E-learning modules for Integrated Virtual Learning



    Posts : 31
    Join date : 2009-06-19
    Age : 32


    Post  gillegarda/joanalynbalino on Wed 01 Jul 2009, 7:16 pm

    By: D2- Gil Legarda and Joanalyn Balino

    The Effect of a Tai Chi Exercise Program on Quality of Life in Patients on
    Peritoneal Dialysis: a Pilot Study

    Stefan Mustata, Lorne Cooper, Nicholas Langrick, Noreen Simon, Vanita Jassal, and
    Dimitrios G. Oreopoulos

    Mustata, S., Cooper, L. et al. made a pilot study about the effects of Tai Chi Wu-style-based exercise training program (the sequence of its movements, performed slowly and rhythmically, is a form of exercise that promotes physical strength, relaxation, and balance) in the quality of life of patients undergoing peritoneal dialysis. They wanted to test that a Tai Chi Wu-style-based exercise training program may have a beneficial effect on the quality of life in patients on peritoneal dialysis by improving balance and strength, decreasing levels of depression and anxiety, and promoting concentration and relaxation. There were a total of 6 patients participated in the study. The inclusion criteria were: (1)18 to 80 years of age; (2) receiving peritoneal dialysis for at least 3 months; (3) with regular follow-up in outpatient clinic. The exclusion criteria: (1) with active symptomatic cardiovascular or respiratory disease; (2) Those who have uncontrolled diabetes; (3) with severe musculoskeletalabnormalities exacerbated by exercise; and (4) those with visual impairment. The intervention was facilitated by a certified instructor. Classes were done in weekly basis with 1 hour’sduration for 3 months in the physiotherapy room of the Peritoneal Dialysis Unit, Toronto Western Hospital. The physician and the nurse were the one providing the medical supervision. Also, patients were encouraged to practice at home at least twice per week without supervision.A well-documented self- administered questionnaire was used to assess patient’s Quality of life this is called Short Form with 36 questions (SF-36). This questionnaire includes physical health and mental health.

    Results: From 48.9 at baseline the total Mental Health dimension score increased significantly to 58.4 at the end of the intervention (p = 0.047). The score for Social Functioning was p = 0.025 and the score of Role Emotional was p = 0.042. After 3 months, SF-36 score increased from 52.8 at baseline to 59.9, but did not reach statistical significance (p = 0.10). There was no effect on the laboratory values and ideal weights in the study group after the exercise program. During and after the Tai Chi classes, there was no complications or side-effects noted.

    The Mental Health dimension score of the SF-36 questionnaire in 6 patients on PD was significantly improved even though it did not reach statistical significance after 3 months of Tai-Chi Wu-style based exercise. This result was considered as the major finding of the study. This pilot study plays a key role on the activity / exercise regimen for patients undergoing peritoneal dialysis because if patients have good mental health condition it is a contributory factor to improve patient’s quality of life.

    Reference: you will see the study in page 7 of the PDF file
    Mustata, S.,Cooper, L. et al. (2005). The Effect of a Tai Chi Exercise Program on Quality of Life in Patients on Peritoneal Dialysis: a Pilot Study. Peritoneal
    Dialysis International 25: 291-294. Retrieved July 1, 2009 from http://www.pdiconnect.com/cgi/reprint/25/3/291?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Tai-chi&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

    Last edited by gillegarda/joanalynbalino on Tue 07 Jul 2009, 2:10 am; edited 3 times in total

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    4TH POSTING: ---------- ACTIVITY AND EXERCISE Empty by guomanman chenya

    Post  guomanman on Thu 02 Jul 2009, 9:39 pm

    Dayd 6 guomanman and chenya

    People on dialysis who exercise regularly get results.They can do more, PLUS they say that they feel better.They have more energy, and they feel less anxious and depressed, perhaps because they have a greater sense of control over their lives. Some people on dialysis were able to cut down on blood pressure medicine when they exercised regularly; a few people didn’t need any at all! Blood pressure control is important for your health and may help to prevent heart problems. Regular exercise can make muscles stronger and joints more flexible. That means it will be easier to
    reach, bend stoop, and do other daily activities. Good flexibility can also improve your sense of balance, so you can move more confidently with less risk of falls. Exercise (along with proper diet) can also help you change the fat and cholesterol content in your blood. And that may reduce your risk of heart problems. All in all, exercise is one of the best things you can do for yourself. It can help you feel better, stronger, and more in control of your health – even if you need to do dialysis.

