Health-related quality of life for pediatric patients with end-stage kidney disease: A systematic review and meta-analysis of the Pediatric Quality of Life Inventory (PedsQL).

INTRODUCTION: Health-related quality of life (HRQoL) studies demonstrate the impact of end-stage renal disease (ESRD) on the physical and psychosocial development of children. While several instruments are used to measure HRQoL, few have standardized domains specific to pediatric ESRD. This review examines current evidence on self and proxy-reported HRQoL among pediatric patients with ESRD, based on the Pediatric Quality of Life Inventory (PedsQL) questionnaires. METHODS: Following PRISMA guidelines, we conducted a systematic review and meta-analysis on HRQoL using the PedsQL 4.0 Generic Core Scale (GCS) and the PedsQL 3.0 ESRD Module among 5- to 18-year-old patients. We queried PubMed, Embase, Web of Science, CINAHL, and Cochrane databases. Retrospective, case-controlled, and cross-sectional studies using PedsQL were included. FINDINGS: Of 435 identified studies, 14 met inclusion criteria administered in several countries. Meta-analysis demonstrated a significantly higher total HRQoL for healthy patients over those with ESRD (SMD:1.44 [95% CI: 0.78-2.09]) across all dimensional scores. In addition, kidney transplant patients reported a significantly higher HRQoL than those on dialysis (PedsQL GCS, SMD: 0.33 [95% CI: 0.14-0.53]) and (PedsQL ESRD, SMD: 0.65 [95% CI: 0.39-0.90]) concordant with parent-proxy reports. DISCUSSION: Patients with ESRD reported lower HRQoL in physical and psychosocial domains compared with healthy controls, while transplant and peritoneal dialysis patients reported better HRQoL than those on hemodialysis. This analysis demonstrates the need to identify dimensions of impaired functioning and produce congruent clinical interventions. Further research on the impact of individual comorbidities in HRQoL is necessary for developing comprehensive, integrated, and holistic treatment programs.

Religion and Spiritual Health in Patients With and Without Depression Receiving Hemodialysis: A Cross-Sectional Correlational Study.

BACKGROUND: Hemodialysis is the most common therapy for managing patients with end-stage renal disease. Depression is one of the most common psychological problems faced by dialysis patients, and there is limited research on the influences of religion and spirituality on dialysis patients. PURPOSE: This study was designed to compare religion and spiritual health status between hemodialysis patients with and without depressive symptoms. METHODS: A cross-sectional survey was conducted on 137 hemodialysis patients living in Taiwan. The self-report instruments used included the Religious Beliefs Scale, Spiritual Health Scale-Short Form, and Beck Depression Inventory-II. Data were analyzed using t test, chi-square test, point-biserial correlation of variance, and logistic regression. RESULTS: Most (63.5%) of the participants were classified with depression, of which most were male (70.1%), older (mean = 62.56 years), and unemployed (73.6%) and had less formal education. Fifty-two of the participants with depression had a 1- to 5-year duration of hemodialysis, whereas the nondepressed group had a higher mean score for number of religious activities, positive religious beliefs, and total score for spiritual health. Logistic regression showed an increased odds ratio ( OR ) of depression for participants with a duration of hemodialysis of 1-5 years ( OR = 3.64, 95% CI [1.01, 13.15]). Participants with higher scores for spiritual health had a lower risk of depression ( OR = 0.82, 95% CI [0.75, 0.90]), indicating a positive association between spiritual health and lower depression risk. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The prevalence rate of depression in hemodialysis patients is higher than that in the general population. Providing screenings for spiritual health and depression as part of routine medical care for hemodialysis patients is recommended to detect spiritual distress and depression early.

Effects of live music during hemodialysis treatments in pediatric patients.

BACKGROUND: Engaging chronically ill pediatric patients with live music has been associated with improved physiological and psychological well-being. However, the impact of live music during hemodialysis treatments has yet to be assessed, in particular in pediatric patients. This study focuses on the effects of live music therapy during chronic hemodialysis treatment. METHODS: An experimental design with randomization was applied in this pilot study. A total of 16 participants with kidney failure requiring hemodialysis participated in the study. In addition to their usual care (N = 96 measurements), the patients in the experimental group listened to 30 min of live music during their hemodialysis procedure. The control group was observed for 30 min while they received their usual care (N = 96 measurements) and were exposed to a series of animated videos that were broadcast in the common room where hemodialysis treatment is performed. Data concerning heart rate, blood pressure, and levels of depression and anxiety were collected for analysis. RESULTS: Live music significantly reduced heart rate (p < 0.05), systolic pressure (p < 0.05) and diastolic pressure (p < 0.05). The findings also highlighted that, after listening to live music, there was a significant decrease in anxiety and depression (p < 0.05). CONCLUSIONS: In our small study sample, live music improved some physiological and psychological indices in pediatric hemodialysis patients. Further research evaluating larger samples with longitudinal follow-up is required.

