Made available in DSpace on 2015-04-14T13:35:28Z (GMT). No. of bitstreams: 1 326678.pdf: 874204 bytes, checksum: b8e45583ced3e993e571303b48afd0a2 (MD5) Previous issue date: 2004-11-11 / Objetivo: O presente trabalho tem como objetivo avaliar os metab?litos do ?xido n?itrico (NO) no soro e no perit?nio, e a fun??o endotelial de pacientes em di?lise peritoneal em diferentes categorias de transporte peritoneal, avaliados pelo teste de equil?brio peritoneal. M?todo: Estudo transversal, em pacientes est?veis em DP. Quartis da raz?o dialisado/plasma (D/P) de creatinina, ap?s 4 horas de perman?ncia do l?quido na cavidade, foram usados para classificar o transporte peritoneal em: baixo, baixom?dio, alto-m?dio e alto. Os metab?litos do NO foram medidos por quimioluminesc?ncia (n=41), e a fun??o endotelial avaliada atrav?s da dilata??o mediada por fluxo da art?ria braquial (n=31). Resultados: Os metab?litos do NO no soro, dialisado de 24 horas e de 4 horas n?o foram diferentes entre as categorias. A raz?o de NO no dialisado de 4 horas/soro (D/P de NO) tamb?m n?o foi diferente (p=0,096), mas houve tend?ncia de aumento do baixo para o alto transportador. A mediana (intervalo interquartil) da dilata??o mediada por fluxo n?o foi diferente entre os grupos. Houve correla??o entre NO no soro e dialisado de 4 horas (r=0,891, p<0,001). A D/P de NO foi inversamente correlacionada com o transporte peritoneal de glicose (r=-0,579, p<0,001), e com a ultrafiltra??o (r=-0,422, p<0,001), e diretamente correlacionada com a D/P de creatinina (r=0,533, p<0,001). Conclus?o: Os resultados sugerem que os n?veis de NO refletem permeabilidade perioneal. Os metab?litos do NO n?o s?o um marcador da produ??o peritoneal de NO, em pacientes sem peritonite. A prescri??o de di?lise peritoneal n?o ? dependente da fun??o endotelial

Made available in DSpace on 2015-04-14T13:35:34Z (GMT). No. of bitstreams: 1 439669.pdf: 2432426 bytes, checksum: 926062560772ee0fef9ad537b63bff41 (MD5) Previous issue date: 2012-06-22 / Introduction: Peritoneal dialysis ultrafiltration failure is a functional abnormality associated with increased risk of death and technique failure. Daily ultrafiltration volume early on therapy may predict patient and technique survival. Objective: to determine the relationship between to presence of risk factors, daily ultrafiltration volume, patient and technique survival. Patients and Method: Data were extracted from the observational, multicenter, BRAZPD cohort study. From a population of 2419 suitable patients, 977 incident patients were selected. At the three-month therapy interval, demographic, clinical and technical variables were appraised and daily ultrafiltration volume was analyzed by quartiles (1st: &#8804; 700 ml; 2nd: > 700 ml up to &#8804; 1100 ml; 3rd: > 1100 ml up to < 1600 ml; 4th: &#8805; 1600 ml), as were its changes at the sixth and twelfth follow-up months. Two outcomes were considered : death and technique failure, which were analyzed till the 30th therapy month. Comparison between groups, correlations, patient and technique uni and multivariate survival analyses, using Kaplan-Meier technique and Cox regression analysis, were performed. Results: Age (HR=1.038; 95% CI: 1.027-1.049; P<0.01), diabetes (HR=1.416; 95% CI: 1.043-1.922; P=0.03) and number of co-morbidities (HR=2.687; 95% CI: 1.336-5.407; P<0,01) were directly associated with increased patient mortality. The 4th ultrafiltration quartile related with higher patient and technique survival (P=0.02 and P=0.10, respectively); peritonitis had a strong negative effect upon therapy maintenance (HR=3.459; 95% CI: 2.218-5.394; P<0.01). Conclusion: young, non-diabetic patients had increased chance for survival. High ultrafiltration volumes promoted patient and technique survival. Peritonitis significantly reduced the likelihood of technical success. / Introdu??o: A falha de ultrafiltra??o na di?lise peritoneal ? uma anormalidade funcional associada a risco aumentado para morte e para falha t?cnica. O volume di?rio de ultrafiltra??o, aos tr?s meses de terapia, pode ser fator de risco e preditor precoce para sobrevida de paciente e t?cnica. Objetivo: determinar a rela??o entre a presen?a de fatores de risco, volume di?rio ultrafiltrado e sobrevida de paciente e terapia. Pacientes e M?todo: estudo de coorte baseado em dados do estudo BRAZPD, multic?ntrico, observacional. Foram inclu?dos 977 pacientes incidentes, dentre 2419 eleg?veis. Aos tr?s meses de terapia analisaram-se vari?veis demogr?ficas, cl?nicas e t?cnicas. O volume di?rio de ultrafiltra??o foi analisado por quartis, (1? quartil: &#8804; 700 ml; 2? quartil: > 700 ml e &#8804; 1100 ml; 3? quartil: > 1100 ml e < 1600 ml; 4? quartil: &#8805; 1600 ml, assim como sua varia??o aos seis e doze meses de seguimento. Dois desfechos foram contemplados: morte e falha t?cnica, analisados at? 30 meses de terapia. Compara??es entre grupos, correla??es bem como an?lise univariada de sobrevida - de paciente e t?cnica - foi feita pela t?cnica de Kaplan-Meier e multivariada por regress?o de Cox. Resultados: idade (HR=1,038; IC 95%: 1,027-1,049; P<0,001), Diabetes Mellitus (HR=1,416; IC 95%: 1,043-1,922; P<0,026) e n?mero de comorbidades (HR=2,687; IC 95% -1,336-5,407; P<0,01) foram diretamente associados com mortalidade aumentada do paciente. O quarto quartil de ultrafiltra??o associou-se a maior sobrevida do paciente e da t?cnica (P=0,02 e P=0,10, respectivamente); a ocorr?ncia de peritonite teve impacto negativo para manuten??o da terapia (HR=3,459; IC 95%: 2,218-5,394; P<0,01). Conclus?o: pacientes jovens, sem diabetes tiveram maior chance de sobrevida. Ter alto volume de ultrafiltra??o foi favor?vel ? sobrevida de pacientes e da t?cnica. A ocorr?ncia de peritonite reduziu significativamente a chance de sucesso da t?cnica.