    Life Options Rehabilitation Resource Center
    Medical Education Institute, Inc.
    414 D’Onofrio Drive, Suite 200
    Madison, WI 53719-2803
    Fitness After Kidney Failure
    National Kidney Foundation, Inc.
    30 E 33rd St
    New York, NY 10016
    Brochure #05-02CP
    An Exercise Program for the Person with
    Chronic Renal Disease
    NKF of Eastern Missouri & Metro East, Inc.
    3117 South Big Bend Blvd.
    St. Louis, MO 63143


    Post  nancelle on Sat 04 Jul 2009, 12:05 am

    DYAD 1: Nancelle Dumlao / Rodel Perez
    Quality of life on chronic dialysis: comparison between haemodialysis and peritoneal dialysis

    By : Jean-Blaise Wasserfallen, Georges Halabi, Patrick Saudan, Thomas Perneger, Harold I. Feldman, Pierre-Yves Martin and Jean-Pierre Wauters
    Nephrol Dial Transplant (2004)Vol. 19 No. 6, p 1594-1599

    This is a study on the effects of treatment modalities such as hemodialysis and peritoneal dialysis on the quality of life of patients with ESRD. It is a given fact that chronic dialysis patients and their families experience difficulties not just physically but more importantly, psychologically and socially due to the limitations imposed by the illness and it management.
    The primary aims of this study were to assess predicted and measured QOL values, and performance of the EQ-5D instrument in chronic HD and PD patients in the 19 dialysis centres of western Switzerland.
    EQ-%D is a questionnaire that is self-administered and composed of 5 items concerning: mobility (problem in walking about), self-care (problem with washing or dressing self), usual activities (problem with performing usual activities), pain/discomfort and anxiety/depression. Moreover, the instrument elicits the answer on whether the patient’s health status is stable, has improved or has deteriorated in the last 12 months as well as measures the patients’ health aspects including physical, functional, and mental states. However, this study has limitations since it did not include comparison of QOL prior to having the HD or PD dialysis.

    The result of the study showed that quality of life (QOL) was significantly diminished in both hemodialysis (HD) and peritoneal(PD) dialysis patients regardless of age, gender and duration of treatment. The five dimensions in the questionnaire were the same for both HD and PD, except for a greater restriction in activities for PD patients. There was a 10% and 16% deterioration of quality of life for HD and PD, respectively. Although the PD patients are very small as compared to HD patients and PD is considered as the easier modality and causes lesser difficulty, still it resulted in severe impairment in the patient’s usual activities. Naturally, the restriction in activity is more evident in HD since it is the more time consuming and limiting treatment modality. In self-care, both HD and PD showed no limitation (71% and 74%, respectively); whereas 14% (HD) and 23% (PD) indicated the severe limitations for usual activities. Also, it turned out that pain/ discomfort and anxiety/depression both caused the highest variation in QOL.

    In summary, the study showed that both HD and PD treatment modalties for ESRD patients equally cause a decrease in the quality of life. It proved that both these modalities do contribute in severely restricting the patients’ ability to do their usual activities. It is good to know that both modalities do not really affect the self-care abilities of the patients. The information generated by this study is important since they can be used by both patients and family members ( especially those newly diagnosed with ESRD) in deciding which treatment modalities to choose.


    Wasserfallen, J, Halabi, G, Saudan, P, Perneger, T, Feldman, H, Martin, P, Wauters, J. Quality of life on chronic dialysis: comparison between haemodialysis and peritoneal dialysis. Nephrol Dial Transplant (2004)Vol. 19 No. 6, p 1594-1599

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    4TH POSTING: ---------- ACTIVITY AND EXERCISE Empty aerobic exercise training by YuanShuHui & YangChunHua

    Post  YangChunHua on Sat 04 Jul 2009, 1:59 am

    Changes in muscle morphology in dialysis patients after 6 months of aerobic exercise training

    Giorgos K. Sakkas1, Anthony J. Sargeant1,3, Thomas H. Mercer1, Derek Ball1, Pelagia Koufaki1, Christina Karatzaferi4 and Patrick F. Naish2
    2003 European Renal Association-European Dialysis and Transplant Association