The Role of Spirituality in Anxiety and Psychological Resilience of Hemodialysis Patients in Turkey.

Chronic kidney disease (CKD) is a significant health problem that affects millions of people worldwide and its end-stage manifestation requires hemodialysis treatment, which can have a considerable impact on patients' mental health and quality of life. This study aims to examine the relationship between spirituality and anxiety, as well as spirituality and psychological resilience among hemodialysis patients using the iterative weighted least squares method. Participants included 91 hemodialysis patients, consisting of 49 females and 42 males, whose ages ranged from 20 to 82 years, with a mean age of 48 (SD = 14). The data were collected using the Beck Anxiety Inventory, Spirituality Scale, and Brief Psychological Resilience Scale. Results indicated a weak positive relationship between spirituality and psychological resilience (t = 1.35, P = .183) and a moderate negative relationship between spirituality and anxiety (t = -2.84, P = .006). Furthermore, spirituality accounted for a 1% variance in psychological resilience and a 5% of the variance in anxiety. Additionally, patients' education level, gender, and whom they live with were relatively stronger correlates of psychological resilience, while the patient's education level, gender, marital status, whom they live with, presence of another patient at home receiving hemodialysis treatment were strong correlates of anxiety. This study emphasizes the need for comprehensive care that addresses both physical and psychological aspects of CKD management to improve patient outcomes and quality of life.

Effects of Exercise on Physiologic and Psychologic Outcomes in Patients with End Stage Kidney Disease on Hemodialysis: A Quasi-Experimental Study.

End stage kidney disease (ESKD), a public health concern, has overwhelming effects on individuals' holistic wellbeing. Hemodialysis, albeit a life-saving treatment for patients with ESKD, can lead to muscle atrophy, weakness, and decreased quality of life mostly due to an inactive lifestyle. This quasi-experimental, pre-post design was used to study the effects of exercise on physiologic and psychologic outcomes of patients with ESKD at a hemodialysis unit in Lebanon. Patients acted as their own controls and were assessed before and after introducing the exercise program. Data were collected on quality of life of patients as well as their dialysis adequacy. Results showed that while there was a significant improvement in the dialysis adequacy post-exercise intervention, quality of life was not affected.

Spiritual Well-Being and Psychological Well-Being Among Hemodialysis Patients in Turkey: A Descriptive and Correlational Study.

This study aimed to determine the psychological and spiritual well-being of hemodialysis patients in Turkey. This descriptive and correlational study included 86 hemodialysis patients. Data were collected using the Spiritual Well-Being Scale and Psychological Well-Being Scale. There was a positive correlation between spiritual and psychological well-being (r = 0.315, p = 0.003). Psychological well-being and age explained 39% of total variance (F = 7.593, p = 0.001). In conclusion, there should be provided individualized spiritual care and counseling to improve the psychological well-being of hemodialysis patients.

Effect of Spiritual Care Based on the Sound Heart Model on Spiritual Experiences of Hemodialysis Patients.

Hemodialysis patients require spiritual care due to their spiritual distress. This study aimed to investigate the effect of spiritual care on spiritual experiences of hemodialysis patients. This randomized controlled trial was conducted in 2017 at hemodialysis departments of Baqiyatallah and Cham ran hospitals in Tehran. The volunteer patients were selected by available sampling according to the inclusion criteria. Participants were randomly assigned to intervention and control groups. Interventions were performed in the educational-supportive nursing system according to the patients' self-care ability. Eight individual counseling sessions, 15-45 min, face-to-face, during dialysis, once a week were implemented for intervention group. Developing the relationship with God, self, people and nature were the main goals of care. Daily spiritual experience questionnaire was completed by patients before and three months after the intervention. There was no significant difference in the spiritual experience score of the intervention (75.20 ± 9.14) and control group (76.63 ± 10.03), before the intervention (P = 0.523). There was a statistically significant difference between the intervention (82.93 ± 5.69) and the control group score (77.24 ± 12.09) three months after the intervention (P < 0.0001). Due to the need for holistic and community-oriented care and the positive effect of this study, the use of the Sound Heart Model is recommended for Muslim patients.

