Effect of Nurse-Led Telephone Follow ups (Tele-Nursing) on Depression, Anxiety and Stress in Hemodialysis Patients

The feasibility of integrating a home telehealth model for older persons living with hemodialysis

BACKGROUND

In Thailand, there is a rapidly increasing population of older persons living with hemodialysis (OPLWH) for whom quality of life and clinical outcomes are their main focus. This study aims to assess the feasibility of an integrated home telehealth model on quality of life and laboratory parameters of OPLWH.

METHODS

In this study, the second phase of a mixed methods exploratory sequential design was conducted using a repeated measures experimental design. Participants met the inclusion criteria, which included being an OPLWH at a single hemodialysis center of one hospital in Chiang Mai province, Thailand, during the experimental period between 1 April and 30 September 2018, and willing to participate in the study. The 54 participants were purposively selected and randomly assigned to receive either an intervention (n = 24) consisting of health education and health monitoring using a telehealth device (an iPad) and a web application, or usual care (n = 30). The instruments included a demographic data form, which was analyzed using the chi-square test. The health-related quality of life questionnaire (the 9-item Thai Health Status Assessment questionnaire) and blood chemistry (BUN, Cr, Hb, Hct, Alb, K, Kt/V, and nPCR) were compared and measured at baseline, and at 3 and 6 months after enrolment using independent t-test and one-way repeated measures ANOVA.

RESULTS

The comparison of quality of life between the two groups at the two points of repeated measurement (after 3 months) showed a statistically significant difference in mental health scores at P < 0.05. Six months after the intervention, mean scores for health outcomes and patients' quality of life improved; however, this change did not reach statistical significance.

CONCLUSIONS

An integrated home telehealth model implemented by a hemodialysis nurse is a feasible holistic care approach for OPLWH. However, the absence of statistical significance may partly be associated with the clinical characteristics of frailty and risk factors such as increased age, hypertension, diabetes, heart disease, longer dialysis time, and inadequacy of Kt/V. Large-scale multi-centre trials are warranted to fully examine the acceptability of the model. The duration and long-term effects of the telehealth model are also recommended for further investigation.

PATIENT OR PUBLIC CONTRIBUTION

The development of a home telehealth model was a collaborative process between patients, caregivers, healthcare professionals from the hemodialysis unit, and the research team.

The impact of telenursing on level of depression, stress and anxiety in discharged patients after coronary artery bypass graft surgery: A randomized clinical trial

BACKGROUND

After coronary artery bypass graft surgery patients are susceptible to mental disorders such as stress, anxiety, and depression following discharge from the hospital and often require post-discharge support and follow-up. Telenursing is an accessible method that may reduce stress, anxiety, and depression experienced by patients. This study aimed to investigate the impact of telenursing on depression, stress, and anxiety in discharged patients after CABG surgery.

MATERIALS AND METHODS

A randomized clinical trial was carried out. Eligible patients were divided randomly into intervention (n=40) and control (n=40) groups. Depression Anxiety Stress Scale-21 (DASS21) questionnaire was filled out by both groups one day before discharge from the hospital. The intervention group received SMS reminders of their treatment plan, referrals to the cardiac rehabilitation clinic, and routine care three times a week for six weeks, while the control group received routine care provided by the hospital only. In the week following the completion of the intervention period, both groups returned to fill out the questionnaire, and the data were analyzed using SPSS version 16.0, descriptive and inferential statistics, and independent and paired T-tests.

RESULT

The mean scores of depression, stress, and anxiety before intervention in the intervention group were 11.95, 18.75, and 18.17, and in the control group were 11.55, 18.37, and 17.4 respectively. The mean scores of depression, stress, and anxiety after intervention in the intervention group were 7.85, 10.5, and 10.45, and in the control group were 10.56, 17.9, and 16.5 respectively. No significant differences were seen between the two groups before the intervention (P>0.05), but the results showed significant differences between the two groups' mean scores of depression, stress, and anxiety after intervention (P<0.001).

CONCLUSION

Telenursing can reduce stress, anxiety, and depression in discharged patients after coronary artery bypass graft surgery by providing proper and cost-effective follow-up.

