"Exercise during hemodialysis and health promoting behaviors: a clinical trial".

BACKGROUND: Health promoting behaviors are among the determinants of health. Hemodialysis causes significant changes in the lives of patients and affects their health promoting behaviors. Accordingly, this study aimed at investigating the effect of exercise during hemodialysis on health promotion behaviors in patients undergoing hemodialysis. METHODS: This study was a two-stage (before and after) clinical trial. The sample of the study consisted of 60 hemodialysis patients in two hospitals in Isfahan who were selected randomly and divided into two groups of control and intervention using random allocation method. A 8-week exercise program by stationary bicycles (Mini-bike) was designed for the intervention group, while the control group underwent a 10-min limbering exercise for 8 weeks. Data were collected using demographic questionnaire and the Health Promoting Lifestyle Profile II (HPLP-II) questionnaire before and after the intervention and were analyzed using SPSS21 software. RESULTS: Based on the independent t-test results, no significant difference was observed between the mean score of health promoting behaviors and its areas before the intervention (P > 0.05). However, the results of this test showed that the mean score of health promoting behaviors and its areas, except for the areas of responsibility (P = 0.052) and spirituality (P = 0.211), was significantly different between the two groups after the intervention (p < 0.05). CONCLUSIONS: The results of this study showed that exercise with stationary bicycle during hemodialysis could promote health promoting behaviors. Thus, this exercise is recommended to be considered as part of the therapeutic protocol of these patients in hemodialysis departments. TRIAL REGISTRATION: The clinical trial was found to be in accordance to the ethical principles and the national norms and standards for conducting medical research in Iran. IRCT registration number: IRCT20150116020675N3 . Registration date: 2019-01-18, 1397/10/28 Approval ID: IR.MUI. RESEARCH: REC.1397.014 Approval Date: 2018-07-01 Evaluated by: Vice-Chancellor in Research Affairs -Medical University of Isfahan.

Effect of moral empowerment program on moral distress in intensive care unit nurses.

BACKGROUND: Moral distress has been experienced by about 67% of critical care nurses which causes many complications such as job dissatisfaction, loss of capacity for caring, and turnover for nurses and poor quality of care for patients as well as health system. OBJECTIVE: The purpose of this research was to provide a moral empowerment program to nursing directors, school of nursing, and the heads of hospitals to reduce moral distress in nurses and improve the quality of care. METHODS: This research was a randomized clinical trial conducted in two groups and three stages before, after 2 weeks, and 1 month after the intervention in order to evaluate the changes in moral distress of 60 nurses working in adults' intensive care unit wards of Al-Zahra teaching hospital of Isfahan University of Medical Sciences. Data were collected using the standard Hamric's Moral Distress Scale (2012) and analyzed using SPSS software version 22. ETHICAL CONSIDERATIONS: This study was approved by the Ethics Committee of Isfahan University of Medical Sciences, Isfahan, Iran. RESULTS: Results showed that in the three stages, there was no significant difference between the mean score of moral distress before (4.12 ± 2.70), 2 weeks after (4.23 ± 2.70), and 1 month after the intervention (4.04 ± 2.54) in the control group (p > 0.05), while in the experimental group, there was a significant difference between the three stages (p < 0.05). The mean score of moral distress in the experimental group before intervention (4.05 ± 2.26) and 2 weeks after the intervention (3.38 ± 2.11) was not significant (p > 0.05). However, this score significantly decreased 1 month after the intervention (2.64 ± 2.23; p < 0.05). CONCLUSION: In this research, it was observed that moral empowerment program has been effective in reducing the mean score of moral distress. Therefore, it is recommended that nursing managers and hospital directors implement empowerment program, in order to reduce the moral distress of nurses and improve the quality of care.

The lived experiences of patients undergoing hemodialysis with the concept of care: a phenomenological study.

