Longitudinal causal effect of modified creatinine index on all-cause mortality in patients with end-stage renal disease: Accounting for time-varying confounders using G-estimation.

BACKGROUND: Standard regression modeling may cause biased effect estimates in the presence of time-varying confounders affected by prior exposure. This study aimed to quantify the relationship between declining in modified creatinine index (MCI), as a surrogate marker of lean body mass, and mortality among end stage renal disease (ESRD) patients using G-estimation accounting appropriately for time-varying confounders. METHODS: A retrospective cohort of all registered ESRD patients (n = 553) was constructed over 8 years from 2011 to 2019, from 3 hemodialysis centers at Kerman, southeast of Iran. According to changes in MCI, patients were dichotomized to either the decline group or no-decline group. Subsequently the effect of interest was estimated using G-estimation and compared with accelerated failure time (AFT) Weibull models using two modelling strategies. RESULTS: Standard models demonstrated survival time ratios of 0.91 (95% confidence interval [95% CI]: 0.64 to 1.28) and 0.84 (95% CI: 0.58 to 1.23) in patients in the decline MCI group compared to those in no-decline MCI group. This effect was demonstrated to be 0.57 (-95% CI: 0.21 to 0.81) using G-estimation. CONCLUSION: Declining in MCI increases mortality in patients with ESRD using G-estimation, while the AFT standard models yield biased effect estimate toward the null.

Can passive pedaling improve sexual function in patients under hemodialysis? A randomized clinical trial.

To investigate the effect of passive pedaling with mini bike on sexual function in patients under hemodialysis. This study was a randomized clinical trial. Thirty-seven patients undergoing hemodialysis were assigned to the intervention (n = 20) and control (n = 17) groups by the stratified block randomization method. The intervention group exercised with a mini bike that was automatic and tuned for patients during the first 2 h of dialysis, twice a week for 20 min each time, for 3 months. The International Index of Erectile Function and Female Sexual Function Index were used to assess the sexual function in the first, second, and third months during the intervention and one month after the intervention. A higher score indicates a better sexual function. Repeated measure ANOVA, Chi-square and Fisher exact tests, independent t, and Mann-Whitney U tests were used for data analysis. The SPSS software version 22 was used for data analysis. Sexual function scores of the intervention group were 35.9 at the beginning of the study, 34.1 in the first month, 37.4 in the second month, 34.8 in the third month, and 31.7 one month after the study. There was no significant difference in the scores of sexual function in the intervention group during the study. The mean scores of sexual function in the control group were 34.5, 34.4, 34.9, 33.8, and 33.9 at the beginning of the study, in the first month, in the second month, in the third month, and one month after the study, respectively (p > 0.05). There was no significant difference between the two groups in terms of sexual function scores during and after the intervention (p > 0.05). Passive pedaling with mini-bike had no effect on sexual function of hemodialysis patients.

Burnout, Anxiety, Stress, and Depression Among Iranian Nurses: Before and During the First Wave of the COVID-19 Pandemic.

Background: Nurses are the major healthcare workforce in an epidemic and have the most contact with patients. Frontline nurses face many health challenges during the COVID-19 epidemic, are directly at risk when treating and caring for COVID-19 patients, and thus experience severe stress and problems in the workplace leading to physical, mental, and social disorders, as well as burnout, anxiety, stress, and depression. The purpose of this study was to compare burnout, anxiety, stress, and depression in nurses before and during the first wave of the COVID-19 pandemic. Methods: This was a cross sectional study. We assessed 266 frontline nurses before and 242 frontline nurses during the first wave of the COVID-19 pandemic with one year apart in 2019 and 2020 (two-stage sampling). The data were collected using demographic questionnaire, Maslach Burnout Questionnaire and Depression, Anxiety and Stress Scale (DASS-21) in public hospitals in Southern Iran. Results: There were no significant differences between groups in subscales of burnout (p > 0.05). Anxiety, stress and depression scores significantly increased during the first wave of the COVID-19 pandemic compared with before the COVID-19 outbreak (p < 0.05). There were significant differences between groups in level of anxiety (p < 0.001) and stress (p = 0.04). Before the COVID-19 outbreak, burnout predicted 11, 15, and 13% of the variance of anxiety, stress and depression, respectively. In addition, stress, monthly working hours and shift were variables that predicted 16% of the variance of burnout before COVID-19. Conclusion: The results of the present study showed that burnout during the first wave of the COVID-19 pandemic did not change significantly compared with before COVID-19. Anxiety, stress and depression increased significantly first wave of the COVID-19 pandemic.

Compassion Satisfaction, Compassion Fatigue and Hardiness Among Nurses: A Comparison Before and During the COVID-19 Outbreak.

