A Systematic Review of Potentially Effective Nonpharmacological Interventions for Reducing Fatigue among Iranian Patients Who Receive Hemodialysis.

BACKGROUND AND PURPOSE: Fatigue control in hemodialysis (HD) patients requires a multidisciplinary approach. This study aimed to comprehensively review the available research literature regarding the nonpharmacological interventions used for reducing fatigue among Iranian HD patients. METHODS: In this systematic review, an extensive search of the literature was conducted on PubMed, Web of Science, and Scopus databases, using the keywords related to the purpose. Also, the Persian equivalent of these keywords was searched in Iranian databases, such as Iranmedex and Scientific Information Database (SID) from the inception to June 16, 2020. RESULTS: Of 2,761 articles, 25 studies were included in the review. Among a total of 1,748 Iranian HD patients with a mean age of 54.17 (SD = 12.27) years, 61.38% were male. Interventions such as educational-based programs (n = 5), nutrition-based programs (n = 2), massage therapy (n = 3), exercise-based programs (n = 4), relaxation technique (n = 3), combination of relaxation technique and inhalation aromatherapy (n = 1), energy therapy (reflexology and acupressure) (n = 3), and mind-guided imagery (n = 1) were effective in reducing fatigue in Iranian HD patients. DISCUSSION/CONCLUSION: These simple, low-cost, and practical interventions can be used for the reduction of fatigue among HD patients by nurses. However, future well-designed studies are recommended to confirm the efficacy of these and other potentially effective interventions for reducing fatigue in HD patients.

The effect of curcumin ointment on knee pain in older adults with osteoarthritis: a randomized placebo trial.

BACKGROUND: Some studies have shown the effect of oral administration of curcumin on knee pain. However, limited studies are available on the effect of topical curcumin. This study aimed to investigate the effect of curcumin ointment on knee pain in older adults with osteoarthritis. METHODS: This double-blind randomized placebo trial was conducted on 72 older adults with knee pain associated with osteoarthritis. The subjects were randomly assigned into an intervention and a placebo group to apply either curcumin 5% ointment or Vaseline ointment twice daily for 6 weeks. Using a Visual Analog Scale, the severity of knee pain was measured at the beginning of the study, at the end of the fourth and sixth week. Data were analyzed using descriptive and inferential methods. RESULTS: The mean baseline knee pain intensity was not significantly different between the two groups (P = 0.15). The mean pain intensity was significantly lower in the intervention group than in the placebo group at the third measurement (P = 0.02). The repeated-measures analysis showed that over time, the curcumin significantly decreased the mean pain intensity in the intervention group (P = 0.001). The mixed model showed an absolute difference of 1.133 (i.e. 11.33 mm) score which signifies a medium effect size and that the patient in the intervention group achieved the minimal clinically important difference. CONCLUSION: Topical administration of curcumin 5% ointment can significantly reduce knee pain in older adults with knee osteoarthritis. Curcumin ointment can be used as an alternative treatment in older adults with knee pain associated with osteoarthritis. TRIAL REGISTRATION: Retrospectively registered in the Iranian Registry of Clinical Trials (IRCT) (IRCT20100403003618N6, 2019-03-08), https://en.irct.ir/trial/37155.

Bias in clinical trials into the effects of complementary and alternative medicine therapies on hemodialysis patients.

BACKGROUND: Chronic renal failure is among the major health challenges in the world. Many clinical trials have been conducted to assess the effects of complementary and alternative therapies on hemodialysis-related outcomes. However, a number of biases may affect the results of these studies. AIMS: This study aimed to assess biases in randomized clinical trials into the effects of complementary and alternative therapies on hemodialysis patients. SETTINGS AND DESIGN: A critical review on clinical trials into the effects of complementary and alternative therapies therapies on hemodialysis patients. MATERIALS AND METHODS: This study was conducted on 114 randomized clinical trials which had been published in 2012-2017 into the effects of complementary and alternative therapies on hemodialysis patients. The Cochrane Risk of Bias Tool was employed to assess biases in the included trials. The collected data were presented using the measures of descriptive statistics, namely absolute and relative frequencies. RESULTS: Among 114 included trials, 71.05% (81 trials) had used low bias methods for random sequence generation, while 60.52% (69 trials) had provided no clear information about allocation concealment. Moreover, respecting blinding, 57.89% of trials (66 trials) were low bias. Around 60.52% of trials (69 trials) had no attrition between randomization and final follow-up assessment and 84.21% (96 trials) had apparently reported all intended outcomes. CONCLUSIONS: This study shows that 50% of randomized clinical trials into the effects of complementary and alternative therapies on hemodialysis patients have low bias. Yet, quality improvement is still needed to produce more conclusive evidence.

