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Our whole concept was based on speed, lower prices and volume. Dick McDonald.

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Title: Our whole concept was based on speed, lower prices and volume. Dick McDonald.


1
????????????
  • ????
  • ??? ??

2
???????
  • Our whole concept was based on speed, lower
    prices and volume. Dick McDonald.
  • I shall return. Old soldiers never die. They just
    fade away. Douglas MacArthur.
  • I have nothing to offer but blood, toil, tears
    and sweat. Winston Churchill.

3
??
  • ???????????, ????,???????(???????????),
    ???????????. ?????????????????.
  • ???????????, ??, ???(??,?)?????. ?????????,
    ??????, ?????????.
  • ??????????(???, renin).

4
????
  • ? ?????????????
  • ? ???????????
  • ? ???????? ????????
  • ? ??????

5
??
  • ???????????? ??????12, 6, 3??.
  • ???????????????
  • 1, ??????????(cortex).
  • 2,????????(medulla).
  • 3,?????(renal sinus).

6
??nephron
  • ??????????, ??????100????.
  • ????????(renal corpuscle)????(renal tubule)???
  • ????????(glomerulus)????(Bowmans capsule).
  • ??????????, ?????????.

7
???????
  • Patricia Painter
  • Exercise in Patients with End-stage Renal
    Disease.
  • ACSM' s Resource Manual for Guidelines for
    Exercise Testing and Prescription, 5th edition,
    2006.

8
Patients are inactive
  • When patients are diagnosed with end-stage renal
    failure, most are never given information on
    exercise and physical activity.
  • If they asked, they are typically told to take
    it easy or just dont overdo it.
  • These comments pose questions and doubt in the
    minds of patients and their families, who are
    very protective.

9
Exercise information for patients
  • It is not surprising that many patients are
    skeptical about becoming physically active, and
    the data clearly indicate that dialysis patients
    are physically inactive. Patients have little
    interaction with others and thus receive little
    information about physical activity from others
    than their dialysis providers.

10
?????????????????? ???? ??
  • ????more energy
  • ??????muscle stronger
  • ????
  • ???????
  • ?????????
  • ??

11
??? ??
  • ?? ??? ??
  • ????????????? ???????
  • ??? ????
  • Regular exercise.

12
????????????
  • 42????????????????????
  • ???????? ?,???????????????
  • ?????????????

13
???????
  • ?????????? ???,??????????60-70?
  • ???????
  • ??? ????(??? ????)????????????????

14
Chronic renal failure
  • Chronic renal failure results from structural
    kidney damage and progressively diminished renal
    function.
  • Once initiated, chronic renal failure progresses
    to end-stage renal disease, requiring some form
    of renal replacement therapy such as dialysis or
    transplantation.

15
????????????
  • ??????
  • 1?????????????????
  • 2?????????????(?????????, ?????????)?
  • 3, ????????????????????????????
  • 4?????? ?????????

16
??????
  • ????????????????? ??? ?????? ??????????
  • ?????????? ?SF(short form???)36????????
  • ?????????

17
???????
  • ????????????????
  • ????????????????? ?.
  • ??????????????????????????????????????(30 vs 24
    ml / kg.min).

18
?????????
  • ???????? ???? ?????????????????16.4?
  • ??????????????.
  • ??????????????
  • ?????????????? ????????????????

19
?????????
  • ????????? ??????
  • ??????????(????????????)?
  • ??36-SF???????? ?.

20
????
  • ?????????????????
  • ??????????????????, ?????????
  • ???????? ??????????(??)???
  • ???????, ?????????

21
?????????
  • ???????
  • ???????
  • ????
  • ????????
  • ??
  • ???????????
  • ??

22
?????????
  • ????
  • ????
  • ????
  • ????
  • ????
  • ????

23
???? --?????
  • ??????????????????????
  • ???????????????
  • ??????????????
  • ???????????, ????????????????????
    ?????????????????????? ?.
  • ??????????????????

24
????? (peritoneal dialysis)
  • ?????????????????
  • ???????????????????????(????????)?

25
????
  • ??? ???
  • ????????????????
  • ???? ????
  • ? ????? ???? ????????

26
??(??)??
  • ????????????????????
  • ????
  • ?????? ?????????
  • ????????

27
????
  • ????
  • ???? ???????????????????
  • ??(??)??? ??????????????
  • ????? ????????????
  • ?????? ???????????(?? ??????????????)

28
Guadalupe, 72? ??????
  • ??????treadmill?????????, ???????????. ???????.
  • ??????????, ???????, ????????(revitalized).
  • ???????????????.
  • I feel good knowing that I can still take care of
    and provide for my family instead of them having
    to provide for me. ?????????

29
????
  • ??????????????????, ????????????????
  • ???????????????????????, ?????????????????????????
    ??

30
????
  • ?????????????????. ??,???(???)??????(????)????????
    ????
  • ?????? ??????????? (??????????)? ????????

31
????
  • ????????, ???????????????
  • ??????????????, ??????????
  • ????????????, ?????????????, ??????????????

32
?????????
  • ???????(RPE)??????
  • ???????RPE? 9-10.
  • ????RPE? 12-15.
  • ????????????, ?????????????, ??????????????,
    ?????????????????.?

33
????
  • ???????????????
  • ???????????????????
  • ??????, ?????????,???,??????????? ??,
    ????????????????????, ????????????
  • ?????, ???????, ????????????, ???????????????.

34
????
  • ???????????
  • ???????????? ?????? ??????
  • ?????????????, ??????,??????????, ???????

35
Susan?? 54 ?????????????
  • ????????, ????, ????3.2???
  • ??????????????????????
  • ???, ????????? The more I walked, the more it
    seemed I had less and less pain.
  • ???????????????
  • ?????????????????

36
????
  • ???????????????, ??????????????????
  • ?????????????????????????
  • Carlson and Carey(1999)??????????????,
    ?????????????? ?

37
Special consideration
  • Exercise professionals should reach out to
    dialysis staff members about how exercise might
    benefit their patients and assure them that
    programs initiated will be safe and not interfere
    with the treatments.
  • This education should also include ideas of how
    the dialysis staff can encourage patients to be
    physically active.

38
  • What you say to yourself and others, what you do
    for yourself and others, what you see for
    yourself and what you think about yourself and
    others determine your destiny.

39
??
  • ?????????????????????
  • ?????????????????????????????????.
  • ????????????

40
????????
  • Life Option Rehabilitation Program
    http//www.lifeoptions.org
  • American Heart Association http//www.americanhea
    rt.orgNational Institutes of Digestive Diabetes
    Kidney Disorders http / / www.niddk.nih.org
  • National Kidney Foundation clinical practice
    guideline http//www.kidney.org/professionals/kdoq
    i/guidelines.cfm
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