The effects of a short-term meditation-based mindfulness protocol in patients receiving hemodialysis.

Mindfulness-based approaches that promote health, improve quality of life, and reduce the impact of comorbidities are key aspects in chronic diseases management. We aimed to verify the impact of a short-term meditation protocol on psychosocial and physiological parameters in chronic hemodialysis patients. We enrolled twenty-two patients, median age of 69.5 years old, into a 12-week meditation protocol that occurred during each hemodialysis session for 10-20 minutes, 3x/week, in a private tertiary hospital. We then evaluated clinical, psychological, and laboratorial parameters pre- and post-meditation. Patients exhibited a better control of serum phosphorus (-0.72 mg/dL; P = 0.002), a decrease in systolic blood pressure (-1.90 mmHg; P = 0.009), a 23% decrease in depressive symptoms (P = 0.014), and an increase of 7% in the self-compassion scale (P = 0.048) after meditation. To note, we observed an increase in 13% of the mindfulness score (P = 0.019). Our preliminary study describes the effects of a short-term meditation protocol in chronic hemodialysis setting. We observed a decrease in depressive symptoms and in blood pressure values, an improvement in self-compassion and serum phosphorous levels. In conjunction with the promising results of meditation in chronic kidney disease setting, this encouraging preliminary study supports the need for additional clinical trials.

Experiences of New Zealand Haemodialysis Patients in Relation to Food and Nutrition Management: A Qualitative Study.

People receiving haemodialysis have considerable and complex dietary and healthcare needs, including co-morbidities. A recent New Zealand study has shown that few patients on haemodialysis are able to meet nutritional requirements for haemodialysis. This study aims to describe the perspectives and experiences of dietary management among patients on haemodialysis in New Zealand. This exploratory qualitative study used in-depth semi-structured interviews. Purposive sampling was used to recruit participants from different ethnic groups. Forty interviews were conducted, audio-recorded and transcribed verbatim. An inductive approach was taken using thematic analysis. Forty participants were interviewed. Participants spoke of major disruption to their lives as a result of their chronic kidney disease and being on haemodialysis, including loss of employment, financial challenges, loss of independence, social isolation and increased reliance on extended family. Most had received adequate dietary information, although some felt that more culturally appropriate support would have enabled a healthier diet. These findings show that further support to make the recommended dietary changes while on haemodialysis should focus on socio-cultural factors, in addition to the information already provided.

Spiritual Well-Being and Associated Factors in End-Stage Renal Disease.

People with CKD depend on religion and spirituality to deal with their chronic illness, and those are essential means of coping for those living with chronic diseases. The present study aims to evaluate ESRD patients' spiritual wellbeing undergoing hemodialysis treatment and to identify critical variables associated with the spiritual wellbeing of those patients. Methods. A cross-sectional study was conducted, in which 367 patients undergoing HD participated. Patients were randomly selected from six HD units in various geographical areas of Greece. Data were collected through an anonymous self-completed questionnaire consisting of two parts. The first part contained questions regarding demographic, social, and clinical information such as age, gender, marital status, and duration of dialysis comorbidities. The second part assessed the patients' spiritual wellbeing with the use of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12. Multivariate analysis was performed to extract predictors or determinants of spiritual wellbeing of hemodialysis patients. Results. From the total of the 367 participants, 228 (62.1%) were males and 139 (37.9%) were females, and the mean age was 61.80 ± 15.11. Spiritual wellbeing had a mean value of 30.55 (SD = 8.22), which means that patients had a satisfactory spiritual wellbeing level. Multivariate analysis revealed that place of residence, marital status, educational level, and comorbidities could predict spiritual wellbeing in ESRD patients. Conclusions. There is much evidence in the literature supporting the positive effect of spirituality, health (physical and mental), and quality of life. Integration of spiritual wellbeing evaluation and spiritual care in everyday practice as a part of clinical care can increase the quality of the provided care and improve health outcome for patients undergoing hemodialysis.

Mindfulness-based Virtual Reality Intervention in Hemodialysis Patients: A Pilot Study on End-user Perceptions and Safety.

