begreppet torrvikt. Studien utnyttjade en beskrivande design med kvalitativ ansats. Data insamlades via intervjuer med öppen frågeställning. Tio intervjuer utfördes med patienter på en dialysenhet i Mellansverige. Manifest innehållsanalys användes för att analysera materialet. Resultatet utmynnade i sex kategorier: överlämnande, okunskap, börda, delaktighet, insikt och ignorans. Begreppet torrvikt är grundläggande vid genomförandet av en adekvat och säker hemodialysbehandling, eftersom torrvikten styr avgörande delar av behandlingsregimen. Huvudresultatet visade att vissa av deltagarna i studien inte har någon uppfattning om vad begreppet torrvikt är och vad det innebär. Andra deltagare uttryckte en känsla av utanförskap samt upplevde torrvikten som en börda i vardagslivet. Vissa av deltagarna kände sig mer delaktig i sin situation när de gjorde en del kontroller under behandlingen själv. I det kliniska arbetet har dialyssköterskan en viktig uppgift i att bistå patienten att uppnå förståelse för vilken central roll begreppet torrvikt har för dennes behandling. Vad begreppet står för utgör en barriär i kommunikationen mellan den dialysbehövande och dennes vårdgivare/sjuksköterska. Konklusionen i denna studie påvisar att det finns brister i kunskapsförmedlingen till dialyspatienter. Resultatet kan ha betydelse för fortsatt utveckling i den kliniska verksamheten.     Nyckelord: Torrvikt, undervisning, dialys. / Abstract The purpose of this study was to describe how haemodialysis patients perceive the concept of dry weight. The study used a descriptive design with a qualitative approach. Data was collected through interviews with open questions. Ten interviews were carried out with participants at a dialysis unit in central Sweden. Manifest content analysis was used to analyze the material. The analysis resulted in six categories: presentment, ignorance, burden, empowerment, insight and neglection. The concept of dry weight is essential in the implementation of an adequate and safe hemodialysis treatment, since the dry weight control crucial aspects of the treatment regimen. The main results showed that few of the participants in the study had no idea of what the concept of dry weight was and what it meant. Some of the participants expressed a sense of alienation and felt that dry weight was a burden in everyday life. A few of the participants felt more involved of their situation when they did some checks during treatment itself. In the clinical work has dialysis nurse an important role in assisting the patient to achieve understanding of the crucial role that the concepts of dry weight are on their treatment. What the concept stands for is a barrier in communication between the patient and his/hers caregiver/nurse. The conclusion of this study demonstrates that there are gaps in knowledge mediation to dialysis patients. Results may be important for further development in the clinical practice.       Keywords: Dry weight, education, dialysis.

Background:Various amalgamation diseases which the ESRD patient of may suffer from have already had quite a lot of research to latter stage abroad .Recently, Abroad research find The ESRD patient in carry on extended dialysis can exert an influence or appear melancholy mood to psychological condition their treat .Extended dialysis may influence its medical resource to use or increase mortality.It gradually become to a topic. Objectives¡GThis study explores the prevelance of ESRD with melancholia and finds out if there are any significant difference upon demography status, comorbodities, dialysis therapy, utilization of health care between ESRD with melancholia and without melancholia.As well as we will discuss the risk factors of ESRD patient with melancholia. Methods¡GWe conducted secondary data analysis with admnstrative data of National Health Insurance between 2000, 2002, 2004 and 2006. We firstly seleced the patients diagnosed as ESRD and melancholia, and merged the data set and other related variables.The data was analyzed by Chi-square test, t-test and logistic regression. Result¡GThe prevelance of ESRD with melancholia were 0.47%(2000), 0.73%(2002),1.27%(2004), 1.34%(2008)¡FESRD patients with and without melancholia was significant difference (p < 0.0001) between sex, dialysis therapy, dialysis duration, and the regions of hospital organizations, class of hospital organizations. ESRD patients with and without melancholia was significant difference (p < 0.0001) between age, comorbidities, dialysis duration, outpatient visits and expenditures. Conclusion¡GThe study was benefited by large sample of adminstative data, but there were some limitation of precision of diagnoses and payment issue of health care system, therefore, we strongly suggested further study could be conducted by research questionnaires to make up the weakness of adminstatrative data.