BACKGROUND: Providing patient-centered care needs in patients with chronic renal failure undergoing hemodialysis is important in inspiring their confidence to continue their treatment and promote their mental and social health. Therefore, recognizing the concept of care from the viewpoint of these patients can be helpful in designing the care programs of this vulnerable group. Accordingly, the aim of this study was to reveal the meaning and concept of care based on the experience of patients with chronic renal failure undergoing hemodialysis. METHODS: Using a descriptive phenomenological method, this study was conducted on 17 patients who were undergoing hemodialysis. Purposive sampling was performed and data was collected through 30 to 60 min, face-to-face and in-depth semi-structured interviews. Data analysis was performed using Colaizzi's method. RESULTS: Seventeen patients (9 women 8 men) aged between 24 and 83, and a minimum of 10 and maximum of 168 months history of hemodialysis participated in the study. After data analysis, 4 themes and 9 sub-themes were extracted, and the concept of care emerged for the participants as empathy, companionship in everyday needs, social support and concern, and good-quality dialysis. CONCLUSIONS: Based on the results of this study, the concept of care from the viewpoint of patients emerged in the form of empathy, companionship in everyday needs, social support and concern, and good-quality dialysis. It is recommended that caregivers of patients consider these concepts in the design of patient-centered care programs.

The Effect of Health-belief-model-Based Training on Behaviors Preventing Peritonitis in Patients on Peritoneal Dialysis.

BACKGROUND: Peritonitis is one of the important complications of peritoneal dialysis and one of the reasons for failure of this therapeutic technique. As one of the important reasons for development of peritonitis is disregard for health behaviors, this study aims to investigate the effect of education based on health belief model (HBM) on behaviors preventing peritonitis in peritoneal dialysis patients. METHODS: This double-blind clinical trial study conducted on 60 patients with peritoneal dialysis in Isfahan, Iran. A researcher-made questionnaire was used to evaluate knowledge, HBM constructs, and peritonitis preventive behaviors in three stages (before, immediately after and 2-month after intervention). The intervention group received four HBM-based educational sessions and the control group received a lecture session. Data were analyzed using Chi-square, Mann-Whitney, Fisher's exact test, independent t-test, and repeated measures ANOVA. RESULTS: There was no significant difference between the two groups' background variables and level of knowledge, perceived, sensitivity, severity, benefits, arriers, self-efficacy, personal and environmental hygiene behaviors and fluid-replacement technique before the intervention. Immediately after the intervention, all of the variables, except perceived barriers, personal, and environmental hygiene, were significantly higher in the intervention group than the control group (P < 0.05); 2 months after the intervention, all of the variables, except personal hygiene and perceived barriers, were significantly higher in the intervention group (P < 0.05); in three stages, personal hygiene was not significantly different between the two groups; and 2 months after the intervention, the variable of perceived barriers decreased significantly in the intervention group (P < 0.05). CONCLUSIONS: Education based on HBM is effective on promoting behaviors preventing peritonitis. Education based on HBM is suggested in peritoneal dialysis patients to prevent peritonitis.

The effect of mindfulness program on general health of patients undergoing hemodialysis.

INTRODUCTION: Patients undergoing hemodialysis have a low level of health and mindfulness technique in mind-body medicine is used to help patients with chronic illness. Therefore, this clinical trial was conducted to determine the effect of the mindfulness program on the general health of patients undergoing treatment with hemodialysis. METHODS: Sixty hemodialysis patients were selected through the convenient method and randomly divided into experimental and control groups. Both groups completed demographic information questionnaire and general health questionnaire. Then, the experimental group received 8 sessions of mindfulness training and the control group received 8 sessions of education in relation to end-stage renal disease and hemodialysis. Educational sessions were performed for both groups in the second 30 min after hemodialysis for 1 h in six individual sessions and two 1.5 h group sessions. Immediately after and 1 month after the intervention, the General Health Questionnaire was completed by both groups. RESULTS: Analysis of the findings showed no significant differences between the mean score of general health disorder and its subscales before the intervention in to two groups (P > 0.05). Nevertheless, after intervention in the experimental group, the mean of general health disorder score decreased from 44.17 ± 12.32 to 21.9 ± 6.4 and 1 month after the intervention, the mean score of this score was 23.6 ± 6.2. The mean score of physical symptoms, anxiety and sleep disorder, social functioning deficiency, and depression were also significantly lower in the experimental group immediately after intervention and 1 month after the intervention; however, there were no significant differences between the mean of this score immediately and 1 month after the intervention. In addition, the mean score of general health disorder changes immediately and 1 month after the intervention in the experimental group was significantly more than the control group. In the control group, there was no significant difference between the mean score of general health disorder and its subscales before, immediately, and 1 month after the intervention (P > 0.05). CONCLUSIONS: The results of this research showed that mindfulness has been effective in reducing physical and anxiety symptoms, sleep disorder, social dysfunction, and depression symptoms. Therefore, the use of mindfulness as a complementary treatment can improve the general health level in these patients.