Background: Virtual reality (VR) is an evolving technology that is becoming a common treatment for pain management and psychologic phobias. Although nonimmersive devices (e.g., the Nintendo Wii) have been previously tested with patients on hemodialysis, no studies to date have used fully immersive VR as a tool for intervention delivery. This pilot trial tests the initial safety, acceptability, and utility of VR during maintenance hemodialysis treatment sessions-particularly, whether VR triggers motion sickness that mimics or negatively effects treatment-related symptoms (e.g., nausea). Methods: Patients on hemodialysis (n=20) were enrolled in a phase 1 single-arm proof-of-concept trial. While undergoing hemodialysis, participants were exposed to our new Joviality VR program. This 25-minute program delivers mindfulness training and guided meditation using the Oculus Rift head-mounted display. Participants experienced the program on two separate occasions. Before and immediately after exposure, participants recorded motion-related symptoms and related discomfort on the Simulator Sickness Questionnaire. Utility measures included the end-user's ability to be fully immersed in the virtual space, interact with virtual objects, find hardware user friendly, and easily navigate the Joviality program with the System Usability Scale. Results: Mean age was 55.3 (±13.1) years; 80% male; 60% Black; and mean dialysis vintage was 3.56 (±3.75) years. At the first session, there were significant decreases in treatment and/or motion-related symptoms after VR exposure (22.6 versus 11.2; P=0.03); scores >20 indicate problematic immersion. Hemodialysis end-users reported high levels of immersion in the VR environment and rated the software easy to operate, with average System Usability Scale scores of 82.8 out of 100. Conclusions: Patients on hemodialysis routinely suffer from fatigue, nausea, lightheadedness, and headaches that often manifest during their dialysis sessions. Our Joviality VR program decreased symptom severity without adverse effects. VR programs may be a safe platform to improve the experience of patients on dialysis.

A Prospective, Controlled Study to Assess Effect of Spiritual Therapy in Patient Undergoing Hemodialysis at Bhaktivedanta Hospital.

End-stage renal disease (ESRD) introduces physical, psychological, social, emotional, and spiritual challenges into patients' lives. Spirituality has been found to contribute to improved health outcomes, mainly in the areas of quality of life (QoL) and well-being in especially in terminal, life-threatening, and chronic diseases. The current study was planned to assess the effect of Spiritual therapy in patient undergoing hemodialysis (HD). Post approval from Ethics Committee, the study was commenced at Dialysis Center, Bhaktivedanta Hospital and Research Institute and conducted for 12 weeks. Participants were divided into two groups (one with spiritual intervention and other being control). Spiritual chanting and listening to it was the intervention. The outcome was assessed by kidney diseases QoL (KDQoL), spiritual well-being [Functional assessment of chronic illness therapy (FACIT) Sp 12] score, certain components of ESRD targeted area, 36 item health survey, and laboratory and nutritional parameters. Statistical analysis was done using IBM SPSS Statistics version 20.0 at 5% significance. A total of 100 participants were included in study; males were outnumbered. KDQoL, ESRD targeted areas, components of 36-item health survey, and FACIT Sp 12 scores were significantly different on better side in interventional group at six weeks and 12 weeks. There was no significant difference in laboratory and nutritional parameters. The findings from this study contribute knowledge to increase our understanding of the influence of spirituality on the health outcomes and general well-being of patients with ESRD currently receiving HD treatment. The current study adds to the evidence in support of the use of spiritual therapy in chronic kidney disease patients on HD.

A mixed-methods feasibility study of an arts-based intervention for patients receiving maintenance haemodialysis.