Made available in DSpace on 2015-04-14T13:35:34Z (GMT). No. of bitstreams: 1 441495.pdf: 393716 bytes, checksum: 44d5110d0dc89507b042452bde0134c9 (MD5) Previous issue date: 2012-08-29 / Objective: The aim of this study was to evaluate the relationship between body weight gain and small solute transport by the peritoneum Methods: A retrospective review was conducted of the records from 50 patients over the age of 18 years, all of whom had undergone peritoneal dialysis for at least one year. Weight changes were recorded at quarterly intervals until completion of one year of therapy and were subsequently compared with the categories of peritoneal transport. Biochemical markers including glucose, albumin and lipid profile were evaluated at the beginning of therapy and again one year later. Results: A significant effect of time on the mean body weight of the study participants was detected, as shown by the Repeated Measures Analysis of Variance. The final BMI mean was significantly higher than the initial. A significant reduction in serum albumin also occurred. However, no significant difference was found when comparing the weight change over the first year of treatment to the categories from the peritoneal equilibration test. Conclusion: This study was unable to demonstrate the existence of an association between the initial peritoneal membrane small solute transport with weight changes in patients undergoing peritoneal dialysis. The acknowledged multifactorial nature of obesity may be a possible explanation for our findings. The glucose uptake rate by the peritoneum does not seem to be responsible, therefore, it is necessary to search for factors linked to peritoneal dialysis that would have a greater influence on the observed alterations in nutritional status / Objetivo: o objetivo do presente estudo foi avaliar a rela??o entre aumento do peso corp?reo dos pacientes em di?lise peritoneal e a fun??o de transporte de solutos pelo perit?nio. M?todos: os registros de 50 pacientes maiores de 18 anos, que realizavam di?lise peritoneal h? no m?nimo de um ano, foram revisados retrospectivamente. As altera??es de peso foram registradas em intervalos trimestrais at? completarem um ano de terapia e, posteriormente, foram comparados com as categorias de transporte peritoneal avaliadas pelo teste de equil?brio peritoneal ?s quais pertenciam os pacientes. Marcadores bioqu?micos inclu?ram glicose, albumina e perfil lip?dico avaliados no inicio e ap?s um ano de terapia. Resultados: Foi detectado um efeito significativo do tempo em di?lise na m?dia de peso dos investigados, quanto realizada a an?lise de vari?ncia para medidas repetidas. A m?dia final do ?ndice de massa corporal (IMC) mostrou-se significativamente maior que a inicial. Tamb?m ocorreu uma redu??o significativa da albumina s?rica. A varia??o do peso ao longo do primeiro ano de tratamento n?o foi significativamente diferente entre as categorias do teste de equil?brio peritoneal. Conclus?es: o presente estudo n?o demonstrou a exist?ncia de uma associa??o entre as caracter?sticas do transporte de membrana peritoneal e absor??o de glicose, com as altera??es de peso em pacientes em di?lise peritoneal. A reconhecida natureza multifatorial da obesidade pode ser uma poss?vel explica??o para nossos achados. Entretanto, mais estudos s?o necess?rios a fim de identificar quais destes fatores ligados a di?lise peritoneal teriam uma maior influ?ncia sobre as altera??es no estado nutricional e na composi??o corporal desta popula??o de pacientes

Made available in DSpace on 2015-04-14T13:35:51Z (GMT). No. of bitstreams: 1 452950.pdf: 1650025 bytes, checksum: d2d9176381fad308a3ded6adffbce4e4 (MD5) Previous issue date: 2013-07-30 / Background: Fluid overload (FO) is common in patients on PD and the combination with inadequate nutritional status causes increased mortality in peritoneal dialysis (PD) patient. Bioimpedance spectroscopy is a precise, sensitive and reliable tool for determining the fluid volume status and body composition of PD patients. The main aims of this study were: to compare body composition and volume variables, measured with the dialysis fluid inside the peritoneal cavity (CC) and after its drainage (EC), using the Body Composition Monitor (BCM); and to evaluate associations of the nutritional status and body composition of patients receiving PD, with their volume status. Methods: A cross-sectional study involving 37 stable adult patients (>18 