Thesis (M.S.)--University of Wisconsin--Madison, 1985. / Typescript (photocopy). eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 81-86).

Thesis (M. Soc. Sc.)--University of Hong Kong, 2003. / Also available in print.

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

Made available in DSpace on 2014-08-13T14:50:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-02-04Bitstream added on 2014-08-13T18:01:33Z : No. of bitstreams: 1 000745597.pdf: 441942 bytes, checksum: 2fa4ddc3e6855f918b616ea4223e18f7 (MD5) / Esta dissertação teve como objetivo estudar os modelos marginais e condicionais utilizados em análise de sobrevivência multivariada e avaliar o efeito das covariáveis medidas no tempo, até a ocorrência de eventos cardiovasculares em pacientes prevalentes em tratamento dialítico no hospital das Clínicas da Faculdade de Medicina da UNESP – Campus de Botucatu, SP, com seguimento de 2008 a 2011. Como os dados tratam de eventos recorrentes do mesmo tipo, foram utilizados na modelagem os modelos marginais – AG (Andersen & Gill, 1982), PWP (Prentice et al., 1981) e WLW (Wei et al., 1989) – e os modelos condicionais – semiparamétricos com distribuições gama e lognormal para a variável de fragilidade. As covariáveis consideradas neste trabalho foram variáveis clínicas, nutricionais, laboratoriais e dialíticas. Foram consideradas em todos os modelos as covariáveis significativas ao nível de 5%, utilizando os critérios de seleção de covariáveis: backward, forward e stepwise. Apresentou-se também os valores do critério de AKAIKE (AIC), critério de AKAIKE corrigido (AICc) e o critério de informação de Bayes (BIC) para esses modelos. Foram discutidas outras questões importantes para selecionar o melhor modelo para o conjunto de dados, como a frequência de eventos e se a ocorrência de novos eventos é influenciada por eventos anteriores. A partir desses critérios, o modelo PWP foi o modelo selecionado para esses dados, e em seguida foi feita a análise de resíduos pelos resíduos de Shoenfeld e Martigale, o que mostrou que esse modelo se ajustou bem aos dados. Sendo esta análise feita no programa estatístico R Development Core Team (2012). Ao interpretar as covariáveis do modelo, observou-se a associação entre o quociente de massa extracelular corporal por massa celular corporal (MEC/MCC) com a ocorrência de eventos cardiovasculares em pacientes em diálise, sendo que tal exploração até o ... / The aim is to study the marginal and conditional models used in multivariate survival analysis and to evaluate the effect of the covariates measuared over time for ocurrence of recurrring cardiovascular events in patients under dialysis treatment from clinics hospital of the Medicine Faculty, UNESP - Botucatu, SP, with follow-up time from 2008 to 2011. As the data treat the recurring events of the same type, the marginals models – AG (Andersen & Gill, 1982), PWP (Prentice et al., 1981) and WLW (Wei et al., 1989) – and the conditionals models – frailty models with lognormal and gamma distributions – were used in the modeling. The covariates considered in this study were clinical, nutritional, laboratory and dialytic. The covariates were considered significant at 5% in all models using the covariates selection criteria: backward, forward and stepwise. It also presented the values of the criteria of AKAIKE (AIC), corrected criteria of AKAIKE and criteria of the Bayes (BIC) for these models. Other issues were discussed to select the best model for the data set, as frequency and the influence of previous events to the occurrence of new events. Based on these criteria, the PWP model was selected to model the data. Residual analysis was done by using the Shoenfeld and Martigale residuals, showed that this model fits the data well. All the results were obtained in R software (R Development Core Team, 2012). The results showed association between the quotient extracellular mass by body cell mass (MEC/MCC) covariate and the occurrence of cardiovascular events in dialysis patients such exploration such finding is new for multiple events per individual

Orientador: Liciana Vaz de Arruda Silveira / Banca: Lídia Raquel de Carvalho / Banca: Aline Araújo Antunes / Banca: Adriano Dias / Banca: Miriam Hamuri Tsunemi / Resumo: Esta dissertação teve como objetivo estudar os modelos marginais e condicionais utilizados em análise de sobrevivência multivariada e avaliar o efeito das covariáveis medidas no tempo, até a ocorrência de eventos cardiovasculares em pacientes prevalentes em tratamento dialítico no hospital das Clínicas da Faculdade de Medicina da UNESP - Campus de Botucatu, SP, com seguimento de 2008 a 2011. Como os dados tratam de eventos recorrentes do mesmo tipo, foram utilizados na modelagem os modelos marginais - AG (Andersen & Gill, 1982), PWP (Prentice et al., 1981) e WLW (Wei et al., 1989) - e os modelos condicionais - semiparamétricos com distribuições gama e lognormal para a variável de fragilidade. As covariáveis consideradas neste trabalho foram variáveis clínicas, nutricionais, laboratoriais e dialíticas. Foram consideradas em todos os modelos as covariáveis significativas ao nível de 5%, utilizando os critérios de seleção de covariáveis: backward, forward e stepwise. Apresentou-se também os valores do critério de AKAIKE (AIC), critério de AKAIKE corrigido (AICc) e o critério de informação de Bayes (BIC) para esses modelos. Foram discutidas outras questões importantes para selecionar o melhor modelo para o conjunto de dados, como a frequência de eventos e se a ocorrência de novos eventos é influenciada por eventos anteriores. A partir desses critérios, o modelo PWP foi o modelo selecionado para esses dados, e em seguida foi feita a análise de resíduos pelos resíduos de Shoenfeld e Martigale, o que mostrou que esse modelo se ajustou bem aos dados. Sendo esta análise feita no programa estatístico R Development Core Team (2012). Ao interpretar as covariáveis do modelo, observou-se a associação entre o quociente de massa extracelular corporal por massa celular corporal (MEC/MCC) com a ocorrência de eventos cardiovasculares em pacientes em diálise, sendo que tal exploração até o ... / Abstract: The aim is to study the marginal and conditional models used in multivariate survival analysis and to evaluate the effect of the covariates measuared over time for ocurrence of recurrring cardiovascular events in patients under dialysis treatment from clinics hospital of the Medicine Faculty, UNESP - Botucatu, SP, with follow-up time from 2008 to 2011. As the data treat the recurring events of the same type, the marginals models - AG (Andersen & Gill, 1982), PWP (Prentice et al., 1981) and WLW (Wei et al., 1989) - and the conditionals models - frailty models with lognormal and gamma distributions - were used in the modeling. The covariates considered in this study were clinical, nutritional, laboratory and dialytic. The covariates were considered significant at 5% in all models using the covariates selection criteria: backward, forward and stepwise. It also presented the values of the criteria of AKAIKE (AIC), corrected criteria of AKAIKE and criteria of the Bayes (BIC) for these models. Other issues were discussed to select the best model for the data set, as frequency and the influence of previous events to the occurrence of new events. Based on these criteria, the PWP model was selected to model the data. Residual analysis was done by using the Shoenfeld and Martigale residuals, showed that this model fits the data well. All the results were obtained in R software (R Development Core Team, 2012). The results showed association between the quotient extracellular mass by body cell mass (MEC/MCC) covariate and the occurrence of cardiovascular events in dialysis patients such exploration such finding is new for multiple events per individual / Mestre

