Effects of Virtual Reality in Patients Undergoing Dialysis: Study Protocol.

Dialysis is often considered slow, repetitive, and with programmed intervals. Patients often perceive it as time taken from their lives with a sense of ineluctability and emptiness, engendering a negative emotional and cognitive perception of the world and one's place in it. Today, it is possible to improve the quality of life of patients during hemodialysis using virtual reality (VR). This creation of a true multisensory experience may absorb the patient's perceptions during hemodialysis, improving his/her quality of life. An Italian multicenter, longitudinal experimental study will be conducted with a randomized, pre-post test design, with balanced allocation 1:1, in parallel groups with a control group in the standard care of patients diagnosed with chronic renal failure who are, undergoing hemodialysis treatment. A sample of 186 patients calculated with sample size (power = 80%, ß = 0.2, α = 0.05) will be randomized into an experimental group exposed to VR, and a control group in standard care. The 2 groups will be studied over a period of 1 month, with 12 applications of VR and with measurements of the following outcomes: anxiety, fatigue, pruritus, arterial pressure, heart rate, respiration rate, and duration of the session at each hemodialysis session. This is the first international experimental protocol that examines the application of VR in patients undergoing hemodialysis. If the results show statistically and clinically significant differences, the VR could be an additional holistic intervention, which is evidence based, linked to the humanization of chronic, repetitive interventions, complementary to and synergistic with standard of care.

[Psychological Assessment of a sample of women with ADPKD: quality of life, body image, anxiety and depression].

INTRODUCTION: The Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a chronic renal disease that has not yet been the subject of psychological research. There are only a few studies related to the consequences and complications of this pathology on female patients, although women affected by this disease present serious problems. AIM: The purpose of this study is to perform a psychological assessment (quality of life, anxiety, depression, body image) on a sample of 37 women with ADPKD. MATERIALS AND METHODS: The assessment is based on ad hoc social and personal record, KDQOL-SF (to evaluate health-related quality of life), HADS (for anxiety and depression) and BUT (for perceived body image). This assessment is administrated in a specific outpatient clinic. RESULTS: Results show that kidney disease has a negative impact on health-related quality of life. Concerns about body image are linked to anxious and depressive symptomatology: an increase in these concerns is related to a worsening of anxiety and depressive symptoms in patients. Moreover, a higher psychological malaise emerges in hypertensive ADPKD patients, in terms of mood and quality of life, compared to those without this concomitant pathology. Finally, it is important to note that social support, real or perceived, is of paramount importance in maintaining psychological well-being. CONCLUSIONS: The psychological evaluation of ADPKD patients can be used in clinical practice as a supplemental model in multidisciplinary Nephrology team.

[Quality of life, anxiety and distress in patients suffering from chronic kidney disease: pre-dialysis and start of dialytic treatment]. / Qualità di vita, ansia e distress nei pazienti affetti da malattia renale cronica: predialisi ed inizio del trattamento dialitico.

The psychological impact of the Chronic Kidney Disease is well known and several factors contribute to a reduction of quality of life, increase of anxiety levels and psychological distress for affected patients. Psychological intervention is becoming ever more consolidating within the Departments of Nephrology. Nevertheless, literature is lacking about the psychological intervention specificity, especially concerning the dialysis and pre-dialysis phase. The purpose of the study is to identify the mainly critical periods for the dialysed patients in terms of anxiety and distress and to examine the impact of medical management in pre-dialysis period on life quality. In this multi-centre study the sample was collected in three Dialysis Centres: the IRCCS San Raffaele, the IRCCS Multimedica and the A.O. Fatebenefratelli. The instruments used were KDQOL-SF, specific for the dialysed patient's quality of life, PDI, for the distress evaluation and STAI, for anxiety evaluation. The data showed the presence of a more severe psychological unease at the beginning of haemodialysis therapy and a better perception of the life quality for those who have received the medical adoption during the pre-dialysis phase than who did not have it. From a psychological point of view, these results highlight the importance of taking charge the patients in a pre-dialysis phase and of structuring specific psychological interventions during the initial period of substitution therapy.

[Burnout in healthcare professionals: a study carried out in the Nephrology Unit of San Raffaele Hospital]. / Il burnout negli operatori sanitari: uno studio condotto nell'U.O. di Nefrologia dell'Ospedale San Raffaele.

Burnout is a work stress syndrome caused by a prolonged contact with users which present physical and emotional suffering. C. Maslach, one of the main authors, refers that this syndrome is characterized by emotional exhaustion, depersonalization and reduced personal skills. However, the researches done within the Nephrology and Dialysis Departments on this phenomenon are still few in the literature, despite the peculiar characteristics of the care relationship that develops between caregivers and patients on dialysis treatment. The present study aims to highlight the importance of assessing the levels of burnout and strategies of adaptation to stress (coping) in healthcare workers of Nephrology and Dialysis Unit, so that their psychological well-being could be preserved, preventing the possibility of a progressive deterioration of the care relationship with the patient. The implementation of psychological training courses for healthcare workers seems to be a useful tool aimed at the prevention and management of the burnout syndrome.

[Integration of a psychologist into Nephrology-Dialysis-Hypertension Operative Unit: from needs evaluation to the definition of an intervention model]. / L'inserimento della figura dello psicologo all'interno dell'Unità Operativa di Nefrologia-Dialisi-Ipertensione.

Chronic Kidney Disease (CKD) and the dialytic treatment cause a significant psychological impact on patients, their families and on the medical-nursing staff too. The psychological aspects linked to the chronic condition of Kidney Disease generate the need to integrated a psychologist into the healthcare team of the Nephrology, Dialysis and Hypertension Operative Unit, in order to offer a specific and professional support to the patient during the different stages of the disease, to their caregivers and to the medical team. The aim of this collaboration project between Nephrology and Psychology is to create a global and integrated healthcare model. It does not give attention simply to the physical dimension of patients affected by CKD, but also to the emotional-affective, cognitive and social dimensions and to the health environment.