Well-being in chronic pediatric inflammatory rheumatic diseases: the experience of a French healthcare network

OBJECTIVE

Current management of patients with pediatric rheumatic diseases (PRD) should aim at achieving the best possible well-being. To identify sociodemographic/clinical characteristics, needed paramedical services and school accommodations associated with well-being in patients at inclusion in a French health network Réseau pour les Rhumatismes Inflammatoires Pédiatriques (RESRIP) that supports coordination of the patient's health pathway. To evaluate the evolution of well-being over time in this patients benefiting from such support.

METHODS

Patients > 3 years old enrolled in RESRIP (2013-2020) were included. At enrollment, data were collected on sociodemographic/clinical characteristics, ongoing medications, and paramedical and educational actions to be implemented by RESRIP. Well-being during the last 6 months was reported with a standardized questionnaire at enrollment and every 6 months. A well-being score was calculated with scores ranging from 0 to 18, 18 corresponding to absolute well-being. Patients were followed up from inclusion until June 2020.

RESULTS

In total, 406 patients were included and followed up for 36 months on average: 205 juvenile idiopathic arthritis, 68 connective tissue diseases, 81 auto-inflammatory diseases and 52 other diseases. The well-being score did not differ between the groups and improved significantly, by 0.04 score units, every 6 months (95% confidence interval [0.03; 0.06]). At inclusion, use of homeopathy, need for implementation of hypnosis or psychological support, occupational therapy or for adjustment of school tests were associated with worse well-being score.

CONCLUSION

Well-being seems associated more with the impact of chronic illness than the type of PRD underlining the importance of a comprehensive patient care.

The Effect of Education and Follow-up Provided via Tele-nursing on the Quality of Life of Patients With COVID-19

Background Patient education and follow-up can be accomplished without time or space constraints via tele-nursing. The aim of this study was to examine the effect of education and follow-up provided via tele-nursing on the quality of life of individuals diagnosed with COVID-19. Method This semi-experimental study used a pretest-posttest design in a single group. It was conducted between April 1, 2021, and October 1, 2021, with 63 patients who presented to a state hospital. The Patient Information Form and the Duke Health Profile were administered to the patients prior to the education. Then, the patients completed the COVID-19 education program. Next, follow-up and counseling occurred via tele-nursing every other day for 14 days. At the end of the 14th day, the Duke Health Profile was once again administered to the patients. Results The patients had decreased physical, mental, and social health scores after the intervention. In addition, their pain, anxiety, and depression scores decreased. Conclusion Nurses should assume a more active role in patient education and include tele-nursing in nursing care. [J Contin Educ Nurs. 2022;53(8):365-371.].

Diagnosis and Management of Depression in Patients With Kidney Disease

Depression disproportionately affects patients with kidney disease, including those with nondialysis chronic kidney disease, end-stage kidney disease requiring dialysis, and kidney transplant recipients. Patients across the spectrum of kidney disease should be screened for depression every 6 to 12 months using self-report questionnaires, followed by an interview with a clinician to confirm the presence of sadness or anhedonia when depressive symptoms are identified. Pharmacologic treatment with selective serotonin reuptake inhibitors has not consistently shown benefit compared with placebo and may be associated with serious adverse outcomes including cardiovascular events, bleeding, and fractures. However, based on the availability of alternative therapies, a watchful trial with close monitoring for therapeutic and adverse effects is reasonable. Several clinical trials have suggested that cognitive behavioral therapy and physical activity improve depressive symptoms when compared with a control group. Given the low risk associated with these therapies, they should be recommended to patients who have access and are amenable to such interventions. Future trials are needed to study therapeutic options for depression in nondialysis chronic kidney disease, peritoneal dialysis, or kidney transplant recipients, as well as alternative pharmacologic therapy and combination therapies. Given improvement in depressive symptoms with placebo in existing trials, inclusion of a control group is paramount.

A cross-sectional study on assessing depression among hemodialysis patients

Depression is the most common disorder of psychiatric illness experienced by hemodialysis patients. Failure to measure depression may diminish their well-being. The main objective of this study is to assess depression in hemodialysis patients. The primary goal is to find out the prevalence of depression among chronic kidney disease (CKD) patients. The secondary goal is to find the association between age, sex, and the severity of depression among patients with CKD. This cross-sectional study was performed at the Nephrology Department of King Fahad Hospital, Tabuk, from December 2021 to April 2022. Depression was assessed using a validated Arabic version of the Zung Self-Rating Depression Scale, which is a self-administered questionnaire to assess depression. The mean age of subjects was 42.13 years (standard deviation = 15.65), most of them were in the age group of 18-29 and 40-49 years (n = 59, 24.58%), and the majority were male (n = 128, 53.33%). The depression prevalence among hemodialysis patients was 74.58%. Majority of the patients were with mild depression (n = 175, 72.92%). No significant difference was found for depression among different age groups or genders with ongoing hemodialysis, in our study. Even though the prevalence of depression was high, mostly they were in the mild category. Depression should be assessed frequently, and psychological counseling should be given to improve the well-being of patients.