The Effects of Motivational Interviewing on the Health Status of Patients Undergoing Hemodialysis.

BACKGROUND: Patients undergoing hemodialysis are exposed to a wide range of physical, psychological, and social problems. One of the most important strategies for health promotion in patients is motivational interviewing. This study investigated the effect of motivational interviewing on the health status of patients undergoing hemodialysis. MATERIALS AND METHODS: This single-blind, parallel, randomized, clinical trial was conducted on 57 patients undergoing hemodialysis who referred to hemodialysis centers of Alzahra and Amin Hospitals, Isfahan, Iran. The participants were selected through quota sampling method and were assigned to the experimental and control groups. The experimental group received five sessions of motivational interviewing, while the control group received five sessions of group discussion about their disease. The General Health Questionnaire (GHQ) was completed by the participants before and after the intervention. Independent t-test, paired-sample t-test, and Mann-Whitney, Chi-square, and Fisher's exact tests were used to analyze the collected data. In this study, the level of significance was 0.05. RESULTS: Before the intervention, there was no significant difference between the mean scores of general health of the two groups (t = 0.48, p = 0.631). However, one week after the intervention, the mean score of general health in the intervention group was significantly lower than that of the control group (t = 3.12, p = 0.003). CONCLUSIONS: It can be concluded that motivational interviewing effectively improved the general health of patients undergoing hemodialysis, and using such interventions in these patients is recommended.

Comparison of the Effect of Topical Application of Rosemary and Menthol for Musculoskeletal Pain in Hemodialysis Patients.

BACKGROUND: Pain is the most common problem experienced by hemodialysis patients, especially musculoskeletal pain in lower extremities, which is usually not completely treated and adversely affects their quality of life. The present study was conducted with the aim to determine and compare the effects of topical application of menthol and rosemary for musculoskeletal pain in hemodialysis patients. MATERIALS AND METHODS: The present single-blind clinical trial recruited 105 eligible patients undergoing hemodialysis in selected hospitals affiliated to Isfahan University of Medical Sciences; patients were selected by convenient sampling. Participants' severity of pain was determined prior to intervention. They were then randomly divided into rosemary, menthol, and placebo groups. All three groups applied medication on the site of pain on their legs three times a day for three days and recorded the severity of pain four hours after morning and afternoon applications. The statistical analysis of data was performed using SPSS 18. RESULTS: The mean score of severity of pain before the intervention was not significantly different among the three groups (p = 0.83), but it became significantly different after intervention (p = 0.001). Significant differences were observed in mean severity of pain before and after intervention in rosemary and menthol groups (p < 0.001), but not in the placebo group (p = 0.21). CONCLUSIONS: Topical application of menthol and rosemary can alleviate severity and frequency of recurrence of musculoskeletal pain in hemodialysis patients; however, according to the results of the study, none had precedence over the other.

Effect of Fordyce's Happiness Program on Stress, Anxiety, and Depression among the Patients Undergoing Hemodialysis.

BACKGROUND: Patients with end-stage renal disease on hemodialysis are affected by psychological stressors, which contribute to poor quality of life and negative clinical outcomes. Stress, anxiety, and depression are highly prevalent in this population. Fordyce's happiness program has been believed to be one of the complementary therapies that could promote psychological wellbeing. The goal of this study was to evaluate the effects of Fordyce's happiness program on the stress, anxiety, and depression in patients with hemodialysis. MATERIALS AND METHODS: This is a clinical trial. A total of 50 patients undergoing hemodialysis were randomly recruited into the study group (n = 25) and the control group (n = 25). Intervention of Fordyce's happiness program was administrated for 20 minutes during hemodialysis sessions once a week for 6 sessions. For the control group, 3 sessions were held by the researcher's colleague through communication, dialogue, and listening to the patients' problems individually. The data was collected by the Stress, Anxiety and Depression (DASS-21) questionnaire. RESULTS: There was a significant difference in the mean scores of stress, anxiety, and depression in the intervention group before immediately after and one month after intervention (P < 0.05), whereas there was no significant difference in the mean scores of stress, anxiety, and depression before, immediately after, and 1 month after intervention in control group. CONCLUSIONS: The obtained results showed that Fordyce Happiness Training Program can reduce the stress, anxiety, and depression in patients treated with hemodialysis.