years) on PD. A BCM report was used for the analysis of fluid status and body composition, and was conducted with both a CC and EC. Results: The study sample had the following characteristics: 62.5% female, 68.8% Caucasian, 75.0% on continuous ambulatory peritoneal dialysis (CAPD) and 25.0% on peritoneal dialysis automatized (APD). Evaluation of 32 patients showed no statistical difference between CC and EC in regard to overhydration (OH), total body water, extracellular water, intracellular water and their corrections for height and weight, lean tissue mass, fat tissue mass and their indices, adipose tissue mass, and body cell mass. Pearson's correlation coefficient of OH between CC and EC was r=0.989 (P<0.001). Bland-Altmann plot for OH full and OH empty had a line of bias of -9 mL and 95% limits of agreement from -603 to 585 ml. In another analysis with 37 patients serum albumin was higher in euvolemic (EV) patients (P=0.013), and the Subjective Global Assessment and Malnutrition Inflamation Score were higher in OH patients (P=0.002 and P=0.004, respectively). All hypertensive patients were diagnosed as OH. Several correlations were disclosed between nutritional markers and body composition markers and volemia. Conclusion: The presence of intraperitoneal fluid does not interferes with the evaluation of hydration status using BCM, or in the analysis of corporal composition - lean tissue mass, fat tissue mass, adipose tissue mass and their indices, suggesting that the BCM methodology can be applied in both conditions, with or without drainage of the dialysate solution. Besides the volume status of PD patients has a strong association with nutritional assessment variables. Consequently, a detailed evaluation of volume status should be part of a complete nutritional assessment, aiming an appropriate nutritional state. / Introdu??o: A sobrecarga h?drica (SH) ? um achado comum em pacientes em di?lise peritoneal (DP) e a combina??o com a inadequa??o do estado nutricional aumenta a mortalidade desta popula??o. A bioimped?ncia espectrosc?pica ? uma ferramenta precisa, sens?vel e confi?vel para determinar o estado vol?mico e a composi??o corporal de pacientes em DP. O principal objetivo deste estudo foi: comparar a composi??o corporal e as vari?veis de volume, medidas com o l?quido de di?lise presente na cavidade peritoneal (CC) e ap?s este ser drenado (EC), atrav?s do Body Composition Monitor (BCM); e avaliar as rela??es do estado nutricional e composi??o corporal de pacientes em DP de acordo com a volemia. M?todos: Estudo transversal, envolvendo 37 pacientes adultos (>18anos de idade) est?veis em DP. Os dados gerados pelo BCM foram utilizados para an?lise da volemia e da composi??o corporal, realizados em dois momentos, CC e EC. Resultados: As caracter?sticas da amostra em estudo foram: 62,5% mulheres, 68,8% caucasianos, 75,0% em CAPD e 25,0% em APD. A avalia??o de 32 pacientes mostrou que n?o h? diferen?a estat?stica entre CC e EC em rela??o ? hiper-hidrata??o (OH), ?gua corporal total, intra e extracelular e suas corre??es por altura e peso, massa magra, massa gorda e seus ?ndices, massa de tecido adiposo e massa celular corporal. A correla??o de Pearson entre OH-CC e OH-EC apresentou valor de r=0,989 (P<0,001). Bland-Altmann plot para OH-CC e OH-EC mostrou linha de vi?s de -9mL e 95% de limites de concord?ncia (-603 a 585 mL). Em outra an?lise com 37 pacientes a albumina s?rica foi maior em pacientes euvol?micos (EV) (P=0,013), e a Avalia??o Subjetiva Global e o Escore de Desnutri??o-Inflama??o foram maiores em pacientes hiperhidratados (P=0,002 e P=0,004, respectivamente). Todos hipertensos foram diagnosticados como hiperhidratados. Diversas correla??es foram encontradas entre marcadores de estado nutricional e composi??o corporal com volemia. Conclus?o: A presen?a de l?quido intraperitoneal n?o interfere na avalia??o do estado de hidrata??o atrav?s do uso do BCM, assim como a an?lise da composi??o corporal massa magra, massa gorda, massa de tecido adiposo e seus ?ndices sugerindo que a metodologia do BCM pode ser aplicada em ambas as condi??es, com e sem o l?quido presente na cavidade peritoneal. Al?m disso, as vari?veis de volemia estudadas apresentam forte associa??o com vari?veis de estado nutricional. Com isso, observa-se que uma avalia??o detalhada do estado de hidrata??o deve fazer parte da avalia??o nutricional criteriosa, visando determinar corretamente o estado nutricional destes pacientes.