Metabolic Syndrome and Psychological Effects of Exercise in Hemodialysis Patients

Metabolic syndrome (MS) and anxiety disorders are common problems among hemodialysis patients (HD). However, there have been no studies defining the role of physical activity in reducing anxiety in HD patients with MS. This study was aimed to determine the effects on the severity of anxiety of a four-week rehabilitation program for HD patients, with or without metabolic syndrome (MS), planned and adapted to their abilities. The study was single-center, interventional, non-randomized, and prospective. Fifty-eight individuals completed the project (28 HD patients and 30 controls (C) with normal kidney function). Each group was divided into two subgroups with respect to MS. The mean age of the subjects in the HD and C groups was 56.9 ± 13.3 years (x¯ ± SD) and 61.5 ± 8.3 years (x¯ ± SD), respectively. Planned and adapted to the patient's abilities, the rehabilitation program based on physiotherapy was provided to each subject for 4 weeks. Baseline and post-intervention determined anxiety levels using the State-Trait Anxiety Inventory (STAI). The X1 scale tests state anxiety, and the X2 scale tests trait anxiety. Post-intervention, there was no significant difference in the intensity of state anxiety observed in HD patients compared to C with normal renal function, as observed before the program. After four weeks of regular physical activity planned and adapted to the patient's abilities in an inpatient ward, the level of state anxiety (X1) and trait anxiety (X2) lowered considerably in all HD patients (respectively: 35.1 ± 8.0 vs. 29.2 ± 5.0, p = 0.001 for X1 and 41.8 ± 9.1 vs. 38.1 ± 5.9, p = 0.008 for X2). The rehabilitation program significantly reduced the intensity of state anxiety (X1) in HD patients with MS (35.8 ± 7.9 vs. 29.2 ± 5.1; p = 0.01). The rehabilitation program helped to significantly reduce the intensity of trait anxiety (X2) in HD patients without MS (41.9 ± 10.7 vs. 36.9 ± 5.9; p = 0.04). Four-week physical activity planned and adapted to the patient's abilities reduces the intensity of anxiety in HD patients and controls with normal renal function. HD patients with MS benefit more in terms of reducing perceived state anxiety, and HD patients without MS in terms of reducing trait anxiety.

Depression in dialysis

PURPOSE OF REVIEW

The aim of this study was to examine updated prevalence rates, risk factors and the prognosis, diagnosis and treatments for depression among dialysis patients.

RECENT FINDINGS

Depression influences prognosis, complications, quality of life (QOL), treatment and costs for dialysis patients worldwide. Reported prevalence of depression is 13.1-76.3%; it is higher for dialysis than transplant and higher post than predialysis. Reported depression rates with peritoneal dialysis (PD) compared with in-centre haemodialysis (HD) are inconsistent. Related medical factors are known, but suspected associated patient characteristics including gender and race remain unexplored. Associations between depression in dialysis and QOL, mortality, pathophysiological mechanisms of increased mortality, infection and pathways of inflammation-mediated and psychosocial factors require clarification. Several depression screening instruments are validated for dialysis patients - the Structured Clinical Interview for DSM disorders (SCID) remains the gold standard - but authors suggest the diagnostic standard should be higher than for the general population. Short-term studies indicate nonpharmacological therapy achieves clinical effects for depression in dialysis patients, but research on long-term effects is needed.

SUMMARY

Depression management through early screening and continuous care models emphasizing dynamic relationships between healthcare teams, patients and families should be encouraged. Large-scale studies of short-term and long-term benefits of pharmacological and nonpharmacological depression management are warranted.

The efficacy of telenursing on caregiver burden among Iranian patients with heart failure: A randomized clinical trial

BACKGROUND

Heart failure is one of the most common syndromes in the world and Iran. Caring for heart failure patients can cause a burden on their caregivers. Traditional and modern treatment techniques are often used for patients with heart failure. This study was conducted with the aim to " determine the impact of telenursing on short-term caregiver burden of patients with heart failure discharged from hospitals in Iran".