Nonadherence Behaviors and Some Related Factors in Kidney Transplant Recipients.

BACKGROUND: Kidney transplantation is the renal replacement therapy of choice for most patients with end-stage renal disease (ESRD), however, adherence to the recommended lifestyle is critical for a positive prognosis. The purpose of this study was to assess adherence to immunosuppressive therapy and lifestyle recommendations along with some related factors among kidney transplant patients. MATERIALS AND METHODS: In this descriptive analytical study, all patients completed a questionnaire regarding medication intake and lifestyle recommendations (preventing of infection, self-monitoring, prevention of cardiovascular disease (CVD), and sun protection). The participants were divided into 4 groups according to the level of adherence (good, partial, poor, and nonadherent) indicated in their responses. RESULTS: Most kidney recipients were adherent to their drug prescriptions, but were partial, poor, or nonadherent regarding lifestyle recommendations. Increased passage of time since transplantation and low family support and educational level resulted in nonadherence. Men showed greater adherence to medication intake than women. Patients with lower number of drugs and reported drug side-effects illustrated better adherence to medication intake. Women adhered to infection protection recommendations more than men, and older and married patients adhered to cardiovascular prevention recommendations more than others. However, younger patients showed greater adherence to self-monitoring recommendations, and singles, young individuals, and women were adherent to sun protection recommendations. CONCLUSIONS: Nonadherence is common among kidney transplant recipients. Thus, it is necessary to determine patients who are at risk of nonadherence and to introduce more educational programs to improve their adherence and their quality of life (QOL).

The effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among hemodialysis patients.

BACKGROUND: Restless leg syndrome prevalence is high among the patients undergoing hemodialysis. Due to several side effects of medicational treatments, the patients prefer non-medicational methods. Therefore, the present study aimed to investigate the effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among patients undergoing hemodialysis. MATERIALS AND METHODS: This study is a randomized clinical trial that was done on 90 qualified patients undergoing hemodialysis in selected hospitals of Isfahan, who were diagnosed with restless leg syndrome through standard restless leg syndrome questionnaire. They were randomly assigned by random number table to three groups: Reflexology, stretching exercises, and control groups through random allocation. Foot reflexology and stretching exercises were conducted three times a week for 30-40 min within straight 4 weeks. Data analysis was performed by SPSS version 18 using descriptive and inferential statistical analyses [one-way analysis of variance (ANOVA), paired t-test, and least significant difference (LSD) post hoc test]. RESULTS: There was a significant difference in the mean scores of restless leg syndrome severity between reflexology and stretching exercises groups, compared to control (P < 0.001), but there was no significant difference between the two study groups (P < 0.001). Changes in the mean score of restless leg syndrome severity were significantly higher in reflexology and stretching exercises groups compared to the control group (P < 0.001), but it showed no significant difference between reflexology massage and stretching exercises groups. CONCLUSIONS: Our obtained results showed that reflexology and stretching exercises can reduce the severity of restless leg syndrome. These two methods of treatment are recommended to the patients.

The effect of acupressure on muscle cramps in patients undergoing hemodialysis.