BACKGROUND: Haemodialysis can negatively impact quality of life and mental health. Arts-based interventions used successfully in other settings to improve health and well-being, could help address the impact of haemodialysis. This study aimed to evaluate the feasibility and acceptability of conducting a randomised controlled trial (RCT) of an arts-based intervention for patients receiving haemodialysis. METHODS: A parallel convergent mixed-methods design was used, including a pilot cluster RCT and qualitative process evaluation. Phase 1 evaluated recruitment and retention rates through a pilot cluster RCT at a single haemodialysis unit in Northern Ireland. Participants included patients who received haemodialysis for ESKD, were over the age of 18 and had the capacity to consent. These participants were randomised to the intervention or control group according to their haemodialysis shift. The intervention involved six one-hour, one-to-one facilitated arts sessions during haemodialysis. Phase 2 explored intervention and trial acceptability through a qualitative process evaluation using semi-structured interviews based on the RE-AIM framework. Participants included 13 patients who participated in phase 1 of the study, including 9 participants from the experimental group and four participants from the control group, and nine healthcare professionals who were present on the unit during implementation. RESULTS: Out of 122 outpatient haemodialysis patients, 94 were assessed as eligible for participation. Twenty-four participants were randomised, meaning 80% of the target sample size was recruited and the attrition rate at 3 months was 12.5% (n = 3). Participants viewed the arts as more accessible and enjoyable than anticipated following implementation. All participants who started the intervention (n = 11) completed the full six sessions. Qualitative benefits of the intervention suggest improvements in mental well-being. Patient choice and facilitation were important factors for successful implementation. CONCLUSION: An arts-based intervention for patients receiving haemodialysis is acceptable for both patients and healthcare professionals, and a definitive trial is feasible. The intervention may help improve mental-wellbeing in patients receiving haemodialysis, but this requires further investigation in a definitive trial. TRIAL REGISTRATION: The trial was prospectively registered on clinicaltrials.gov on 14/8/2018, registration number NCT03629496 .

Effect of Omega-3 supplements on quality of life among children on dialysis: A prospective cohort study.

Children with end stage renal disease (ESRD) are liable to various health disorders that possibly impair their quality of life (QoL). Low dietary intake of Omega-3 fatty acids also called marine n-3 fatty acid (n-3 FA) may be associated with health problems which are among the leading causes of impaired QoL.The objective of this study was to assess the effect of omega-3 Fatty acid (n-3 FA) supplements on quality of life among children on dialysis and to evaluate its use regarding adequacy of dialysis and inflammatory markers.A prospective cohort study was conducted on 31 hemodialysis children. Quality of life was measured for patients and an equal number of matched controls using the PedsQL Inventory where the higher the score the poorer is the quality of life. n-3FA supplementation had been given to the patients for 3 months to study its effects on QoL. Laboratory investigations like hemoglobin, lipid profile, inflammatory markers, and tests for adequacy of dialysis had been carried out.Patients had significantly higher QoL scores (42.22 ±â€Š13.31) than controls (22.70 ±â€Š1.31) (P < .001). Young ages showed higher score of physical functioning (18.23 ±â€Š4.22) than older ones (13.92 ±â€Š6.84) (P = .049). Females had significantly higher total QoL score (25.53 ±â€Š6.61) than males (20.06 ±â€Š7.09) (P = .010). The total QoL score was significantly lower post than pre administration of n-3FA (35.41 ±â€Š10.36 vs 42.22 ±â€Š13.31) (P < .001). Triglycerides and CRP were significantly lower post than pre n-3FA supplementation (160.64 ±â€Š32.55 vs 169.35 ±â€Š31.82) (P < .001) and (10.29 ±â€Š4.39 vs 11.19 ±â€Š4.83) (P = .006) respectively. Means of Kt/V and urea reduction ratio (URR) were significantly higher post (1.37 ±â€Š0.09, 70.0 ±â€Š5.99 respectively) than pre n-3FA (1.31 ±â€Š0.07 and 65.25 ±â€Š6.06 respectively) (P = .005, .001 respectively).Quality of life and adequacy of dialysis get improved after n-3FA supplementation among children on dialysis which encourages its testing for more patients to evaluate its long term effects and support its routine use.

Effectiveness of Music to Improve Anxiety in Hemodialysis Patients: A Systematic Review and Meta-analysis.

Anxiety affects many hemodialysis patients. The response to treatment varies and often requires patients to take therapeutics for long periods; thus, many patients look for complementary approaches. There have been reports of music alleviating anxiety in hemodialysis patients. However, the efficacy of music needs to be evaluated. The objective of this study was to conduct a systematic review and meta-analysis to compare the effects of participation in standard care combined with music with standard care alone. This was a systematic review and meta-analysis of randomized controlled trials to determine the efficacy of music to lower anxiety in hemodialysis patients. Five studies were included in the review (290 patients). Listening to music resulted, on average, in an anxiety reduction that was -0.52 standard deviation units greater (95% confidence interval, -1.02 to -0.03 lower, P = .003) than in the standard care group. No adverse events were identified. All trials contained a risk of bias due to lack of blinding. The heterogeneity showed an I = 75%. The strength of evidence was very low. No adverse events were identified. Few trials were available for inclusion, with small sample sizes and significant heterogeneity. Within these considerable limitations there was a demonstrated decrease in anxiety for hemodialysis patients receiving standard care augmented with music. The effect size was moderate. Results were inconsistent across studies. We are uncertain about the estimate. The likelihood that effect will be substantially different is very high. Further research has a large potential for reducing uncertainty about the effects of the music interventions.

