Effect of Acupressure on Fatigue in Hemodialysis Patients: A Single-Blinded Randomized Controlled Trial.

Objectives: The objective of this study was to investigate the effect of acupressure on fatigue severity, sleep quality, and psychological status in patients with end-stage renal disease (ESRD) receiving hemodialysis (HD) treatment. Design: A single-blinded parallel-group randomized controlled trial. Settings/Location: A medical center in central Java, Indonesia. Subjects: One hundred and six patients who had been receiving HD for at least 3 months were enrolled in this study and randomly assigned to two groups. Interventions: The experimental group received acupressure at K1, ST36, and SP6 acupoints. In contrast, the control group received sham acupressure at 1 cun from these three acupoints. Subjects received acupressure thrice per week for 4 weeks, and pressure on each acupoint was applied for 3 min bilaterally. Outcome measures: The primary outcome was fatigue severity, while sleep quality and psychological status (depression/anxiety) were evaluated as secondary outcomes. Outcomes were assessed using the Brief Fatigue Inventory, Pittsburgh Sleep Quality Index, and Hospital Anxiety and Depression Scale. Results: Acupressure induced a significant medium to large effect on improvement in fatigue (b = -1.71, confidence interval [95% CI]: -1.90 to -1.51, ΔR2 = 0.744), sleep quality (b = -5.81, 95% CI: -6.80 to -4.81, ΔR2 = 0.525), and anxiety (Estimate = -3.213, 95% CI: -4.238 to -2.188, pseudo R2 = 0.292)/depression (Estimate = -3.378, 95% CI: -4.432 to -2.325, pseudo R2 = 0.268) in experimental group patients compared to controls. No adverse events of acupressure were reported during the study process. Conclusions: Acupressure significantly and independently improved fatigue, depression/anxiety, and sleep quality in ESRD patients receiving HD. Clinical Trial Registration: NCT05571007.

Exploring demands of hemodialysis patients in Taiwan: A two-step cluster analysis.

AIMS AND OBJECTIVES: To classify hemodialysis patients into subgroups via cluster analysis according to the Somatic Symptoms Disturbance Index, Taiwanese Depression Scale, and Herth Hope Index scores. Patient demands in each cluster were also examined. BACKGROUND: Overall patient demands among hemodialysis patients have been demonstrated in numerous reports; however, variables among subgroups have not been explored. METHODS: Data were analyzed from a cross-sectional survey of 114 hemodialysis patients recruited from dialysis centers in Northern Taiwan. Hope, depression, and symptom disturbance were used as parameters for clustering because they have been shown to be important factors affecting patient demands. A two-step cluster analysis was performed to classify participants into clusters. Patient demands in each cluster were analyzed. RESULTS: Among the 114 participants, there was a negative correlation between hope and depression as well as between hope and symptom disturbance; there was a positive correlation between depression and symptom disturbance. Two clusters were identified: Cluster 1 (n = 49) included patients with moderate levels of hope and symptom disturbance, and high levels of depression; and Cluster 2 (n = 65) included patients with low levels of depression and symptom disturbance and high levels of hope. Demographic profiles differed between the two clusters. Regarding patient demands, medical demand showed the highest average score; whereas, occupational demand exhibited the lowest average score. Psychological and occupational demands differed significantly between the two clusters. The two clusters were defined as subgroups: Cluster 1 was labeled "resting"; Cluster 2 was labeled "active". CONCLUSIONS: Cluster analysis may further classify hemodialysis patients into distinct subgroups base on their specific patient demands. A better understanding of patient demands may help health professionals to provide a holistic individualized treatment to improve patients' outcomes.

Factors associated with family functioning among people with a diagnosis of schizophrenia and primary family caregivers.