METHODS

This randomized clinical trial (RCT) was undertaken in Kerman, Iran, in 2018-2019. From among caregivers of patients with minimal grade 2 heart failure, 100 patients were randomly selected to participate in the study. The intervention group, in addition to routine discharge training, received training and care files with videos and related photos via social media every other day for 1 month. The control group received only routine discharge training. The Caregiver Burden Scale (CBS) was completed before and after the intervention in both groups. This scale includes 22 items scored on a Likert scale ranging from 0 (never) to 4 (almost always). The data were analyzed using SPSS software.

RESULTS

The mean age of the participants was 56.44 ± 13.09 years. The mean caregiver burden score in the control and intervention groups at baseline was 37.26 and 35.58, respectively, and after the intervention, it was 34.56 and 24.28, respectively. A significant difference was found in the 2 groups after the study; the mean caregiver burden score in the intervention group was significantly reduced compared to the control group after the study.

CONCLUSION

Telenursing reduces the caregiver burden in caregivers of patients with heart failure. Telenursing can be considered as an auxiliary method to control the symptoms associated with heart failure.

Survey of Telemedicine by Pediatric Nephrologists During the COVID-19 Pandemic

Introduction

The slow increase in use of telemedicine began to expand rapidly, along with reimbursement changes, during the coronavirus disease-2019 (COVID-19) pandemic. Standardized protocols for these services are lacking but are needed for effective and equitable health care. In this study, we queried pediatric nephrologists and their patients about their telemedicine experiences during the pandemic.

Methods

Surveys that were in compliance with the Health Insurance Portability and Accountability Act were deployed online to patients and physicians.

Results

We collected survey responses from 400 patients and 197 pediatric nephrologists. Patients reported positive experiences with telemedicine visits as it was logistically easier than in-person visits. Patients also felt that the quality of their visits were equivalent to what they would receive in person. Physicians used a wide variety of online systems to conduct synchronous telemedicine with Zoom (23%), EPIC (9%), Doxy.me (7%), services not specified (37%), or a mix of local or smaller services (24%). Most physicians' concerns were related to technological issues and the ability to procure physical exams and/or laboratory results.

Conclusions

There is a paucity of published trials on telemedicine services in pediatric nephrology. Virtual care was feasible and acceptable for patients, caregivers, and providers during the COVID-19 pandemic.

Virtual models of care for people with palliative care needs living in their own home: A systematic meta-review and narrative synthesis

BACKGROUND

Access to palliative care in the community enables people to live in their preferred place of care, which is often home. Community palliative care services struggle to provide timely 24-h services to patients and family. This has resulted in calls for 'accessible and flexible' models of care that are 'responsive' to peoples' changing palliative care needs. Digital health technologies provide opportunities to meet these requirements 24-h a day.

AIM

To identify digital health technologies that have been evaluated for supporting timely assessment and management of people living at home with palliative care needs and/or their carer(s), and the evidence-base for each.

DESIGN

A systematic review of systematic reviews ('meta-review'). Systematic reviews evaluating evidence for virtual models of palliative or end-of-life care using one or more digital health technologies were included. Systematic reviews were evaluated using the Risk of Bias Tool for Systematic Reviews. A narrative approach was used to synthesise results.

DATA SOURCES

Medline, Embase, Web of Science, CINAHL and Cochrane Database of systematic reviews were searched for English-language reviews published between 2015 and 2020.

RESULTS

The search yielded 2266 articles, of which 12 systematic reviews met criteria. Sixteen reviews were included in total, after four reviews were found via handsearching. Other than scheduled telehealth, video-conferencing, or after-hours telephone support, little evidence was found for digital health technologies used to deliver virtual models of palliative care.

CONCLUSIONS

There are opportunities to test new models of virtual care, beyond telehealth and/or video conferencing, such as 24-h command centres, and rapid response teams.

SYSTEMATIC REVIEW REGISTRATION NUMBER

Prospero CRD42020200266.

Telemedicine in the Satellite Dialysis Unit: Is It Feasible and Safe?