Movie watching during dialysis sessions reduces depression and anxiety and improves quality of life: A randomized clinical trial.

OBJECTIVE: Evaluate the effect of watching comedy movies as a complementary practice during dialysis on levels of anxiety, depression, quality of life, stress, laboratory findings and intra-dialysis complications. METHODS: A randomized clinical trial was conducted involving the practice of presenting comedy movies during dialysis. The primary outcome was depression. The secondary outcomes were anxiety, quality of life, stress, laboratory findings and intra-dialysis complications.ResultsTwenty-six patients were in the control group and 35 were in the experimental group. Significant intra-group differences [6.0 to 3.0 (p <0.001) and 8.0 to 4.0 (p <0.001), respectively] and inter-group differences [5.0 vs. 3.0 (p = 0.016) and 7.0 vs. 4.0 (p = 0.017), respectively] were found regarding anxiety and depression scores, with improvements in the experimental group. The experimental group was also less likely to have intra-dialysis complications, such as hypertension (p = 0.003) and headache (p = 0.020), and reported significant improvements in different domains of quality of life [symptoms/problems (p = 0.003); effects of the disease (p = 0.008); pain (p = 0.027); general health state (p = 0.004); and social function (p = 0.036)]. No significant differences were found in salivary cortisol or the results of the biochemical exams, with the exception of a reduction in hematocrit in the control group.ConclusionsThe proposed complementary practice was associated with reductions in anxiety and depression scores and intra-dialysis complications (hypertension and headache) as well as improvements in quality of life in patients with chronic kidney disease.

Effects of sweet orange aromatherapy on pain and anxiety during needle insertion among patients undergoing hemodialysis: A quasi-experimental study.

PURPOSE: Patients undergoing hemodialysis experience pain and anxiety during needle insertion, and the scientific interest in aromatherapy in reducing pain and anxiety is increasing. Thus, this study aimed to determine the effects of sweet orange aromatherapy on pain and anxiety during needle insertion in hemodialysis. DESIGN: Quasi-experimental, pretest, and posttest. METHODS: This study was carried out among 50 patients with chronic kidney disease who were non-randomly assigned to either sweet orange aromatherapy or calm breathing in three outpatient hemodialysis centers in the Philippines between July and August 2015. The numeric rating scale and adapted state-trait anxiety inventory were utilized to measure pain and anxiety. RESULTS: After the intervention, both the pain and anxiety scores were significantly lower for patients who received sweet orange aromatherapy than those who received calm breathing. The results obtained modest effect sizes that imply high practical significance. CONCLUSION: The sweet orange aromatherapy can be effective in reducing pain and anxiety. Thus, this can be used by nurses as an alternative and complementary approach to reduce both pain and anxiety in painful procedures like needle insertion.

Priorities of palliative care: comparison of perspectives of patients and nurses in a haemodialysis ward in Iran.

BACKGROUND: Palliative care is an important branch of nursing care. Patients with end-stage renal disease, owing to the chronic nature of the disease, will require palliative care, with nursing staff being responsible for delivering these services. Understanding the priorities of this type of care from the perspective of patients and nursing staff can be helpful in delivering it effectively and efficiently. This study was conducted to determine and compare palliative care priorities from the perspectives of patients and nursing staff in a haemodialysis ward in Iran. METHOD: This research is a cross-sectional and descriptive-analytic study with a sample size equal to the research population (322 patients and 45 nursing staff) in a haemodialysis ward in Kerman, Iran. Data were collected using two self-administered questionnaires that included demographic information and palliative care priorities. Data were analysed using SPSS19 with central tendency and dispersion indicators (frequency, percentage, mean and standard deviation, Mann-Whitney U-test, Kruskal-Wallis, independent t, ANOVA and one-way ANOVA). The significance level was P<0.05. RESULTS: The mean total score (± standard deviation) of palliative care priorities from the patients' and nurses' perspective was 268.83±3.90 and 271.11±29.76, respectively, which was categorised for both groups as 'high priority'. From the patients' perspective, the highest mean score was obtained from 'supporting patient with insurance concerns', while the lowest mean score was derived from 'managing diarrhoea'. The nurses also believed that 'managing and relief of pain' had the highest priority and 'bloating' had the lowest priority in palliative care. From the perspective of both groups, holistic support and relief of physical disorders had the highest and lowest mean scores, respectively. Further, the mean scores of palliative care priorities did not differ significantly from the perspective of patients and nursing staff in the haemodialysis ward (P=0.68). CONCLUSION: Palliative care is a high priority for both haemodialysis patients and nursing staff and both groups prioritised it similarly. As palliative care has not yet been initiated formally across all treatment centres in Iran, it is necessary to prioritise its inclusion within the renal and haemodialysis wards in Iran and provide further training or education for nurses to ensure they are equipped to deliver effective and informed palliative care.

