Effect of a Breathing Exercise on Respiratory Function and 6-Minute Walking Distance in Patients Under Hemodialysis: A Randomized Controlled Trial.

BACKGROUND: Pulmonary disorders and poor functional capacity are common complications in patients under hemodialysis. Although breathing exercise is frequently prescribed to improve respiratory function, its efficacy in this patient community is not well established. PURPOSE: Our study was designed to determine the effectiveness of a breathing exercise on respiratory function and 6-minute walk (6MW) distance in patients under hemodialysis. METHODS: A randomized controlled trial approach was used. The sample consisted of 52 patients under hemodialysis from a university teaching hospital in Iran. The experimental group (n = 26) received the breathing exercise program and was encouraged to perform incentive spirometry for 2 months. The control group (n = 26) received only routine hospital care. The respiratory function test and 6MW test were performed at baseline and at 2 months after the intervention (posttest). RESULTS: The two groups were homogeneous in terms of respiratory function parameters, 6MW distance, and demographic characteristics at baseline. Forced expiratory volume in 1 second and forced vital capacity were significantly better in the experimental group compared with the control group at 2 months after intervention. No significant difference was found in 6MW distance between the groups at the 2-month posttest. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The 2-month breathing exercise effectively improved pulmonary function parameters (forced vital capacity, forced expiratory volume in 1 second) in patients under hemodialysis but did not affect 6MW distance. Hemodialysis nurses should strengthen their clinical health education and apply breathing exercise programs to reduce the pulmonary complications experienced by patients under hemodialysis.

The Effect of Increasing Blood Flow Rate on Severity of Uremic Pruritus in Hemodialysis Patients: A Single Clinical Trial.

BACKGROUND: Although the prevalence of uremic pruritus has decreased compared to the past, the problem still remains as a matter of health and a major challenge of research in medical field, and has no effective treatment at present. This study aimed to investigate the effect of increasing blood flow rate on severity of uremic pruritus in hemodialysis patients in Iran. METHODS: This clinical trial was performed on 60 hemodialysis patients that referred to hospitals affiliated to Tehran University of Medical Sciences and these patients were selected through the convenience method and were treated for four weeks. They were divided into two groups of experimental and control as random allocation block, and studied for 4 weeks. Information on pruritus severity was collected using a researcher-made questionnaire in three steps of before intervention and two and four weeks after start of intervention. The rate of blood flow was increased in the first two weeks and the second two weeks by 25 and 50 rounds per minute (rpm) compared to the mean rate of blood flow of hemodialysis device in the last two sessions before intervention. Data were analyzed using the tests Mann-Whitney, Fisher, and t-test. RESULTS: Analysis of data from 50 persons in both groups who completed the study revealed a significant difference between the groups in the severity of pruritus between the two sessions of hemodialysis (pruritus at home) at the end of the first two weeks of the intervention (<0.05) and the number of cases of pruritus (<0.05) at the end of the study. CONCLUSIONS: Increasing blood flow for hemodialysis machine can induce significant statistical and clinical reduction in the severity and the frequency of pruritus in hemodialysis patients and can be help to be improve the quality of life of these persons by increased the blood flow rate.

The Effect of Stretching Exercises on Severity of Restless Legs Syndrome in Patients on Hemodialysis.

BACKGROUND: The restless legs syndrome is a sensorimotor disorder that is very common in patients on hemodialysis. Due to pharmacological treatments which have their own side effects, nowadays, studies have turned to non-pharmacological treatments. OBJECTIVES: The present study aims to assess the effect of stretching exercises on the severity of restless legs syndrome in patients on hemodialysis. PATIENTS AND METHODS: This clinical trial study was conducted on 33 patients who had been identified using diagnostic criteria from the hemodialysis ward of Hasheminejad Hospital in Tehran. Participants were randomly divided into the intervention group (n = 17) and control group (n = 16). Stretching exercises were performed on legs during the dialysis for half an hour, three times a week for 8 weeks in intervention group. Data were collected by using the international restless legs syndrome study group scale. RESULTS: The results showed that the majority of participants were suffering from moderate restless legs syndrome. The symptom severity of this syndrome meaningfully changed eight weeks after intervention in the intervention group compared to the control group (P < 0.001). CONCLUSIONS: The results highlighted the significance of training and performing the stretching exercises during dialysis for the purpose of improving restless legs syndrome symptoms and the quality of care of hemodialysis patients.

Effects of an educational program on self-management in patients with epilepsy.