The effects of chamomile extract on sleep quality among elderly people: A clinical trial.

BACKGROUND: The prevalence of insomnia increases with age. Chamomile is among the medicinal plants which are used as tranquilizer. Yet, there is inadequate experimental and clinical evidence regarding its hypnotic effects. This study sought to evaluate the effects of chamomile extract on sleep quality among elderly people. DESIGN: A single-blind randomized controlled trial was performed. SETTING: A convenient sample of sixty elderly people who aged sixty or more and lived in Kahrizak day care nursing home, Karaj, Iran, were randomly allocated to a control and a treatment group. The treatment group received chamomile extract capsules (200mg) twice a day for 28 consecutive days while the control group received wheat flour capsules (200mg) in the same manner. Using the Pittsburgh Sleep Quality Index, sleep quality was assessed immediately before, two weeks after beginning, immediately after the completion, and two weeks after the completion of the intervention. The data were analyzed via the independent-sample t, Chi-square, and Fisher's exact tests as well as the repeated measures analysis of variance. RESULTS: The means of age in the control and the treatment groups were 70.73±6.44 and 69.36±4.99, respectively. Except for the habitual sleep efficiency component of the Sleep Quality Index, the study groups did not differ significantly from each other at baseline regarding the scores of the other components of the index. Moreover, at baseline, sleep quality in both groups was low, with no statistically significant between-group difference (P=0.639). However, after the intervention, sleep quality in the treatment group was significantly better than the control group (P<0.05). CONCLUSION: The use of chamomile extract can significantly improve sleep quality among elderly people. Thus, it can be used as a safe modality for promoting elderly people's sleep.

Iranian nurses' professional competence in spiritual care in 2014.

BACKGROUND: The holistic approach views the human as a bio-psycho-socio-spiritual being. Evidence suggests that among these dimensions, the spiritual one is largely ignored in healthcare settings. OBJECTIVES: This study aimed to evaluate Iranian nurses' perceived professional competence in spiritual care, the relationship between perceived competence and nurses' personal characteristics, and barriers to provide spiritual care. RESEARCH DESIGN: A cross-sectional study was conducted in the year 2014. Participants and research context: The study population consisted of nurses working in teaching hospitals in Kashan city. Using a stratified, systematic random method, 250 samples were selected from a total of 1400 nurses. An indigenous instrument was used to assess the nurses' competencies in spiritual care. Ethical considerations: A research ethics committee approved the study. All the participants were briefed on the study aims, were assured of the confidentiality of their personal information, and signed a written informed consent. RESULTS: Among a total of 250 nurses, 239 answered the questionnaire completely, and in total, 23%, 51%, and 26% had poor, moderate, and favorable competence in spiritual care, respectively. No significant differences were found between the mean competence scores of spiritual care in terms of gender, marital status, employment status, and level of qualification. Significant difference was found between nurses' overall score of competence in spiritual care and receiving training on spiritual care, nurses' position, and the ward they worked in. DISCUSSION: Confirming the findings of the international literature, this study puts light on the situation of nurses' perceived competence and barriers to providing spiritual care in Iran as an eastern and Islamic context. CONCLUSION: Three-quarters of the nurses had moderate or unfavorable competence in spiritual care. Due to the crucial role of spiritual care in quality of care and patient satisfaction, nurses should be trained and supported to provide spiritual care.

Developing and Validating an Instrument to Assess the Nurses' Professional Competence in Spiritual Care.