Association Between Spiritual Well-Being and Resilience Among Turkish Hemodialysis Patients.

This study aimed to determine the association between spiritual well-being and resilience among Turkish hemodialysis patients. This cross-sectional study was conducted with 134 hemodialysis patients treated at two state hospitals' hemodialysis units between February 2019 and July 2019. The data were collected with a Personal Information Form, the Spiritual Well-Being Scale and the Resilience Scale for Adults with the face-to-face interview technique. To analyze the data, descriptive statistics, t tests, ANOVA, Pearson's correlation and multivariate linear regression analysis were used. The patients' spiritual well-being levels were high, while their psychological resilience levels were medium. There was a moderate positive correlation between spiritual well-being and resilience (p < 0.01). Education level, economic level, duration of disease and spiritual well-being were determined to be statistically significant predictive factors of the patients' resilience (p < 0.001). In this context, nurses may provide psychosocial and spiritual care, education and counseling services that will increase patient's resilience.

The Effects of Melatonin Supplementation on Parameters of Mental Health, Glycemic Control, Markers of Cardiometabolic Risk, and Oxidative Stress in Diabetic Hemodialysis Patients: A Randomized, Double-Blind, Placebo-Controlled Trial.

OBJECTIVE: This study evaluated the effects of melatonin supplementation on parameters of mental health, glycemic control, markers of cardiometabolic risk, and oxidative stress in diabetic hemodialysis (HD) patients. DESIGN: A randomized, double-blind, placebo-controlled clinical trial was conducted in 60 diabetic HD patients, 18-80 years of age. Participants were randomly divided into 2 groups to take either melatonin (2 x 5mg/day) (n = 30) or placebo (n = 30) 1 hour before bedtime for 12 weeks. The effects of melatonin on mental health, metabolic status, and gene expression related to metabolic status were assessed using multiple linear regression adjusting for age and BMI. RESULTS: Melatonin supplementation significantly decreased Pittsburgh Sleep Quality Index (P = .007), Beck Depression Inventory index (P = .001), and Beck Anxiety Inventory index (P = .01) compared with the placebo. Additionally, melatonin administration significantly reduced fasting plasma glucose (ß = -21.77 mg/dL, 95% CI -33.22 to -10.33, P < .001), serum insulin levels (ß = -1.89 µIU/mL, 95% CI -3.34 to -0.45, P = .01), and homeostasis model of assessment-insulin resistance (ß = -1.45, 95% CI -2.10 to -0.80, P < .001), and significantly increased the quantitative insulin sensitivity check index (ß = 0.01, 95% CI 0.007-0.02, P < .001) compared with placebo treated subjects. In addition, melatonin administration resulted in a significant reduction in serum high sensitivity C-reactive protein (ß = -1.92 mg/L, 95% CI -3.02 to -0.83, P = .001) and plasma malondialdehyde (ß = -0.21 µmol/L, 95% CI -0.36 to -0.06, P = .005); also, significant rises in plasma total antioxidant capacity (ß = 253.87 mmol/L, 95% CI 189.18-318.56, P < .001) and nitric oxide levels (ß = 2.99 µmol/L, 95% CI 0.71-5.28, P = .01) were observed compared with the placebo. CONCLUSION: Overall, melatonin supplementation for 12 weeks to diabetic HD patients had beneficial effects on mental health, glycemic control, inflammatory markers, and oxidative stress.