Made available in DSpace on 2015-04-14T13:36:06Z (GMT). No. of bitstreams: 1 386777.pdf: 1331431 bytes, checksum: 9edac4706a3d3ef38e1923efe97de1f0 (MD5) Previous issue date: 2006-10-31 / Objetivo: Observar as varia??es de glicemia e insulinemia induzidas pela exposi??o da cavidade peritoneal ? solu??o de glicose, durante teste de equil?brio peritoneal (PET), e buscar rela??o com a velocidade de transporte peritoneal de pequenos solutos. Pacientes e M?todo: Estudo transversal, observacional, com 34 pacientes prevalentes em di?lise peritoneal, submetidos a PET modificado (uso de glicose a 4,25%). Glicemia e insulinemia foram seq?encialmente determinadas sete vezes (em zero, 15, 30, 60 120, 180 e 240 minutos) ao longo do teste e ?ndice de resist?ncia a insulina (IR-HOMA) foi calculado. Categorias de transporte peritoneal foram definidas, na amostra, por quart?s da raz?o dialisado/soro das concentra??es de creatinina ap?s 240 minutos de exposi??o do perit?nio ao l?quido (D4/PCr). Vari?veis demogr?ficas e cl?nicas foram computadas e poss?veis correla??es entre vari?veis e categorias de transporte peritoneal foram testadas. Resultados: N?o houve diferen?a para o IR-HOMA ou para medidas de glicemia e de insulinemia, entre as categorias de transporte peritoneal. Houve correla??o direta entre os incrementos iniciais da glicemia, bem como a varia??o m?xima de insulinemia e a vari?vel D4/PCr uma medida de velocidade de transporte de solutos pelo perit?nio. O IR-HOMA relacionou-se diretamente com o ?ndice de massa corporal. Conclus?o: Os incrementos iniciais de glicemia e o pico m?ximo de insulinemia est?o associados ? velocidade de transporte peritoneal de pequenos solutos medida pelo PET. O significado destes achados sobre o progn?stico de pacientes com alto transporte deve ser mais bem avaliado.

Orientador: Fracieli Cristina Delatim Vannini / Resumo: INTRODUÇÃO: A depleção proteico-energética está relacionada à piora da qualidade de vida e menor sobrevivência do paciente em diálise. A avaliação da composição corporal, especialmente da massa livre de gordura (MLG) e massa gorda (MG), é importante para a predição de desfechos nesses indivíduos. O objetivo deste trabalho foi comparar as medidas de MLG e MG obtidas por antropometria, bioimpedância unifrequencial (BIAUNI) e bioimpedância multifrequencial (BIAMULT), utilizando a densitometria de raio-X de dupla energia (DXA) como padrão de referência, em pacientes submetidos a tratamento dialítico. CASUÍSTICA E MÉTODOS: Estudo transversal realizado com pacientes adultos em tratamento regular por hemodiálise (HD) ou diálise peritoneal (DP). As avaliações foram realizadas por antropometria, BIAUNI, BIAMULT e DXA no mesmo momento. Para comparação entre os valores obtidos por esses métodos com a DXA foram utilizados testes de correlação de Person (r), Coeficiente de Correlação Intraclasse (ICC) e análise de concordância de Bland-Altman. RESULTADOS: A casuística foi composta de 112 pacientes adultos (62 em HD e 50 em DP) com média de idade de 55,5±14,5 anos (HD) e 55,1±16,3 anos (DP). Os grupos (HD e DP) foram semelhantes quanto à maioria das características, embora pacientes em DP tenham apresentado maior índice de hiperidratação (OH) (0,8±1,1 vs. -0,9±1,3, p<0,001), maior percentual de OH/AEC (água extracelular) (5,0±7,2% vs. -7,4±11,7%, p<0,001) e menor concentração de albumina s... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: INTRODUCTION: Protein-energy wasting is related to impairment of quality of life and lower survival of dialysis patients. The evaluation of body composition, especially fat free mass (MLF) and fat mass (MG), is important for the prediction of outcomes in these individuals. The objective of this study was to compare the MLG and MG measurements obtained by anthropometry, unifrequency bioimpedance (BIAUNI) and multifrequency bioimpedance (BIAMULT), using Dual-energy X-ray absorptiometry (DXA) as the reference method in patients submitted to dialysis treatment. MATERIAL AND METHODS: A cross-sectional study with adult patients undergoing regular hemodialysis (HD) or peritoneal (PD) dialysis. The evaluations were performed by anthropometry, BIAUNI, BIAMULT and DXA at the same time. To compare the values obtained by these methods with DXA, we used correlation tests of Person (r), Intraclass Correlation Coefficient (ICC) and Bland-Altman concordance analysis. RESULTS: The sample consisted of 112 adult patients (62 in HD and 50 in PD) with mean age of 55.5 ± 14.5 years (HD) and 55.1 ± 16.3 years (PD). The groups HD and DP were similar for most of the characteristics, although patients with PD had a higher hyperhydration index (OH) (0.8±1.1 vs. -0.9±1.3, p <0.001), higher OH/extracellular water (ECW) (5.0±7.2% vs. - 7.4±11.7%, p<0.001) and a lower serum albumin concentration (3.6±0.4g/dl vs. 4.0±0.4g/dl, p<0.001). Considering the sample of patients from both groups, all methods showed ... (Complete abstract click electronic access below) / Doutor