BACKGROUND AND PURPOSE: Spiritual care is an important issue in health-related professions and has significant effects on patients' psychological well-being. This study aimed to develop an instrument for assessing Iranian nurses' professional competence in spiritual care. METHODS: First, extensive reviewing of articles and books on spirituality and spiritual care was performed to extract the primary items and then validation tests were conducted. RESULTS: A 38-item instrument was developed for assessing nurses' professional competence in providing spiritual care. The content validity index (CVI) and content validity ratio (CVR) values of the final instrument were .90 and .75, respectively. The Cronbach's alpha coefficient for the total instrument was .934. CONCLUSIONS: The instrument developed in this study has good CVI and CVR values and is useful in assessing nurses' competence in providing spiritual care.

Investigating the effects of inhaling ginger essence on post-nephrectomy nausea and vomiting.

OBJECTIVE: There is a knowledge gap regarding the effects of ginger essence on postoperative nausea and vomiting. This study aimed to evaluate the effect of ginger essence on post-nephrectomy nausea and vomiting. DESIGN: A randomized controlled trial was conducted. SETTING: This study was conducted from third April to first October 2014 in Labbafinejad hospital, Tehran, Iran. Totally, 120 nephrectomy patients were randomly allocated to either the treatment or the control groups. After nephrectomy, we applied two drops of ginger essence to a 2 × 2-inch gauze that was attached to the patients' collars in the treatment group to allow patients to inhale the evaporated essence along with the air room and then repeated every 30 min for two hours. The control group was similarly treated with normal saline. Nausea was assessed using a visual analogue scale every 30 min for two hours and at the sixth hour after surgery. The paired- and independent-samples t and repeated measures analysis of variance tests were used for data analysis. RESULTS: The means nausea intensity were in the treatment and the control groups were 7.09 ± 1.59 and 7.40 ± 1.71 at thirty minutes after surgery (P value > 0.05). However, the mean nausea intensity in the treatment group at the four subsequent times were significantly lower than the control group (P value < 0.001). The numbers of vomiting episodes at two and six hours after the surgery were 0.88 ± 0.78 and 2.58 ± 1.35, in the treatment group and 4.80 ± 1.87 and 2.58 ± 1.35 in the control group. The differences between the two groups regarding the numbers of vomiting episodes were statistically significant (P value < 0.001). CONCLUSION: Inhaling ginger essence has positive effect on postoperative nausea and vomiting. Using ginger essence for managing postoperative nausea and vomiting is recommended.

Effect of adding the herb Achillea millefolium on mouthwash on chemotherapy induced oral mucositis in cancer patients: A double-blind randomized controlled trial.

BACKGROUND: Oral mucositis (OM) is a debilitating side-effect of chemotherapy. It has different complications, including impairment of drinking, eating and even talking, sometimes so severe that physician stops the therapy. OBJECTIVE: Investigating the effect of Achillea millefolium distillate solution in the treatment of chemotherapy-induced OM. INTERVENTIONS/METHODS: In this randomized controlled trial, 56 cancer patients with chemotherapy-induced OM were randomly assigned into control and experimental groups in similar blocks based on the severity of OM. The experimental group gargled 15 mL of a mixture of routine solution and distilled A. millefolium 4 times a day for 14 days while the control group gargled 15 mL of routine solution. The severity of OM was assessed at three times before, 7 and 14 days after intervention. Data was analyzed using Wilcoxon, Kruskal-Wallis, Mann-Whitney U, Friedman, Chi-square and Fisher's exact tests. RESULTS: The mean severity score of OM was 2.39 ± 0.875 in both groups at start of the study that was changed to 1.07 ± 0.85 and 0.32 ± 0.54 in the intervention group in days 7 and 14 (p < 0.001). However, the severity of OM was increased to 2.75 ± 0.87 and 2.89 ± 0.956 in the control group respectively (p < 0.001). CONCLUSIONS: A. millefolium distillate healed OM much more than the routine solution. Therefore, it is suggested to be used in patients with chemotherapy-induced OM. The study was registered in the Iranian Registry of Clinical Trials, Number: IRCT2013092214729N1.

Comparing the effects of Bentonite & Calendula on the improvement of infantile diaper dermatitis: A randomized controlled trial.