BACKGROUND: Pain resulting from muscle cramps is one of the most common outcomes of hemodialysis. One of the mechanisms associated with muscle cramps is unnatural muscle metabolism. Because acupressure improves muscle metabolism through the releasing of energy, this study was performed with the purpose of determining the impact of acupressure on muscle cramps. MATERIALS AND METHODS: This study was a single-blind clinical trial. Accordingly, 64 patients were selected and intensity and frequency of muscle cramps were determined by randomly categorizing them into two groups. The intervention group received 9 sessions of acupressure and the control group received 9 sessions of placebo intervention. The intervention was performed 15 min before hemodialysis in both groups. In both the groups, average intensity of pain and the frequency pain was compared before, after, and 1 month after completion of the intervention. RESULTS: Data analysis revealed that there were no significant statistical differences between the two groups in terms of mean value of intensity (P = 0.586) and frequency (P = 0.780) of muscle cramps before the intervention. We observed a significant difference after completion of intervention sessions (P < 0.001). Moreover, there were no significant differences between mean value of intensity (P < 0.001) and frequency (P = 0.030) of muscle cramps in the control group before, after, and 1 month after the completion of 9 sessions of placebo intervention. CONCLUSIONS: Employing acupressure may result in decrease of muscle cramps in patients undergoing hemodialysis.

Assessment of hemodialysis adequacy and its relationship with individual and personal factors.

BACKGROUND: Hemodialysis is the most common renal replacement therapy in the world, and hemodialysis adequacy is an important and influencial factor in the reduction of various complications experienced by these patients. Multiple factors influence hemodialysis adequacy. This study was conducted to determine hemodialysis adequacy and its relationship with individual and personal factors in patients undergoing hemodialysis in three hemodialysis centers of Isfahan, Iran. MATERIALS AND METHODS: This descriptive, cross-sectional study was conducted in partnership with 202 patients undergoing hemodialysis in three hemodialysis centers of Isfahan. The data were collected using a researcher-made questionnaire, and hemodialysis adequacy was measured using the urea reduction ratio (URR). Data analysis was conducted using Spearman's correlation coefficient, Mann-Whitney and Kruskal-Wallis tests, and descriptive statistics (frequency distribution). In this study, the level of significance was considered to be 0.05. RESULTS: Hemodialysis adequacy in 56.4% of patients was optimal, in 29.7% near optimum, and in 13.9% less than optimal. Statistical tests showed a significant correlation between hemodialysis adequacy and age (P = 0.05), prehemodialysis systolic blood pressure (BP) (P = 0.02) and diastolic BP (P = 0.04), the duration of hemodialysis in months (P = 0.02), and patients' sex (P = 0.01). There was no significant correlation between hemodialysis adequacy and the number of hemodialysis cessations per week (P = 0.20), interdialytic weight gain (P = 0.40), prehemodialysis blood urea nitrogen (P = 0.40), creatinine (P = 0.10), hemoglobin (P = 0.20), hematocrit (P = 0.08), venous access type (P = 0.30), needle distance and direction (P = 0.70), underlying causes of end-stage renal disease (P = 0.50), and personnel's shift (P = 0.90). CONCLUSIONS: The results of the study showed that approximately half of the patients did not have an optimal level of hemodialysis adequacy, and multiple individual and personnel factors affect hemodialysis adequacy directly or conversely.

Supporting hemodialysis patients: A phenomenological study.

BACKGROUND: Chronic renal disease and hemodialysis cause numerous psychological, social, cultural, and spiritual challenges for both patients and their families. Overcoming these challenges is possible only through providing holistic support for the patients. Today, despite the support provided by family and professional caregivers for the patients, patients still express dissatisfaction with the support provided and believe it to be inadequate. In fact, patients and family caregivers and healthcare practitioners seem to have different understandings of the notion of support. Thus, the researcher decided to examine the concept of support from the viewpoint of hemodialysis patients. MATERIALS AND METHODS: This descriptive phenomenological research was conducted on 17 patients with end-stage renal disease (ESRD) who were undergoing hemodialysis. Purposive sampling was performed and continued until data saturation. Data were collected through 30-60 min unstructured interviews and analyzed using Colaizzi's method. RESULTS: From the analysis of data, 4 themes (psychological support, accompaniment, social support, and spiritual support) and 11 sub-themes were obtained. Psychological support consisted of two sub-themes of psychological support by healthcare practitioners and emotional support by family and relatives. Accompaniment included three sub-themes of assistance in transportation, providing and using medicine, and daily activities. Social support was identified with four sub-themes of promotion of the society's understanding of the patients' condition, improvement of communication with others, the need for employment, and independence. Spiritual support was identified with two sub-themes of the need for faith and trust in God or Imams and the need to resolve spiritual contradictions. CONCLUSION: The results showed that from the viewpoint of the participants, the concept of support consisted of psychological support, social support, accompanying the patient, and spiritual support. Hence, it can be concluded that this concept should be considered in healthcare planning, in order to improve the health and quality of life of these patients and their adaptation to the disease and its treatment process.