WHAT IS KNOWN ON THE SUBJECT?: Families act not only as the primary support for people with a diagnosis of schizophrenia but also as partners in the healthcare system. Families who have members with mental disorders, particularly schizophrenia, experience challenges in family functioning. Research on families in relation to schizophrenia primarily focuses on the determinants that affect family functioning from primary family caregivers' perspectives. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: This report provides evidence that there is a concordance between family functioning and inpatient psychiatric rehabilitation facilities for the patient-caregiver dyad; both care-receivers and primary family caregivers considered family functioning as poor. Care-receivers with lower education levels, increased number of previous hospitalizations and poor quality of family-centred care experienced unhealthy family functioning. Primary family caregivers and care-receivers with higher education levels, lower suicidality and greater quality of family-centred care experienced healthier family functioning. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Understanding the degree of family functioning, particularly its concordance and correlates as perceived by patients and primary family caregivers, may serve as a platform for inculcating assessment of family functioning to achieve holistic patient care. Open dialogue in family-focused care planning is essential to facilitate collaborative partnerships and improve family functioning among people with a diagnosis of schizophrenia and their primary family caregivers. Further research on culturally relevant, evidence-based family interventions to enhance the functioning of affected families is warranted, especially for families with members in inpatient psychiatric rehabilitation facilities. ABSTRACT: Introduction Families provide frontline caregiving support for people with a diagnosis of schizophrenia. However, research primarily addresses correlates of family functioning from primary family caregivers' perspectives. Aim To examine perceived family functioning, particularly its concordance within patient-caregiver dyads and associated factors in families of people living with schizophrenia. Methods A cross-sectional, descriptive correlational design was used. A total of 133 dyads of patients and primary family caregivers from inpatient psychiatric rehabilitation services participated. Descriptive statistics, independent-sample t test, one-way ANOVA, Pearson's correlation coefficients, intraclass correlation coefficient and stepwise multiple linear regression analyses were applied. Results Family functioning was perceived as impaired by patient-caregiver dyads, and there existed a concordance in this regard. Patients' and family caregivers' education levels, patients' suicidality, number of previous hospitalizations and quality of family-centred care correlated with patients' and primary family caregivers' family functioning. Discussion Findings highlight the importance of patient- and family-reported family functioning with implications to address individual and collective concerns. Implications for Practice Evidence-based family interventions are crucial for assisting vulnerable families in promoting family functioning. Mental health nurses should facilitate collaboration and open dialogue concerning perspectives of patients and families to improve delivery of comprehensive mental health care.

Effects of mouthwash interventions on xerostomia and unstimulated whole saliva flow rate among hemodialysis patients: A randomized controlled study.

BACKGROUND: Dry mouth (xerostomia) is a common symptom in hemodialysis patients, which is associated with a reduced salivary flow. Xerostomia affects patients' oral health and quality of life. OBJECTIVES: The aim of this study was to investigate using a mouthwash as a means to reduce xerostomia and improve saliva flow rates in hemodialysis patients. DESIGN: A randomized controlled trial. SETTINGS AND METHODS: Three dialysis centers in Northern Taiwan served as the study sites. Patients were purposively sampled from three hemodialysis centers in Taiwan and randomly assigned to one of three groups: pure water mouthwash; n=41, licorice mouthwash; n=44, or no mouthwash (control); n=37. The Summated Xerostomia Inventory, and unstimulated whole salivary flow rate measured dry mouth and salivary flow, respectively. Data was collected at baseline, dialysis Day 5 and Day 10. RESULTS: One hundred twenty-two patients participated in this study. Baselines were adjusted for any imbalances in variables and generalized estimating equations analysed the data. Compared to control, a pure water mouthwash resulted in an increase in the unstimulated salivary flow rate of 25.85×10-3mL/min and 25.78×10-3mL/min (p<0.05) at Day 5 and Day 10, respectively. The estimated effect size was 1.38. However, there was no significant decrease in Summated Xerostomia Inventory scores. The licorice mouthwash also significantly improved the unstimulated salivary flow rates to 114.92×10-3mL/min, and 131.61×10-3mL/min at Day 5 and Day 10, respectively (p< 0.001). However, in contrast to the pure water mouthwash, the licorice mouthwash resulted in a significant improvement in the scores for the Summated Xerostomia Inventory (p<0.001). CONCLUSION: Although a pure water or a licorice mouthwash and improved the objective measure of salivary flow rate, only the licorice mouthwash provided subjective relief of xerostomia. This suggests the use of a licorice mouthwash may effectively relieve feelings of dry mouth in hemodialysis patients.