末期腎衰竭乃是一種慢性並且會持續惡化的疾病，現時唯一的治療方案便是腎功能替代療法。在香港，一般新發現患有末期腎衰竭的病人，將會被安排進行持續性家居腹膜透析。接受持續性家居腹膜透析的病人均需遵照以下四項治療性方案(包括限制膳食和流質食物，服用處方葯物，及跟從腹膜透析的指引)，以減慢病程的惡化。以往有關病人遵照治療性方案的研究，大多側重於使用血液透析的病人及醫護專業人仕的評估。本研究的目的乃是從現正進行持續性家居腹膜透析的病人的觀點，去明白及解釋病人遵照治療性方案的模式。 / 此硏究採用混合方法硏究設計，並分兩期進行。在第一期的調查，173位病人自我評估其遵照治療性方案中四個環節的程度。調查結果顯示:參加對葯物及腹膜透析的遵照程度，比限制膳食和流質食物的遵照程度為高。再者，男性、較年青、或進行了透析治療一至三年的參加者，自覺其遵照程度比其他參加者為低。此調查結果將指導第二期硏究的最大變化採樣，方法是跟據參加者自我報告其遵照治療性方案的程度分為跟從及不跟從兩組，硏究採用立意取樣方法去選取36位不同性別、年齡、及透析年歷的參加者作第二期硏究的面談。整合第一期的調查及第二期的面談結果後，硏究為參加者遵照治療性方案的模式提供了解釋。 / 結果顯示參加者的遵照模式乃是一個浮動過程，此過程可分為三個階段: 起初的遵照模式、隨後的遵照模式、及長期的遵照模式。在起初的遵照模式階段，參加者嘗試嚴謹地遵照各項治療性方案，但體會到這是不能持久的。在進行了透析二至六個月後，參加進入隨後的遵照模式，透過試驗、監察及不斷的調校，參加者學會選擇性地去遵照某些治療性方案。當參加者接受透析三至五年後，他們開始進入長期的遵照模式，在這階段，參加者已能將自行修改了的治療性方案融入日常的生活當中。 / 參加者遵照治療性方案的浮動過程，乃是受其「抱怨失去自主及常規」和「嘗試挽回自主及常規」所驅使。此浮動情況在每個階段都會發生。除了透析年歷，影響參加者遵照治療性方案的決定性因素乃是其家人及醫護專業人仕的支持。參加並認為醫護專業人仕非常強調其需絶對遵照所有治療性方案，反眏現行以治療為本的照料模式。 / 此硏究在理論及臨床上皆有貢獻。在理論方面，此乃首個硏究確立接受持續性家居腹膜透析的病人，在遵照治療性方案的浮動過程中出現的三個階段。在臨床上，此三個階段的確立可作為策劃護理方案的參照，以幫助病人順利過渡各個階段。硏究的結果亦倡導醫療模式的轉變，即由以治療作主導的模式轉變為以病人為本的照料模式，授權病人在末期腎衰竭的治療過程中參與自我料理。 / End-stage renal disease (ESRD) is a chronic, progressive and debilitating illness with renal replacement therapy (RRT) as the only treatment modality. In Hong Kong, patients newly diagnosed with ESRD who require RRT are generally started on continuous ambulatory peritoneal dialysis (CAPD). Patients receiving CAPD are required to adhere to a renal therapeutic regimen comprising four components (dietary and fluid restrictions, and medication and dialysis prescriptions) to decelerate disease progression. Studies on patients' adherence have mainly focused on those undergoing haemodialysis and are generally from healthcare professionals' perspectives. The aim of this study was to understand and explain adherence from the perspectives of patients undergoing CAPD. / The study employed a mixed-methods design and was conducted in two phases. In phase I, a survey was conducted to examine 173 patients' self-reported adherence to the four components of the therapeutic regimen. Results showed that participants were more adherent to dialysis and medication prescriptions than to fluid and dietary restrictions. Moreover, participants who were male, younger or had received dialysis for 1 to 3 years rated themselves as more non-adherent than other participants. These findings guided the maximum variation sampling of 36 purposively recruited participants of different genders, ages, and duration of dialysis from the adherent and non-adherent groups for the phase II interview. The survey and interview data were merged in the interpretation of findings to provide an understanding of participants' adherence. / Findings indicate that participants' adherence was a dynamic process with three stages: initial adherence, subsequent adherence and long-term adherence. At the stage of initial adherence, participants attempted to follow instructions but found that strict persistent adherence was impossible. After the first 2 to 6 months of dialysis, participants entered the stage of subsequent adherence. Through experimenting, monitoring and making continuous adjustments, they learned to adopt selective adherence. The stage of long-term adherence commenced after participants had received dialysis for more than 3 to 5 years. At this stage, they were able to assimilate the modified therapeutic regimen into everyday life. / The dynamic process of adherence was driven by "grieving for the loss of autonomy and normality" and "attempting to regain autonomy and normality". The process was dynamic as there were fluctuations at each stage of the participants' adherence. In addition to the duration of dialysis, the major determinant influencing the participants' adherence was the support provided by family members and healthcare professionals. Moreover, participants perceived that the focus of care provision was on strict adherence to all components of the therapeutic regimen, reflecting a biomedical model of care. / This study has theoretical and clinical significance. Theoretically, this is the first study that identified three stages in the dynamic process of adherence among patients undergoing CAPD. Clinically, with reference to each stage identified, nursing interventions can be developed to help patients achieve a smooth transition throughout all the stages. The findings also call for a paradigm shift from the biomedical model of care to patient-centred care, so as to empower patients to engage in self-management of their ESRD. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Lam, Lai Wah. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references. / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; some appendixes also in Chinese. / LIST OF TABLES --- p.xv / LIST OF FIGURES --- p.xvi / LIST OF ABBREVIATIONS --- p.xvii / LIST OF APPENDICES --- p.xviii / Chapter CHAPTER ONE --- INTRODUCTION / Introduction --- p.1 / ESRD and its management in the Hong Kong context --- p.2 / The research problem --- p.3 / Aim of the study --- p.6 / Overview of the thesis --- p.6 / Chapter CHAPTER TWO --- LITERATURE REVIEW / Introduction --- p.7 / Literature search strategies --- p.7 / The concept of adherence --- p.8 / Theoretical models used to understand adherence --- p.14 / Health belief model --- p.14 / Locus of control --- p.16 / Self-efficacy --- p.19 / Transtheoretical model --- p.22 / Measurement of adherence --- p.24 / Prevalence of adherence --- p.27 / Patients undergoing HD --- p.28 / Patients undergoing PD --- p.31 / Factors influencing patients’ adherence --- p.34 / Demographic and clinical characteristics --- p.34 / Social support --- p.37 / Knowledge about adherence --- p.39 / Chinese culture --- p.43 / Exploring adherence from patients’ perspectives --- p.47 / Adherence among patients undergoing dialysis in Hong Kong --- p.51 / An introduction to the concept of self-management --- p.52 / Summary --- p.53 / Chapter CHAPTER THREE --- METHODOLOGY / Introduction --- p.56 / Aim --- p.56 / Objectives --- p.56 / Operational definitions --- p.57 / Research design --- p.57 / The paradigm of mixed methods research --- p.58 / Justification for using a mixed methods design --- p.60 / Application of the mixed methods design --- p.61 / Phase I study --- p.67 / Sampling --- p.67 / Setting --- p.67 / Sampling method and sample size --- p.67 / Data collection method --- p.68 / Instrument --- p.68 / Data collection procedures --- p.70 / Data analysis --- p.70 / Pilot Study --- p.71 / Validity and reliability --- p.72 / Phase II study --- p.74 / Sampling --- p.74 / Sample size --- p.74 / Sampling method --- p.75 / Data collection method --- p.80 / Semi-structured interview --- p.80 / Development of the interview guide --- p.81 / Data collection procedures --- p.82 / Making contact with participants --- p.82 / The interviewing process --- p.83 / Data analysis --- p.87 / Pilot study --- p.89 / Rigour of the study --- p.91 / Credibility --- p.91 / Dependability --- p.95 / Confirmability --- p.95 / Transferability --- p.95 / Ethical considerations --- p.96 / Summary --- p.98 / Chapter CHAPTER FOUR --- FINDINGS OF THE PHASE I STUDY / Introduction --- p.99 / Results --- p.99 / Participants --- p.99 / Demographic and clinical characteristics of the participants --- p.100 / Overall adherence to the therapeutic regimen --- p.103 / Number of days non-adherent to the therapeutic regimen --- p.103 / Degree of deviation from the therapeutic regimen --- p.104 / Adherence in relation to demographic and clinical variables --- p.106 / Summary --- p.109 / Chapter CHAPTER FIVE --- FINDINGS OF THE PHASE II STUDY / Introduction --- p.110 / Demographic and clinical characteristics of the participants --- p.110 / Major categories and subcategories identified --- p.115 / Perceptions of adherence --- p.117 / Meaning of adherence --- p.117 / Perceived needs to adhere --- p.118 / Perceived levels of adherence --- p.120 / The process of adherence --- p.123 / Initial adherence --- p.124 / Practising two major types of adherence --- p.124 / Striving to live with strict adherence --- p.124 / Doing what I am told --- p.124 / Trying my best --- p.125 / Exercising self-control --- p.127 / Adopting partial adherence --- p.128 / Recognizing limitations of current types of adherence --- p.129 / Sacrificing freedom for strict adherence --- p.129 / Social restriction --- p.129 / Having nothing to eat --- p.132 / Paying the price of inadequate adherence --- p.133 / Physiological complications --- p.134 / Need for additional treatment --- p.136 / Harsh comments from healthcare professionals --- p.137 / Realizing the need for changes in adherence --- p.139 / Rationalising an easy-going approach to adherence --- p.139 / Seeing the need for stricter adherence --- p.144 / Subsequent adherence --- p.146 / Experimenting with an easy-going approach to adherence --- p.147 / Allowing some slippage --- p.147 / Monitoring indicators of adherence --- p.148 / Making continuous adjustments --- p.149 / Adopting selective adherence --- p.153 / Long-term adherence --- p.158 / Factors influencing the process of living with adherence --- p.159 / Support --- p.159 / Family members --- p.159 / Healthcare professionals --- p.163 / Hope for the future --- p.165 / Situational factors --- p.168 / Dinning out --- p.169 / Employment --- p.171 / Summary --- p.173 / Chapter CHAPTER SIX --- DISCUSSION / Introduction --- p.177 / The dynamic process of adherence --- p.179 / Initial adherence --- p.182 / Following instructions --- p.182 / Grieving for the loss of autonomy and normality --- p.184 / Social restriction --- p.185 / Unmet nutritional and psychosocial needs --- p.187 / Subsequent adherence --- p.193 / Experimenting with an easy-going approach to adherence --- p.193 / Attempting to regain autonomy and normality --- p.198 / Dialysis --- p.199 / Medication --- p.201 / Fluid --- p.204 / Diet --- p.205 / Long-term adherence --- p.209 / Support as a major determinant of adherence --- p.212 / Family --- p.213 / Healthcare professionals --- p.216 / Biomedical model of care --- p.221 / Disease-oriented perspective --- p.222 / One-way paternalistic communication --- p.228 / Summary --- p.232 / Chapter CHAPTER SEVEN --- CONCLUSIONS / Introduction --- p.235 / Limitations of the study --- p.235 / Implications --- p.237 / Implications for clinical practice --- p.237 / Initial stage --- p.237 / Provision of timely appropriate support --- p.238 / Psychological support --- p.238 / On-site support --- p.239 / Adjustment of the CAPD training content --- p.240 / Empowering patients for self-management of their ESRD --- p.241 / Subsequent stage --- p.244 / Long-term stage --- p.245 / Implications for administration --- p.246 / Implications for nursing education --- p.247 / Recommendations for further research --- p.249 / Conclusions --- p.252 / REFERENCES --- p.254

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-05-19T12:54:32Z No. of bitstreams: 1 DIS_ROBERTA_MONTEIRO_KATZAP_COMPLETO.pdf: 1440611 bytes, checksum: 60581bcd966d13bb2ed8592af3528373 (MD5) / Made available in DSpace on 2016-05-19T12:54:32Z (GMT). No. of bitstreams: 1 DIS_ROBERTA_MONTEIRO_KATZAP_COMPLETO.pdf: 1440611 bytes, checksum: 60581bcd966d13bb2ed8592af3528373 (MD5) Previous issue date: 2016-03-02 / Funda??o de Amparo ? Pesquisa do Estado do Rio Grande do Sul - FAPERGS / Chronic kidney disease patients on peritoneal dialysis therapy are susceptible to infections, with peritonitis being the primary cause of technique failure. Peritoneal fluid culture is one of the essential elements for proper diagnosis and treatment of peritonitis. The aim of this study was to compare the time required to obtain a positive culture using different laboratory methods. An in vitro cross-sectional study comparing different laboratory techniques for preparation and culture of bacteria in peritoneal fluid. The research was conducted with 21 sterile dialysis fluid bags with 1.5% glucose concentration, and 21 peritoneal dialysis bags containing peritoneal fluid drained from patients without peritonitis, assisted at the Nephrology Unit from HSL-PUCRS. Fluids from the 42 peritoneal dialysis bags were contaminated by injecting a coagulase-negative Staphylococcus suspension and then prepared for culture using four distinct techniques - A (direct culture), B (post-centrifugation culture), C (direct culture after 4h sedimentation), and D (culture after 4h sedimentation and centrifugation) ? followed by seeding. In the 21 contaminated sterile bags, the mean times to obtain a positive culture with techniques D (19.6 h ?2.6) and C (19.1 h ?2.3) were longer in comparison to A (15.8 h ?3.0; p<0.01), but not statistically different from group B mean (19.0 h ?3.2). The same occurred in the 21 bags drained from patients, with mean times for techniques D (14.0 h ?1.9) and C (14.5 h ?1.7) being longer than technique A (12.22 h ?1.94; p<0.05), however not statistically different from technique B (13.2 h ?1.3). The sedimentation and centrifugation steps were unnecessary and may delay antibiotics sensitivity test result by approximately 8 hours. / Pacientes com doen?a renal cr?nica que realizam terapia de di?lise peritoneal est?o suscet?veis a infec??es, sendo peritonite a principal causa de fal?ncia do m?todo. A cultura do l?quido peritoneal ? um dos elementos essenciais para o manejo cl?nico e tratamento adequados da peritonite. O objetivo deste estudo foi comparar o tempo necess?rio para obter uma cultura positiva, com diferentes m?todos laboratoriais. Estudo transversal, in vitro, comparando diferentes t?cnicas laboratoriais de preparo e cultura para bact?rias em l?quido peritoneal. O estudo foi feito com 21 bolsas de l?quido de di?lise peritoneal est?reis, com concentra??o de 1,5% de glicose, e em 21 bolsas contendo l?quido peritoneal drenado de pacientes sem peritonite, atendidos pelo Servi?o de Nefrologia do HSL-PUCRS. O dialisado das 42 bolsas de di?lise peritoneal foi contaminado, injetando-se suspens?o de Staphylococcus coagulase negativa e, em seguida, submetido a quatro t?cnicas distintas ? A (cultura direta); B (cultura p?s-centrifuga??o); C (cultura ap?s sedimenta??o de 4 h); e D (cultura ap?s sedimenta??o de 4 h e centrifuga??o) ? de preparo e semeadura. Nas 21 bolsas est?reis contaminadas se verificou que as m?dias de tempo para positivar a cultura nas t?cnicas D (19,6 h ?2,6) e C (19,1 h ?2,3) foram maiores, comparadas ? A (15,8 h ?3,0; p<0,01), mas estatisticamente n?o diferentes da m?dia do grupo B (19,0 h ?3,2). O mesmo aconteceu nas 21 bolsas drenadas dos pacientes, com tempos m?dios para as t?cnicas D (14,0 h ?1,9) e C (14,5 h ?1,7) superiores ao tempo da t?cnica A (12,22 h ?1,94; p<0,05), por?m n?o estatisticamente diferente da t?cnica B (13,2 h ?1,3). As etapas de sedimenta??o e centrifuga??o foram desnecess?rias, podendo postergar em quase oito horas o resultado final da cultura, comparativamente ? cultura direta, atrasando o resultado do teste de sensibilidade aos antibi?ticos.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