    In the present study we investigated the effect of a 6-month aerobic exercise programme on the morphology of the gastrocnemius muscle of end-stage renal disease (ESRD) patients.
    Twenty-four ESRD patients were recruited from the dialysis unit in North Staffordshire Hospital, UK and volunteered to participate in a 6-month exercise programme [12 continuous ambulatory peritoneal dialysis (CAPD) and 12 haemodialysis (HD), seven women and 17 men, mean age 59 ± 13 years, range 35–76 years]. All 24 patients underwent biopsy of the gastrocnemius muscle before exercise training commenced. Eighteen patients completed the training programme of whom nine agreed to biopsy at the end of training. Data are presented before (PRE) and after (POST) training for the nine patients who completed the study (three CAPD and six HD, one woman and eight men, mean age 56 ± 15 years, range 35–76 years). Additional cross-sectional data are also presented on the 15 patients who were biopsied only once before the commencement of training (this group was comprised of nine CAPD and six HD, six women, and nine men, mean age 60 ± 12 years, range 40–74 years). Exclusion criteria to participate in the study were: evidence of recent myocardial infarction (within 6 weeks), uncontrolled arrhythmias, uncontrolled hypertension, unstable angina, severe uncontrolled diabetes, symptomatic left ventricular dysfunction or neurological disorder with functional deficit, demonstrating an interdialytic weight 2.5 kg, pre-dialysis potassium 5.5 mmol l–1, and urea clearance, Kt/V 1.
    Results. There were no significant differences (P > 0.05) in fibre type distribution or myosin heavy chain (MyHC) expression between the cross-sectional and PRE/POST groups. The mean cross-section fibre area after training (POST) increased by 46% compared with the PRE training status (P < 0.01). The proportion of atrophic fibres decreased significantly after training in type I, IIa and IIx fibre populations (from 51 to 15%, 58 to 21% and 62 to 32%, respectively). Significant differences were also found in capillary contact per fibre (CC/F), with the muscle having 24% (P < 0.05) more CC/F compared with the PRE training status. No significant differences in cytochrome c oxidase concentration were found between the groups.
    Conclusions. In conclusion, exercise appeared to be beneficial in renal rehabilitation by correcting the fibre atrophy, increasing the cross-section fibre area and improving the capillarization in the skeletal muscle of renal failure patients.
    1.Johansen KL, Shubert T, Doyle J, Soher B, Sakkas GK, Kent-Braun JA. Muscle atrophy in patients receiving hemodialysis: effects on muscle strength, muscle quality and physical function. Kidney Int 2003; 63: 291–297
    2.Phaneuf S, Leeuwenburgh C. Apoptosis and exercise. Med Sci Sports Exer 2001; 33: 393–396


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    Post  alkhaloidz on Tue 07 Jul 2009, 11:11 pm

    DYAD 4

    Quality of life, mental health and health beliefs in haemodialysis and peritoneal dialysis patients: Investigating differences in early and later years of current treatment

    The study examines differences regarding quality of life (QoL), mental health and illness beliefs between in-centre haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD/PD) patients. Differences are examined between patients who recently commenced treatment compared to patients on long term treatment. 144 End-Stage Renal Disease (ESRD) patients were recruited from three treatment units, of which 135 provided full data on the variables studied. Patients consisted of: a) 77 in-centre haemodialysis (HD) and 58 continuous ambulatory peritoneal dialysis (CAPD/PD) patients, all currently being treated by dialysis for varied length of time. Patients were compared for differences after being grouped into those who recently commenced treatment (< 4 years) and those on long term treatment (> 4 years). Next, cases were selected as to form two equivalent groups of HD and CAPD/PD patients in terms of length of treatment and sociodemographic variables. The groups consisted of: a) 41 in-centre haemodialysis (HD) and b) 48 continuous ambulatory peritoneal dialysis (CAPD/PD) patients, fitting the selection criteria of recent commencement of treatment and similar sociodemographic characteristics. Patient-reported assessments included: WHOQOL-BREF, GHQ-28 and the MHLC, which is a health locus of control inventory.

    Differences in mean scores were mainly observed in the HD patients with > 4 years of treatment, providing lower mean scores in the QoL domains of physical health, social relationships and environment, as well as in overall mental health. Differences in CAPD/PD groups, between those in early and those in later years of treatment, were not found to be large and significant. Concerning the analysis on equivalent groups derived from selection of cases, HD patients indicated significantly lower mean scores in the QoL domain of environment and higher scores in the GHQ-28 subscales of anxiety/insomnia and severe depression, indicating more symptoms in these areas of mental health. With regards to illness beliefs, HD patients who recently commenced treatment provided higher mean scores in the dimension of internal health locus of control, while CAPD/PD patients on long term treatment indicated higher mean scores in the dimension of chance. Regarding differences in health beliefs between equivalent groups of HD and CAPD/PD patients, HD patients focused more on the dimension of internal health locus of control.

    The results provide evidence that patients in HD treatment modality, particularly those with many years of treatment, were experiencing a more compromised QoL in comparison to CAPD/PD patients. Further, patients who had similar length of current treatment in the two treatment modalities, differ only with regards to their environmental well-being. Thus, in relation to differences between patients in early and later years of treatment, it appears that QoL deficits in HD patients become more extended over time, and seem to be more precisely signified by the factors in the environmental QoL domain. It may be argued that HD patients on long term dialysis appear to be more seriously compromised in their quality of life and mental health.

    Reference: Ginieri-Coccossis, M et. al. Quality of life, mental health and health beliefs in haemodialysis and peritoneal dialysis patients: Investigating differences in early and later years of current treatment. PMC. November 2008

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