BACKGROUND & OBJECTIVES: Infantile diaper dermatitis is a common, acute inflammatory reaction of the skin around diaper among infants. This study was undertaken to compare the effect of topical application of Bentonite and Calendula creams on the improvement of infantile diaper dermatitis. METHODS: This double blind randomized controlled trial was undertaken on 100 patients of infantile diaper dermatitis. The 100 participants were randomly assigned into two groups of 50 each, and were prescribed the coded medicine. The mothers were trained to apply the cream and level of improvement was judged by observing the affected area on the first visit and then after three days of receiving treatment. RESULTS: The mean age of infants was 6.45±5.53 months in Calendula group and 7.35±6.28 months in Bentonite group. Overall, 88 per cent of lesions in the Bentonite group started improving in the first six hours while this rate was 54 per cent in Calendula group (P<0.001). The risk ratio for the improvement in the first six hours was 2.99 folds in the Bentonite group. Also, lesions in 86 per cent infants in the Bentonite group and 52 per cent in the Calendula group were completely improved in the first three days after treatment (P<0.001). INTERPRETATION & CONCLUSIONS: Our results showed that in comparison with Calendula, Bentonite had faster healing effect and was more effective on the improvement of infantile diaper dermatitis (IRCT ID: IRCT 2012112811593N1).

Effect of Rosa damascene aromatherapy on sleep quality in cardiac patients: a randomized controlled trial.

OBJECTIVE: Sleep disorders are common among patients hospitalized in coronary care unit (CCU). This study aimed to investigate the effect of Rosa damascene aromatherapy on sleep quality of patients hospitalized in CCU. METHODS: In this randomized controlled trial, 60 patients who met the inclusion criteria were conveniently sampled and randomly allocated to the experimental and control groups. Patients in the control group received routine care. In the experimental group, patients received routine care and Rosa damascene aromatherapy for three subsequent nights. In the both groups the sleep quality was assessed using the Pittsburgh Sleep Quality Index. RESULTS: After the study, the mean scores of five domains of Pittsburg Sleep Quality Index as well as the mean of total score of the index in the experimental group were significantly lower than the control group. CONCLUSION: Rosa damascene aromatherapy can significantly improve the sleep quality of patients hospitalized in CCUs.

Knowledge, attitude and practice toward complementary and traditional medicine among Kashan health care staff, 2012.

OBJECTIVES: Studies show that medical staff in different countries have different attitudes toward traditional and complementary medicine. Therefore, the current study aimed to evaluate the knowledge, attitude and practice of complementary and traditional medicine by medical staff of Kashan, Iran. DESIGN: A cross-sectional study was performed. SETTING: A total of 378 questionnaires were distributed among health care team members in Kashan University of Medical Sciences in 2012. The questionnaire was consisted of 5 questions regarding demographic characteristics and 12 questions on knowledge, attitude and practice of traditional and complementary medicine. Data were analyzed using descriptive statistics. RESULTS: In total, 309 questionnaires were returned and 302 questionnaires were analyzed. Among the participants, 60.9% were female. The mean age of subjects was 29.70±9.28 years. Totally, 88.4% of the participants had no previous education on complementary and traditional medicine, and 77.8% showed interest to learn in this area. Also, 57.6% of participants had the experience of personal use of complementary and traditional therapies. The commonly used methods were: herbal therapy, cupping and traditional bathing. Participants used traditional medicine mostly for digestive diseases, colds, migraine and headaches, skin disorders, losing weight, and diabetes. Moreover, 56% of participants had recommended complementary and traditional therapies to the others. CONCLUSIONS: Most of the participants had low level knowledge on complementary and traditional medicine, but expressed their interest to learn in this field. Therefore, training health care team members and especially nurses and doctors on the applications, benefits and side effects of complementary and traditional medicine is recommended.

Effect of acupressure of Ex-Le7 point on pain, nausea and vomiting after appendectomy: A randomized trial.