PURPOSE: Self-management majorly determines the health status of patients with epilepsy because the most important strategies for controlling seizures include receiving and adhering to prescribed therapies, and making appropriate lifestyle adjustments. Patients with epilepsy have various educational needs and must adopt many self-management behaviors to control their condition. This study was a clinical trial that evaluated the effects of an educational program on self-management in patients with epilepsy. METHODS: Participants (n=60) were recruited from the Neurology Clinic in Zanjan, Iran. Patients were randomly assigned to the intervention and control groups (n=30 in each). The intervention group received four educational sessions on epilepsy, including a self-management plan. All participants completed the Epilepsy Self-Management Scale before the intervention and 1 month post-intervention. The chi-square test, Fisher's exact test, independent t-test, and paired samples t-test were used to compare the groups. RESULTS: At baseline, demographic characteristics and self-management scores did not differ significantly. One month after the intervention, self-management scores differed significantly (p<0.001) between the two groups. CONCLUSION: The educational program had beneficial effects on self-management behaviors in patients with epilepsy.

Psychometric properties of the persian version of self-management scale for a sample of Iranian patients with epilepsy.

BACKGROUND: Despite the importance of self-management in epileptics, no instrument has been developed or validated in Iran. Since self-management is a multi-dimensional construct, having a valid and reliable instrument for measuring this compound construct is crucial. OBJECTIVES: This study aims to validate the Persian version of the self-management scale and provide a valid and reliable tool to measure self-management of patients with epilepsy. PATIENTS AND METHODS: This is a methodological psychometric study. Construct , face and content validity was calculated on 200 samples after translation. Tool reliability was examined by using two methods: internal consistency and test-retest. Finally, the modified model was presented using exploratory factor analysis for the Iranian version of the tool. RESULTS: The validity of all items was above 0.63 and their content validity indexes (0.81-1) were appropriate. Construct validity, exploratory and confirmatory factor analysis confirmed all the dimensions except for some safety and pharmacotherapy items. The overall tool reliability with internal consistency had alpha of 0.77. CONCLUSIONS: Persian version of the self-management scale for patients with epilepsy is valid and reliable to measure the dimensions of self-management in Iranian patients and it can be used to measure epileptics' self-management. Further research on the safety of this tool is recommended.

Effect of a self-efficacy promotion training programme on the body weight changes in patients undergoing haemodialysis.

INTRODUCTION: Haemodialysis is the most common form of medical management of patients affected by end-stage renal disease (ESRD). For haemodialysis to be successful, strict fluid and weight control is recommended. Education, in terms of self-care activities, is an important intervention for improving patients' outcomes. A self-efficacy promotion training programme can be an effective strategy to bring about behavioural change. The aim of this study was to investigate the effect of a self-efficacy promotion training programme on the body weight changes in patients undergoing haemodialysis. METHODS: In this single-blind quasi-experimental study, we recruited a convenience sample of 63 patients undergoing haemodialy-sis from two teaching hospitals and allocated them randomly to the experimental or control group. Patients in the experimental group received a six-session self-efficacy promotion training programme while the control group received the routine care of the institute. Mean body weight gain and self-efficacy were measured before, immediately and two months after the study. FINDINGS: The groups did not differ significantly regarding the study variable before the study. However, immediately and two months after the study, the mean body weight gain and self-efficacy in the experimental group were significantly lower and higher, respectively, than the control group (p < 0.05). CONCLUSION: Implementing a self-efficacy promotion training programme is effective in decreasing weight gain and increasing self-efficacy in patients undergoing haemodialysis. Nurses in haemodialysis units can use self-efficacy promotion training programmes as an effective intervention for improving patients' outcomes.

The care process of diabetic foot ulcer patients: a qualitative study in Iran.

BACKGROUND: The Purpose of this study is to clarify the care process for Iranian diabetic patients with diabetic foot ulcer condition. METHODS: The main question of this research was "How is the care process for diabetic foot ulcer patients and how do patients experience it?" This study was within the Grounded Theory method. Data collection was carried out until data saturation was achieved. Saturation was achieved after interviewing 11 patients, 4 physicians, one head nurse and one nurse. RESULTS: Three main themes emerged from this study, including: "disease management, disease experience and continuity of care". Each of these themes is consisted of different sub-themes. CONCLUSIONS: This is the first study to describe the care process in Iranian diabetic patients with diabetic foot ulcer disease. Knowing patients' experience and the manner of dealing with them once faced with foot ulcer condition could facilitate a comprehensive decision making by therapists and better recovery of diabetic patients.