Effects of aerobic exercise on blood glucose in continuous ambulatory peritoneal dialysis patients.

BACKGROUND: Peritoneal dialysis has a number of complications including increased blood glucose. Although exercise has been suggested to resolve this complication, most patients are not active. The present study aimed at determining the effects of twice-weekly, 40-min sessions of pedaling on a stationary bicycle on mean fasting blood sugar (FBS) and 2-h postprandial blood sugar (PPBS) among continuous ambulatory peritoneal dialysis patients. MATERIALS AND METHODS: In this clinical trial, convenience sampling was used to select 22 patients [age: 51.4 (12.3) years] undergoing continuous ambulatory peritoneal dialysis [mean duration: 12.5 (8.5) months] from university hospitals in Isfahan, Iran. The subjects were randomly divided into two groups (test and control). The test group participated in an 8-week exercise program in which they pedaled a stationary bicycle with an intensity of four on Borg Scale of Perceived Exertion. FBS and PPBS were measured at baseline and at the end of the 8(th) and 16(th) sessions of exercise. Data were analyzed with Student's t-test and repeated measures analysis of variance. RESULTS: After the eighth session, the mean FBS and PPBS levels were lower in the test group than in the control group. However, the differences were not statistically significant. After 16 sessions of exercise, the mean FBS and PPBS levels in the intervention group were significantly less than the in control group. CONCLUSIONS: Forty minutes of pedaling on a stationary bicycle for two times a week can significantly reduce mean FBS and PPBS levels in continuous ambulatory peritoneal dialysis patients.

Efficacy of stepwise sodium profile versus individualized dialysate sodium in blood pressure control among hemodialysis patients.

BACKGROUND: Hypertension is very common in patients with end-stage renal disease and accelerates cardiovascular morbidity and mortality. The most important factor in achieving normal blood pressure in these patients is reaching dry weight. Sodium and extracellular fluid balance play a vital role in this regard. Considering the lack of consensus about the efficacy of stepwise sodium profile and individualized dialysate sodium, this study aimed to determine the superior method for blood pressure control in hemodialysis patients. MATERIALS AND METHODS: In a quasi-experimental study, patients satisfying the inclusion criteria were enrolled through convenience sampling. The patients were randomly assigned to two groups of stepwise sodium profile and individualized dialysate sodium. Information record form was used for data collection. Data were analyzed with paired and independent t-test and descriptive statistics using SPSS for Windows 20.0. RESULTS: Patients in the two groups were similar in qualitative and quantitative background variables. While systolic blood pressure significantly decreased following hemodialysis with individualized dialysate sodium (P < 0.001), there was no significant difference between pre- and post-dialysis systolic blood pressure values using stepwise sodium profile (P = 0.060). Individualized dialysate sodium caused greater change in the mean systolic blood pressure than stepwise sodium profile did (P = 0.040). Pre- and post-dialysis diastolic blood pressure values showed significant differences in both groups (P < 0.001 using individualized dialysate sodium and P = 0.009 using stepwise sodium profile). However, the mean changes in diastolic blood pressure of the two groups were not significantly different (P = 0.295). CONCLUSIONS: We found no significant difference in interdialytic weight gain and blood pressure control by the two methods. The change in systolic blood pressure was lower in the stepwise profile method than in the individualized dialysate sodium method, and this method did not cause interdialytic hypertension. So, by adjusting the dialysis solution with regard to plasma sodium levels, lead to more blood pressure control. Meanwhile, the two groups were not significantly different in the mean changes of diastolic blood pressure.

Effect of hope therapy on depression, anxiety, and stress among the patients undergoing hemodialysis.