Telemedicine has gained popularity during the recent COVID-19 pandemic. Regular and timely physician review is an essential component of care for the maintenance of hemodialysis patients. While it is widely acknowledged that telemedicine cannot fully replace the role of physical review in this group of patients with organ failure, it can perhaps reduce the reliance on physical review or serve as a filter and triage in determining which patient requires actual physical review. The use of technology in any healthcare setting should always align with existing clinical workflow and protocols. We discuss the safety and quality aspects of this new concept applied to the satellite dialysis unit.

Effect of Cool Dialysate on Depression in Patients with Chronic Renal Failure Treated with Hemodialysis: A Randomized Clinical Trial

Background: Depression is one of the most common psychiatric problems in hemodialysis patients. Objectives: This study aimed to evaluate the effect of cool dialysate on depression in patients with chronic renal failure treated with hemodialysis. Methods: This randomized clinical trial was performed on 66 hemodialysis patients suffering from depression. Patients were selected by a convenience sampling method and divided equally into intervention and control groups randomly by permuted block allocation, each group containing 33 patients. Data were acquired with the Beck Depression inventory-I. The intervention and control groups underwent one month of treatment with cool dialysate at 35.5 and 37°C, respectively. The severity of depression for each group was measured at the end of each treatment stage and two weeks after the intervention. Data were analyzed using R version 25 software with a confidence level of 95%. Results: There was no statistically significant difference between the control and intervention groups before and after the intervention (P-values more than 0.05). While the mean of depression severity for the control group decreased from 26.15 ± 1.46 to 22.24 ± 2.00 (P-values < 0.01), the mean of depression severity for the intervention group decreased from 25.56 ± 1.28 to 22.41 ± 1.65 by the intervention (P-value > 0.05). Conclusions: The application of cool dialysate as a non-pharmacological method did not significantly reduce the severity of depression in patients undergoing hemodialysis. Therefore, it is advised to perform further studies that include more research units from different geographical locations, considering a longer intervening duration.

Telemedicine for Pediatric Nephrology: Perspectives on COVID-19, Future Practices, and Work Flow Changes

Although the use of telemedicine in rural areas has increased steadily over the years, its use was rapidly implemented during the onset of the coronavirus disease 2019 (COVID-19) crisis. Due to this rapid implementation, there is a lack of standardized work flows to assess and treat for various nephrotic conditions, symptoms, treatment modalities, and transition processes in the pediatric population. To provide a foundation/suggestion for future standardized work flows, the authors of this report have developed standardized work flows using the Delphi method. These work flows were informed based on results from cross-sectional surveys directed to patients and providers. Most patients and providers were satisfied, 87% and 71%, respectively, with their telemedicine visits. Common issues that were raised with the use of telemedicine included difficulty procuring physical laboratory results and a lack of personal warmth during telemedicine visits. The work flows created based on these suggestions will both enhance safety in treating patients and allow for the best possible care.

The Effectiveness of Depression Treatment for Adults with ESKD: A Systematic Review

Adults with dialysis-dependent ESKD experience higher rates of depression than the general population, yet efficacy of depression treatments in this population is not well understood. We conducted a systematic review of the benefits and harms of depression treatment in adults with ESKD. We searched multiple data sources through June 2020 for English-language, controlled trials that compared interventions for depression in adults with ESKD to another intervention, placebo, or usual care, and reported depression treatment-related outcomes. Observational studies were included for harms. Two investigators independently screened all studies using prespecified criteria. One reviewer abstracted data on study design, interventions, implementation characteristics, and outcomes, and a second reviewer provided confirmation. Two reviewers independently assessed study quality and resolved any discords through discussion or a third reviewer. Strength of evidence (SOE) was assessed and agreed upon by review-team consensus. We qualitatively analyzed the data and present syntheses in text and tables. We included 26 RCTs and three observational studies. SSRIs were the most studied type of drug and the evidence was largely insufficient. We found moderate SOE that long-term, high-dose vitamin D3 is ineffective for reducing depression severity. Cognitive behavioral therapy is more effective than (undefined) psychotherapy and placebo for depression improvement and quality of life (low SOE), and acupressure is more effective than usual care or sham acupressure in reducing depression severity (low SOE). There is limited research evaluating treatment for depression in adults with ESKD, and existing studies may not be generalizable to adults in the United States. Studies suffer from limitations related to methodologic quality or reporting. More research replicating studies of promising interventions in US populations, with larger samples, is needed. Systematic Review registry name and registration number: PROSPERO, CRD42020140227.