BACKGROUND: Nurses provide the majority of health-care services and face numerous health challenges during an epidemic. During the COVID-19 epidemic, nurses are subjected to physical, mental, and social disorders that impair their quality of life and hardiness. Therefore, it is important to be aware of the situation of nurses. The current study aimed to compare the compassion satisfaction, compassion fatigue and hardiness among nurses before and during the COVID-19 outbreak. MATERIALS AND METHODS: This cross-sectional study included 508 clinical nurses from one public hospital in southern Iran. The subjects were recruited using census sampling methods in 2019-2020. Sampling was performed before (n = 266) and during the COVID-19 (n = 242) with a 1-year interval. Although, the study setting was the same before and during the COVID-19, questionnaires were completed by different nurses before and during the COVID-19. Demographic questionnaire, professional quality of life (ProQOL) questionnaire and Occupational Hardiness Questionnaire were used to collect data. RESULTS: The scores of compassion satisfaction, compassion fatigue and hardiness did not differ significantly during the COVID-19 compared with before the COVID-19 (p > 0.05). Before COVID-19, hardiness and work experience predicted 11% of the variance of compassion satisfaction, whereas during COVID-19, hardiness and gender predicted 26% of the variance of compassion satisfaction. Before COVID-19, hardiness and work experience predicted 3% of the variance of compassion fatigue, whereas during COVID-19, hardiness, type of employment and gender predicted 6% of the variance of compassion fatigue. CONCLUSION: The current study found that compassion satisfaction, compassion fatigue and hardiness did not change during the COVID-19 outbreak compared with before the COVID-19 outbreak. However, during the COVID-19, the hardiness was a significant predictor of compassion satisfaction and compassion fatigue. The study results showed that it was possible to increase the compassion satisfaction and reduce the compassion fatigue by strengthening the hardiness of nurses. However, these results need to be considered in future studies, especially in crises such as COVID-19 disease.

Effectiveness of exercise on fatigue in hemodialysis patients: a randomized controlled trial.

BACKGROUND: Hemodialysis is one of the common therapies in patients with end-stage renal disease. Even patients who receive regular treatment suffer from fatigue, which is one of the main factors leading to poor quality of life. This study aimed to determine the effectiveness of exercising on mini-bikes on fatigue in hemodialysis patients. METHODS: This study is a randomized controlled clinical trial. Thirty-seven hemodialysis patients participated in the study. The patients were randomly allocated to either the intervention group (n = 20) or the control group (n = 17). The participants in the intervention group exercised on mini-bikes for 20 min twice a week for 3 months. The patients' fatigue was measured four times during and after the intervention. Multidimensional Fatigue Inventory was used to measure the fatigue level. The total score in the MFI is 4 to 20 for each domain, with the resulting total fatigue score ranging from 20 to 100; thus, the higher the score, the higher the level of fatigue. Data were analyzed by SPSS 18. The repeated measures ANOVA was used to compare the fatigue scores within each group and between the groups at different times. RESULTS: The mean score of fatigue in the intervention group at the beginning was 58.80 ± 15.29, which steadily decreased to 58.78 ± 13.54, 58.75 ± 14.73, 54.20 ± 15.16, and 54.23 ± 13.60 for the 3 months of intervention and 1 month post-intervention, respectively. In contrast, in the control group, this score was 62.53 ± 16.32 in the beginning, increasing to 64.03 ± 13.91, 64.22 ± 13.07, 69.53 ± 9.22, for the 3 months of intervention and 70.34 ± 7.69 one-month post-intervention. There were significant differences between the intervention group and the control group in the third month (P = 0.001) and 1 month after the intervention (P < 0.001). CONCLUSIONS: The results showed that rehabilitation through exercising using mini-bikes had a significant impact on preventing further fatigue build-up in hemodialysis patients, making the mini-bike an effective non-pharmaceutical intervention preventing the increase in fatigue experienced by patients undergoing hemodialysis. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT20180314039100N1. Registered 10 June 2018.

Ultrasonic monitoring of erosion/corrosion thinning rates in industrial piping systems.

Monitoring pipe wall erosion/corrosion thinning rates is an important issue in petrochemical and power generation industries. In this paper, two signal processing techniques are utilized for estimating the thinning rate based on ultrasonic pipe wall thickness data collected over a short period of time. The first is a combination of cross-correlation and polynomial curve fitting and the second is a model-based estimation (MBE) scheme. These techniques are applied to data collected from an accelerated thinning rate apparatus and both show that they are capable of estimating the thinning rates quickly in short time periods with good accuracy. In laboratory applications, thinning rates as low as 10 µm/year were measured within 15 days with an uncertainty of ±1.5 µm/year by both techniques. Although the MBE technique can yield marginally better accuracy, the greater stability and computational speed of the cross-correlation technique make it the preferred choice for industrial use.

Does L-carnitine improve endothelial function in hemodialysis patients?

BACKGROUND: Atherosclerosis is the leading cause of death in hemodialysis patients. These patients are also very prone to L-carnitine deficiency due to kidney disease. In this clinical trial, we investigated the effect of oral L-carnitine on endothelial function of these patients. MATERIALS AND METHODS: [corrected] We studied 31 adult chronic hemodialysis patients in our center and divided them into two groups. The first group (n = 20) received 1500 mg/dialysis interval (every other day) oral L-carnitine. The control group (n = 11) received placebo for one month. Ultrasonographic measurements of flow mediated dilation and carotid intima-media thickness were performed before and after one month of L-carnitine and placebo therapy. RESULTS: This study showed that after one month of L-carnitine or placebo therapy there was no significant improvement in flow mediated dilation (p = 0.80 and p = 0.59, respectively) or decrease in carotid intima-media thickness (p = 0.12 and p = 0.50, respectively). CONCLUSIONS: Our study revealed that one month of oral L-carnitine therapy did not improve endothelial function in hemodialysis patients. Long-term studies with large sample size using intravenous form and higher doses of the drug are required to clarify the questionable role of L-carnitine in hemodialysis patients.