BACKGROUND: The Le7 acupoint had been known as an acupoint for reducing pain of appendicitis. However, no study on the effect of its acupressure on post-appendectomy pain is available. The objective of this study was to evaluate the effects of acupressure of Le7 acupoint on pain, nausea, and vomiting after appendectomy. MATERIALS AND METHODS: A single-blind randomized controlled trial was conducted on 70 post-appendectomy patients in a general surgical ward. Patients with inclusion criteria were selected consecutively and were randomly assigned into two groups. The intervention group received acupressure to the Le7 acupoint and the second group was the control group. The severity of post-operative pain, nausea, and vomiting measured hourly till the seventh post-operative hour. T-test was used to compare the mean of pain and nausea severity of two groups. Paired t-test was used to compare the mean of pain intensity of each group before and total mean of pain at post-intervention hours. Chi-squared test and Fisher exact test were used for nominal data. RESULTS: The mean of pain intensity in the intervention group was 5.10 ± 3.52 before intervention and decreased to 3.53 ± 0.75 in the post-operative hours (P = 0.018). The mean of pain intensity in the control group was 4.45 ± 3.16 before intervention and changed to 4.01 ± 0.92 in the post-operative hours (P = 0.32). However, the mean of pain intensity in the intervention group was less than the control group till 6(th) h after the surgery. No significant differences were observed between the two groups in terms of nausea and vomiting (P = 0.74). CONCLUSION: Acupressure on Le7 acupoint was effective on post-appendectomy pain but did not affect nausea and vomiting. Further investigations are suggested with starting acupressure at the onset of pain or nausea and vomiting.

Effects of progressive relaxation on anxiety and quality of life in female students: a non-randomized controlled trial.

OBJECTIVES: This study conducted to assess the effects of relaxation techniques on anxiety and the quality of life of female dormitory students. DESIGN AND SETTING: A non-randomized controlled trial was conducted in 4 female dormitories of Tehran University of medical sciences. INTERVENTIONS: The students of four dorms were randomly allocated to the experimental and control groups. The Spielberger inventory and a modified version of WHO quality of life questionnaire were administered to both groups. Then the experimental group was taught to do the relaxation techniques for two months. A post-test conducted on both groups after two months. RESULTS: Significant differences were noticed between anxiety and quality of life of the two groups after the intervention. The overall quality of life score was significantly higher in experimental group after the two months of relaxation exercises. CONCLUSIONS: relaxation techniques can be effective for improving the students' anxiety that in turn will improve their quality of life especially in the examination periods.

The effects of acupressure on primary dysmenorrhea: a randomized controlled trial.

OBJECTIVE: The current study was conducted to evaluate the effect of acupressure on primary dysmenorrhea in Iranian medical sciences students. DESIGN: A randomized controlled pre and post-test design was employed to verify the effects of SP6 acupressure on dysmenorrhea. SETTING: A total of 30 young college female students with primary dysmenorrhea were randomly allocated to intervention (n = 15) and control (n = 15) groups. INTERVENTION: The intervention group received SP6 acupressure during menstruation cycle and the control group received light touch on the SP6 acupoint. Using a Visual Analog Scale, the severity of dysmenorrhea was assessed prior to and immediately, 30 min, 1, 2, and 3 h following treatment. MAIN OUTCOME MEASURES: Data were analyzed using X(2), t-test and ANOVA statistical tests. RESULTS: Significant differences were observed in the scores of dysmenorrhea between the two groups immediately after (3.50 ± 1.42 vs. 5.06 ± 1.43, p = 0.004) and also 3 h after treatment (1.66 ± 1.98 vs. 4.80 ± 1.37, p = 0.000). CONCLUSIONS: Acupressure on the SP6 meridian can be an effective non-invasive nursing intervention for alleviating primary dysmenorrhea and its effects last for 3 h post-treatment.

Prayer in Iranian cancer patients undergoing chemotherapy.

UNLABELLED: Chronic illnesses such as cancer are very stressful events and prayer is a valuable coping strategy for Muslim cancer patients. This study was conducted to assess the impact of prayer in Iranian cancer patients undergoing chemotherapy. A descriptive cross sectional survey was conducted on 360 cancer patients over 20 years of age who were able to read and write. Data collection employed Meraviglia's prayer questionnaire. Mean scores of prayer activity, prayer experience and attitude toward prayer were, respectively, (94.5+/-12.98), (51.2+/-7.49) and (38.2+/-4.84). Mean of total scores was (184.05+/-21.67). Significant relationships were observed between age, marital status and educational level with prayer activity, prayer experience and attitude toward prayer (P< or = 0.001). Also the relationship between sex and prayer activity was significant (P< or = 0.01). CONCLUSION: Individual characteristics had an important effect on prayer. It is suggested that health care providers can augment holistic care to these patients by encouraging prayer.