Initiating Telephone Follow Up After Hospital Discharge From an Inpatient Psychiatric Setting to Reduce Recidivism

The purpose of the current evidence-based practice (EBP) project was to reduce recidivism in patients with depression after acute psychiatric hospital discharge through implementation of telephone follow up. Eight patients (intervention group) were called within 72 hours of discharge to reinforce discharge instructions and administer the Patient Health Questionnaire-9 (PHQ-9). The results were compared to 16 patients (control group) who were discharged during the same timeframe 1 year prior. The findings from the control group revealed one (6.25%) patient was readmitted and three (18.75%) patients visited the emergency department (ED) within 30 days of discharge. No one in the intervention group was readmitted or visited the ED within 30 days post discharge. Statistically significant differences were not detected in discharge telephone call status (received or did not receive) and readmissions (p = 1.000) and ED visits (p = 0.526). For six patients in the intervention group, the mean PHQ-9 score was 3.3, which was within a depression severity of none to minimal. This quality improvement project helped address patient lack of knowledge related to discharge instructions after being discharged from the hospital to home. [Journal of Psychosocial Nursing and Mental Health Services, 58(5), 25-31.].

Psychosocial interventions for preventing and treating depression in dialysis patients

BACKGROUND

People with end-stage kidney disease (ESKD) treated with dialysis are frequently affected by major depression. Dialysis patients have prioritised depression as a critically important clinical outcome in nephrology trials. Psychological and social support are potential treatments for depression, although a Cochrane review in 2005 identified zero eligible studies. This is an update of the Cochrane review first published in 2005.

OBJECTIVES

To assess the effect of using psychosocial interventions versus usual care or a second psychosocial intervention for preventing and treating depression in patients with ESKD treated with dialysis.

SEARCH METHODS

We searched Cochrane Kidney and Transplant's Register of Studies up to 21 June 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and quasi-RCTs of psychosocial interventions for prevention and treatment of depression among adults treated with long-term dialysis. We assessed effects of interventions on changes in mental state (depression, anxiety, cognition), suicide, health-related quality of life (HRQoL), withdrawal from dialysis treatment, withdrawal from intervention, death (any cause), hospitalisation and adverse events.

DATA COLLECTION AND ANALYSIS

Two authors independently selected studies for inclusion and extracted study data. We applied the Cochrane 'Risk of Bias' tool and used the GRADE process to assess evidence certainty. We estimated treatment effects using random-effects meta-analysis. Results for continuous outcomes were expressed as a mean difference (MD) or as a standardised mean difference (SMD) when investigators used different scales. Dichotomous outcomes were expressed as risk ratios. All estimates were reported together with 95% confidence intervals (CI).