Background: Chronic Kidney Disease is a global health problem. In the United Kingdom, there is impetus for self-management of long term conditions. In 2002, the National Institute for Health and Clinical Excellence’ technology appraisal guideline on haemodialysis suggested that 10%-15% of the centre’s dialysis population should undertake home haemodialysis. The clinical community is yet to rise to this challenge. In this study, we seek to explore patient-related clinical and psychosocial predictors and provider beliefs and attitudes which determine the choice of self-care dialysis, particularly, home haemodialysis. Design and methods: The design is a combined cross-sectional and longitudinal study employing an integrated mixed methodology (convergent, parallel design). Study participants include patients and multidisciplinary staff. The three patient cohorts (n = 535) include pre-dialysis (222), hospital (213) and self-care haemodialysis patients (100) from geographically distinct NHS sites, and with variable prevalence of home haemodialysis (low <3%; medium 5-8%; high >8%). The pre-dialysis patients were followed up for a period of 12 months from study entry. Quantitative data ascertained include biomarkers, clinical, psychosocial quantitative and neuropsychometric-cognitive tests in the study cohorts. Organizational attitudes and dialysis unit practices were gathered from a survey of the participating units. Semi-structured interviews were carried out for patients and care-providers. The datasets were analysed independently and the findings mixed at the stage of interpretation. Statistical tests appropriate to the specific questions were considered for the quantitative data and qualitative data was analysed using thematic analysis. Results: Home haemodialysis has a high composite (training+home) technique survival rate of 90.2%, 87.4% & 81.5% at 1, 2 and 5-years respectively in a death and transplantation censored analysis. The key predictors of self-care dialysis, especially home haemodialysis, are self-perceived higher cognitive ability (metaconcentration), lower comorbidity score, home ownership, and white ethnicity background. There are 20% lower odds of choosing self-care dialysis over fully-assisted dialysis for every unit reduction in metaconcentration score and this is significantly associated with trails making test B, an objective test of executive brain function. Perceived inability to self-cannulate was a significant predictor of the choice of peritoneal dialysis over home haemodialysis amongst CKD-5, predialysis patients. However, approximately 1 in 3 patients from the predialysis and hospital haemodialysis groups feel able to consider self-cannulation. The centre to which the patient belonged had an impact on the choice of dialysis modality, with greater proportion opting for home haemodialysis in a centre with greater home haemodialysis prevalence. Amongst predialysis patients who made a modality choice, the experience of their interaction with healthcare teams and dialysis counselling, self-efficacy, personal fulfilment through work and social engagements, and their views of the modality’s impact on their significant others, influenced the choice of home or hospital-based haemodialysis. 45% of all respondents in a survey of healthcare practitioners felt that staff knowledge and bias influenced the offer of home haemodialysis therapy. At a policy level, the tariff for home haemodialysis was not a clear incentive for its adoption due to uncertainty about operational costs. Conclusions: There exists a perception of lack of uniformity in practice pertaining to offer of home haemodialysis across the study centres. The impact of financial incentives designed at a policy level is influenced by the understanding of cost and benefits at the local operational level. Most barriers are surmountable and patients should be able to consider self-care therapies option in all but the most limiting physical and cognitive states. There is a need locally, for units to investigate barriers to home haemodialysis therapy using a conceptual framework in order to facilitate change.

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13268号 / 論医博第2182号 / 新制||医||1038(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 佐藤 俊哉, 教授 今中 雄一, 教授 柳田 素子 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

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

Valacyclovir is an oral antiviral agent being used more frequently than acyclovir because of the ease of administration and efficacy. Serious neuropsychiatric side effects have been demonstrated with the use of valacyclovir in renal failure patients. We report a case of valacyclovir neurotoxicity to emphasis the importance of dose adjustment in patients with chronic kidney disease and on dialysis.