BACKGROUND: Renal failure is a major public health problem in the world. These patients experience high levels of psychological tension, anxiety, and depression, which leads to their lowered quality of life, increased health care costs, and early mortality. Due to medication side effects in these patients, non-medicational methods are more in demand now. This study aimed to investigate the effect of hope therapy on depression, anxiety, and stress among the patients undergoing hemodialysis. MATERIALS AND METHODS: This is a clinical trial. Fifty patients undergoing hemodialysis were selected. Patients were assigned to two groups of hope therapy and placebo. Intervention of hope therapy was administered for 60-90 min during dialysis sessions once a week for eight sessions. In the placebo group, non-specific intervention was administered with the same number of sessions. Depression, Anxiety, and Stress scale (DASS)-21 questionnaire was completed at the end of the last session and 4 weeks later. Data were analyzed by paired t-test, repeated measures analysis of variance (ANOVA), and least significant difference (LSD) post hoc test through SPSS 18. RESULTS: There was a significant difference in mean scores of depression, anxiety, and stress in hope therapy group before, immediately after, and 1 month after intervention (P < 0.05), while there was no significant difference in mean scores of depression, anxiety, and stress before and immediately after intervention in the placebo group. Changes in mean scores of depression, anxiety, and stress were significantly higher in hope therapy group compared to placebo (P < 0.05). CONCLUSIONS: The obtained results showed that hope therapy is effective on reduction of depression, anxiety, and stress.

Impact of stepwise sodium and ultra filtration profiles and dialysis solution flow rate profile on dialysis adequacy.

BACKGROUND: Inadequate dialysis is one of the main causes of mortality of the patients undergoing hemodialysis. The methods that lead to improvement of dialysis adequacy in these patients are of great importance due to them causing an improvement of quality of life. As numerous factors can play a role in improvement of dialysis adequacy, the present study aimed to investigate the level of impact of stepwise sodium and ultra filtration profiles and dialysis solution flow rate profile on dialysis adequacy. MATERIALS AND METHODS: This is a cross-over clinical trial conducted on 32 patients selected from two hemodialysis centers in Isfahan in 2013. The patients were assigned to two identical groups through random allocation, and each patient in group 1 underwent hemodialysis for four routine dialysis sessions, four stepwise sodium and ultra filtration profile sessions, and four sessions by stepwise dialysis solution flow rate profile. The patients in group 2 underwent hemodialysis for four sessions of stepwise dialysate flow rate profile, four sessions of stepwise sodium and ultra filtration profiles, and four sessions of routine dialysis method. Dialysis adequacy was on line calculated by Kt/V ratio in each session, and was analyzed by repeated measure analysis of variance (ANOVA), least significant difference (LSD) post-hoc test, and independent t-test. RESULTS: Means of dialysis adequacies were 1.239 (0.25) in the routine method, 1.407 (0.26) in stepwise sodium and ultra filtration profiles, and 1.414 (0.26) in dialysis solution flow rate profile. There was a significant difference between the routine method and the other two profiles (P < 0.05), but the difference in dialysis adequacy means in the two profile methods was not significant (P > 0.05). Mean scores of dialysis adequacy in the three treatment methods in the two groups showed that the sequence of methods had no effect on treatment outcome (P > 0.05). CONCLUSIONS: Stepwise sodium and ultra filtration profiles and stepwise dialysis solution flow rate profile are suggested as they can increase dialysis adequacy compared to the routine method.

The effect of tai chi exercise on quality of life in hemodialysis patients.