MAIN RESULTS

We included 33 studies enrolling 2056 participants. Twenty-six new studies were added to this 2019 update. Seven studies originally excluded from the 2005 review were included as they met the updated review eligibility criteria, which have been expanded to include RCTs in which participants did not meet criteria for depression as an inclusion criterion. Psychosocial interventions included acupressure, cognitive-behavioural therapy, counselling, education, exercise, meditation, motivational interviewing, relaxation techniques, social activity, spiritual practices, support groups, telephone support, visualisation, and voice-recording of a psychological intervention. The duration of study follow-up ranged between three weeks and one year. Studies included between nine and 235 participants. The mean study age ranged between 36.1 and 73.9 years. Random sequence generation and allocation concealment were at low risk of bias in eight and one studies respectively. One study reported low risk methods for blinding of participants and investigators, and outcome assessment was blinded in seven studies. Twelve studies were at low risk of attrition bias, eight studies were at low risk of selective reporting bias, and 21 studies were at low risk of other potential sources of bias. Cognitive behavioural therapy probably improves depressive symptoms measured using the Beck Depression Inventory (4 studies, 230 participants: MD -6.10, 95% CI -8.63 to -3.57), based on moderate certainty evidence. Cognitive behavioural therapy compared to usual care probably improves HRQoL measured either with the Kidney Disease Quality of Life Instrument Short Form or the Quality of Life Scale, with a 0.5 standardised mean difference representing a moderate effect size (4 studies, 230 participants: SMD 0.51, 95% CI 0.19 to 0.83) , based on moderate certainty evidence. Cognitive behavioural therapy may reduce major depression symptoms (one study) and anxiety, and increase self-efficacy (one study). Cognitive behavioural therapy studies did not report hospitalisation. We found low-certainty evidence that counselling may slightly reduce depressive symptoms measured with the Beck Depression Inventory (3 studies, 99 participants: MD -3.84, 95% CI -6.14 to -1.53) compared to usual care. Counselling reported no difference in HRQoL (one study). Counselling studies did not measure risk of major depression, suicide, or hospitalisation. Exercise may reduce or prevent major depression (3 studies, 108 participants: RR 0.47, 95% CI 0.27 to 0.81), depression of any severity (3 studies, 108 participants: RR 0.69, 95% CI 0.54 to 0.87) and improve HRQoL measured with Quality of Life Index score (2 studies, 64 participants: MD 3.06, 95% CI 2.29 to 3.83) compared to usual care with low certainty. With moderate certainty, exercise probably improves depression symptoms measured with the Beck Depression Inventory (3 studies, 108 participants: MD -7.61, 95% CI -9.59 to -5.63). Exercise may reduce anxiety (one study). No exercise studies measured suicide risk or withdrawal from dialysis. We found moderate-certainty evidence that relaxation techniques probably reduce depressive symptoms measured with the Beck Depression Inventory (2 studies, 122 participants: MD -5.77, 95% CI -8.76 to -2.78). Relaxation techniques reported no difference in HRQoL (one study). Relaxation studies did not measure risk of major depression or suicide. Spiritual practices have uncertain effects on depressive symptoms measured either with the Beck Depression Inventory or the Brief Symptom Inventory (2 studies, 116 participants: SMD -1.00, 95% CI -3.52 to 1.53; very low certainty evidence). No differences between spiritual practices and usual care were reported on anxiety (one study), and HRQoL (one study). No study of spiritual practices evaluated effects on suicide risk, withdrawal from dialysis or hospitalisation. There were few or no data on acupressure, telephone support, meditation and adverse events related to psychosocial interventions.

AUTHORS' CONCLUSIONS

Cognitive behavioural therapy, exercise or relaxation techniques probably reduce depressive symptoms (moderate-certainty evidence) for adults with ESKD treated with dialysis. Cognitive behavioural therapy probably increases health-related quality of life. Evidence for spiritual practices, acupressure, telephone support, and meditation is of low certainty . Similarly, evidence for effects of psychosocial interventions on suicide risk, major depression, hospitalisation, withdrawal from dialysis, and adverse events is of low or very low certainty.

eHealth interventions for people with chronic kidney disease

BACKGROUND

Chronic kidney disease (CKD) is associated with high morbidity and death, which increases as CKD progresses to end-stage kidney disease (ESKD). There has been increasing interest in developing innovative, effective and cost-efficient methods to engage with patient populations and improve health behaviours and outcomes. Worldwide there has been a tremendous increase in the use of technologies, with increasing interest in using eHealth interventions to improve patient access to relevant health information, enhance the quality of healthcare and encourage the adoption of healthy behaviours.

OBJECTIVES

This review aims to evaluate the benefits and harms of using eHealth interventions to change health behaviours in people with CKD.

SEARCH METHODS

We searched the Cochrane Kidney and Transplant Register of Studies up to 14 January 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-RCTs using an eHealth intervention to promote behaviour change in people with CKD were included. There were no restrictions on outcomes, language or publication type.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trial eligibility, extracted data and assessed the risk of bias. The certainty of the evidence was assessed using GRADE.