Maintaining patients' dignity during clinical care: a qualitative interview study.

AIM: This article is a report of a study undertaken to understand how nurses maintain patients' dignity in clinical practice. BACKGROUND: Dignity is a core concept in nursing care and maintaining patients' dignity is critical to their recovery. In Western countries, measures to maintain dignity in patients' care include maintaining privacy of the body, providing spatial privacy, giving sufficient time, treating patients as a whole person and allowing patients to have autonomy. However, this is an under-studied topic in Asian countries. METHODS: For this qualitative descriptive study, data were collected in Taiwan in 2009 using in-depth interviews with a purposive sample of 30 nurses from a teaching hospital in eastern Taiwan. The audiotaped interviews were transcribed verbatim and analysed using content analysis. FINDINGS: Nurses' measures to maintain dignity in patient care were captured in five themes: respect, protecting privacy, emotional support, treating all patients alike and maintaining body image. Participants did not mention beneficence, a crucial element achieved through the professional care of nurses that can enhance the recovery of patients. CONCLUSION: In-service education to help nurses enhance dignity in patient care should emphasize emotional support, maintaining body image and treating all patients alike. Our model for maintaining dignity in patient care could be used to develop a clinical care protocol for nurses to use in clinical practice.

Marijuana effectiveness as an HIV self-care strategy.

Persons living with HIV/AIDS use self-care for symptom management. This study assesses the use of marijuana as a symptom management approach for six common symptoms for persons living with HIV/AIDS--anxiety, depression, fatigue, diarrhea, nausea, and peripheral neuropathy. This sub-analysis of the efficacy of a symptom management manual encompasses the experiences of participants from sites in the U.S., Africa, and Puerto Rico. Baseline data are analyzed to examine differences in the use and efficacy of marijuana as compared with prescribed and over-the-counter medications as well as the impact on adherence and quality of life.

Self-care symptom management strategies for auditory hallucinations among patients with schizophrenia in Taiwan.

This descriptive study explored self-care management strategies for controlling auditory hallucinations (AH) among Taiwanese patients with schizophrenia. Patients with schizophrenia (N = 200) were recruited by convenience from 2 general hospitals. Self-report and semistructured questionnaires were used to identify 41 self-management strategies. Strategies were categorized into 3 groups: physiological, cognitive, and behavioral. Ignoring AH, a cognitive strategy, was the single most frequently used strategy. As a group, strategies in the behavioral category were used the most. The most common resource for strategies was self-learning. These results can help health care providers better understand self-care management strategies for coping with AH among outpatients with schizophrenia. We suggest the development of a manual of selected self-care strategies identified by these patients to empower other patients to use self-care for AH.

Prayer as a complementary health strategy for managing HIV-related symptoms among ethnically diverse patients.

Data were analyzed from an ethnically diverse convenience sample comprising 1071 adults participating in a multisite study. Older African Americans, Hispanics, and females were more likely to use prayer as a complementary health strategy for HIV-related anxiety, depression, fatigue, and nausea. Implications for future studies are discussed.

The effects of light therapy on depressed elders.

BACKGROUND: Elderly depression has gradually become a severe issue in the health care system. No studies have focused on evaluating the effects of light therapy on the elderly with depression in a subtropical climate area. OBJECTIVES: To evaluate the effects of light therapy on hospitalized, depressed elders living in a subtropical climate area. METHODS: Experimental design was used. For the experimental group, patients sat in front of a light box, receiving 5000 lux in the morning. The light therapy course was administered for 50 minutes per day and lasted for 5 days. The control group did not receive any treatment. RESULTS: Depressive symptoms were significantly reduced in the experimental group at post-test but no significant decline was found in the control group. CONCLUSIONS: Based upon the results of this study, light therapy could be used to decrease depressive symptoms in the elderly.