BACKGROUND: Today, despite remarkable advances in the care of hemodialysis patients, the quality of life (QOL) for these patients is still unsatisfactory. Although previous reports confirmed the effect of exercise on the well-being of renal patients, less than 50% of end-stage kidney patients participate in a regular sports program. Tai chi is a slow and gentle exercise that is suitable for people with chronic illnesses and those with severe intolerance of exercise. Therefore, this study aimed to determine the effect of tai chi exercise on the QOL of hemodialysis patients. MATERIALS AND METHODS: This was a quasi-experimental study conducted in a single group and in two steps. Twenty-five hemodialysis patients, admitted to hospitals in Isfahan, Iran, were selected, and their QOL was compared before and after intervention in two domains of satisfaction and importance. Convenience sampling was used. The sampling was convenience. The subjects were trained in the intervention through a single session of tai chi exercise class for one hour weekly, for 12 weeks, with a training compact disc (CD) that helped the patients to exercise at least twice a week at home. Data were collected by the completion of a demographic characteristics form and a researcher-made QOL questionnaire adopted from Ferrans and Powers Quality of Life Index Dialysis Version and the Kidney Disease Quality of Life-Short Form (KDQOL-SF) questionnaire by the researchers. The data were analyzed by a paired t-test through SPSS software version 18. RESULTS: Data analysis showed that there was a statistically significant difference in health and functioning (P < 0.001), socioeconomic (P < 0.001), and psychospiritual (P < 0.001) dimensions, and the family dimension had P = 0.002 in the satisfaction domain and P = 0.008 in the importance domain; the total score of quality of life in both domains was P < 0.001. CONCLUSIONS: According to the research findings, tai chi exercise improves the QOL score significantly in all dimensions, and adding tai chi classes to the rehabilitation program of hemodialysis patients can have a positive effect including an improved QOL for them. Therefore, this study supports the results of other research studies that showed positive effects of tai chi on QOL.

An investigation of coping styles of hemodialysis patients.

BACKGROUND: Hemodialysis patients are exposed to different stressful factors and have to use coping strategies as supportive processes. The goal of the present study is to investigate coping styles of hemodialysis patients. MATERIALS AND METHODS: This is a descriptive analytical study conducted on 96 patients referring to hemodialysis centers affiliated to Isfahan University of Medical Sciences in 2011. The data, collected by a questionnaire including two sections of demographic characteristics and patients' coping with the disease, were analyzed by parametric and non- parametric statistical tests. RESULTS: Patients used emotion focused coping strategies more (mean = 20.07, SD = 4.39) to adapt with the disease compared to problem focused coping strategies (mean = 14.65, SD = 5.08). There was a significant association in coping (P = 0.027) and emotion focused dimension (P = 0.008) in various ages, but there was no significant association in problem focused dimension (P = 0.134). CONCLUSION: Since most of the hemodialysis patients use emotion focused coping styles, it is suggested to consider educational programs on application of problem focused coping styles for these patients in order to decrease the pressures of the disease and treatment, and to promote their mental health, quality of life and efficiency.

Reviewing and comparing self-concept in patients undergoing hemodialysis and peritoneal dialysis.

BACKGROUND: Chronic renal disease is a health problem in today's world. In the end-stages of renal disease patients depend upon alternative therapies including dialysis for their survival. However, dialysis causes several stressors on physical, mental and social performance of patients. The present study aimed to review and compare the self-concept in patients undergoing hemodialysis and peritoneal dialysis. MATERIALS AND METHODS: This was a case-control study including two groups of patients, undergoing hemodialysis and peritoneal dialysis, who referred to Al-Zahra and Ali Asghar Hospitals, which are affiliated to Isfahan University of Medical Sciences. These groups were compared to the control group. Data were collected through completing the form of demographic characteristics and a questionnaire, written by the researcher, pertaining to the self-concept which was collected by the samples. The data were analyzed by the Software SPSS version 18. FINDINGS: ANOVA (analysis of variance) showed that statistically there was a significant difference between mean score of self-concept in the three physical (body-image), psychological, and social self aspects in the two groups of hemodialysis and peritoneal dialysis with the control group; however, Duncan's post-hoc analysis showed no significant difference between mean score of self-concept in the three mentioned aspects in the two groups of hemodialysis and peritoneal dialysis. Furthermore, ANOVA (analysis of variance) showed that there was no significant difference between mean score of the spiritual aspect of the self-concept in the two groups of hemodialysis and peritoneal dialysis with the control group. Duncan's post-hoc analysis also showed no significant difference in this aspect between the two groups of hemodialysis and peritoneal dialysis. CONCLUSIONS: Patients undergoing dialysis have many psychological disorders and the type of dialysis is not of much importance in this regard; therefore, adequate education and information for clients in order to use appropriate methods of adaptation as well as appropriate social relationship, continuing social support and developing health policies seem necessary in order to prevent mental disorders and providing required services and supports for patients.