A endometriose é uma doença ginecológica crônica que afeta pelo menos 10% das mulheres em idade reprodutiva. É caracterizada pelo crescimento de tecido endometrial fora da cavidade uterina. Embora sua etiologia permaneça controversa, estudos propõem que alterações imunológicas e inflamatórias estão correlacionadas com a causa da endometriose e podem contribuir para o crescimento e sobrevida de implantes ectópicos. Como parte integrante desse processo, um microambiente peritoneal anormal pode ser constituído por níveis aumentados de células imunológicas. Dentre estas, a elevação de citocinas pró-inflamatórias no ambiente peritoneal e sistêmico participariam desse processo. Citocinas incluindo a interleucina-6 (IL-6), uma glicoproteína com atuação na resposta imune e considerada como um marcador de inflamação tem sido proposta na patogênese da endometriose. Recentemente, demonstramos que as concentrações de IL-6 no fluído peritoneal (FP) apresentam-se elevadas em mulheres com endometriose em comparação com mulheres hígidas (Andrade et al., 2017, in press). No entanto, a fonte do aumento de IL-6 no FP ainda não foi totalmente elucidada e seu potencial envolvimento com a endometriose merece maior investigação. No presente estudo, avaliamos a expressão proteica de IL-6 no tecido endometrial e sua concentração no FP de mulheres com endometriose pélvica e comparamos com mulheres hígidas. Um total de 18 pacientes com endometriose e 12 mulheres com pelve normal foram incluídas neste estudo caso-controle. Foram realizadas avaliações clínicas e laboratoriais. Os níveis de IL-6 no FP e a expressão proteica no tecido endometrial foram determinados utilizando ensaio imunoenzimático (ELISA) e imuno-histoquímica respectivamente. A concentração de IL-6 no FP foi significativamente mais elevada no grupo endometriose em comparação com o grupo controle [48,2 (36,7 - 89,9) ng/ml versus 23,1 (11,8 - 35,3) ng/ml, P = 0,002]. A expressão proteica de IL-6 foi positiva na maior parte das amostras de ambos os grupos sendo significativamente mais intensa no tecido endometriótico em comparação com a expressão no endométrio de mulheres com pelve normal (P < 0,05). Os resultados do presente estudo sugerem que a fonte da IL6 no FP de pacientes com endometriose possa ser, pelo menos em parte, proveniente dos focos endometrióticos. / Endometriosis is a chronic gynecological disease that affects at least 10% of women of reproductive age. It is characterized by growth of endometrial tissue outside the uterine cavity. Although its etiology remains controversial, studies suggest that immunological and inflammatory changes are associated with endometriosis and may contribute to the growth and survival of ectopic implants. As part of this process, an abnormal peritoneal microenvironment may be constituted by increased levels of immune cells. Among these, the elevation of proinflammatory cytokines in the peritoneal and systemic environment would participate in this process. Cytokines including interleukin-6 (IL-6), a glycoprotein that acts on the immune response and is considered as a marker of inflammation has been proposed to play a role in the pathogenesis of endometriosis. Recently, we have shown that IL-6 concentrations in the peritoneal fluid (PF) were higher in women with endometriosis compared to healthy women (Andrade et al., 2017, in press). However, the source of IL-6 in PF has not yet been fully elucidated and its potential involvement with endometriosis warrants further investigation. In the present study, we evaluated the protein expression of IL-6 in endometrial tissue and its concentration in PF of women with pelvic endometriosis and compared them with healthy women. A total of 18 patients with endometriosis and 12 women with normal pelvis were included in this case-control study. Clinical and laboratory evaluations were performed. IL-6 levels in PF and protein expression in endometrial tissue were determined using enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry respectively. The concentrations of IL-6 in PF were significantly higher in the endometriosis group compared to the control group [48.2 (36.7-89.9) ng / ml versus 23.1 (11.8-35, 3) ng / ml, P = 0.002]. Protein expression of IL-6 was positive in most samples from both groups being significantly more intense in the endometriotic tissue of patients with endometriosis compared to the endometrial expression in women with normal pelvis (P < 0.05). The results of the present study suggest that the source of IL6 in the PF of patients with endometriosis may come, at least in part, from the endometriotic focus.