MAIN RESULTS

We included 43 studies with 6617 participants that evaluated the impact of an eHealth intervention in people with CKD. Included studies were heterogeneous in terms of eHealth modalities employed, type of intervention, CKD population studied and outcomes assessed. The majority of studies (39 studies) were conducted in an adult population, with 16 studies (37%) conducted in those on dialysis, 11 studies (26%) in the pre-dialysis population, 15 studies (35%) in transplant recipients and 1 studies (2%) in transplant candidates We identified six different eHealth modalities including: Telehealth; mobile or tablet application; text or email messages; electronic monitors; internet/websites; and video or DVD. Three studies used a combination of eHealth interventions. Interventions were categorised into six types: educational; reminder systems; self-monitoring; behavioural counselling; clinical decision-aid; and mixed intervention types. We identified 98 outcomes, which were categorised into nine domains: blood pressure (9 studies); biochemical parameters (6 studies); clinical end-points (16 studies); dietary intake (3 studies); quality of life (9 studies); medication adherence (10 studies); behaviour (7 studies); physical activity (1 study); and cost-effectiveness (7 studies).Only three outcomes could be meta-analysed as there was substantial heterogeneity with respect to study population and eHealth modalities utilised. There was found to be a reduction in interdialytic weight gain of 0.13kg (4 studies, 335 participants: MD -0.13, 95% CI -0.28 to 0.01; I² = 0%) and a reduction in dietary sodium intake of 197 mg/day (2 studies, 181 participants: MD -197, 95% CI -540.7 to 146.8; I² = 0%). Both dietary sodium and fluid management outcomes were graded as being of low evidence due to high or unclear risk of bias and indirectness (interdialytic weight gain) and high or unclear risk of bias and imprecision (dietary sodium intake). Three studies reported death (2799 participants, 146 events), with 45 deaths/1000 cases compared to standard care of 61 deaths/1000 cases (RR 0.74, CI 0.53 to 1.03; P = 0.08). We are uncertain whether using eHealth interventions, in addition to usual care, impact on the number of deaths as the certainty of this evidence was graded as low due to high or unclear risk of bias, indirectness and imprecision.

AUTHORS' CONCLUSIONS

eHealth interventions may improve the management of dietary sodium intake and fluid management. However, overall these data suggest that current evidence for the use of eHealth interventions in the CKD population is of low quality, with uncertain effects due to methodological limitations and heterogeneity of eHealth modalities and intervention types. Our review has highlighted the need for robust, high quality research that reports a core (minimum) data set to enable meaningful evaluation of the literature.

Anxiety-Depression of Dialysis Patients and Their Caregivers

Background and Objectives: Anxiety–depression of patients undergoing hemodialysis has a strong relation with the levels of anxiety–depression of their caregivers. The aim of this study was to evaluate anxiety–depression of dialysis patients and their caregivers. Materials and Methods: In this cross-sectional study, 414 pairs of patients and caregivers from 24 hemodialysis centers of Greece completed the Hospital Anxiety and Depression Scale (HADS). The statistical analysis of the data was performed through the Statistical Program SPSS version 20.0. The statistical significance level was set up at 5%. Results: The mean age of patients was 64 (54.06–72.41) years old and the mean duration of hemodialysis was 36 (16–72) months. The mean age of caregivers was 54 (44–66) years old. Of the total sample, 17.1% (n = 71) of patients had high levels of anxiety and 12.3% (n = 51) had high levels of depression. Additionally, 27.8% (n = 115) of caregivers had high levels of anxiety and 11.4% (n = 47) had high levels of depression. Caregivers had higher levels of anxiety when their patients had high levels of anxiety as well (42.3%). Additionally, they had higher levels of depression when their patients had high levels of depression as well (17.6%). Conclusions: The results of this study showed a significant association between the levels of anxiety and depression among patients and caregivers. There is a necessity for individualized assessment of dialysis patients and their caregivers and the implementation of specific interventions for reducing the levels of anxiety and depression among them.

The effect of an educational program on quality of life in patients undergoing hemodialysis in western Saudi Arabia

OBJECTIVES

To assess health-related quality of life (QOL) among hemodialysis (HD) patients attending HD units in Jeddah, Saudi Arabia and to evaluate the effect of an educational program on health-related QOL.

METHOD

One hundred HD patients were recruited and followed from 4 different dialysis units in Jeddah, Saudi Arabia between January 2018 and May 2018. The patients were divided into an intervention group (n=50) receiving educational program and control group (n=50). All sociodemographic and laboratory variables were recorded. The QOL short form 36 (SF-36) questionnaire has been used and the score calculated to all patients enrolled in the study before and after educational program. The participants received the educational program in individualized sessions.

RESULTS

The mean ± standard deviation in the intervention group were significantly greater than in controls after the educational program in most dimensions of QOL, including role-physical (35.5 ± 24.7 versus 24.5 ± 23.9, p less than 0.02), role-emotional (58.6 ± 40.1 versus 44.6+43.4, p less than 0.001) and general health (76.6 ± 16 versus 62.9 ± 19.4, p less than 0.001). This reflects high impact of patient counseling in the QOL of HD patients.

CONCLUSION

The scores of health-related quality of life for HD patients were low. The educational program had significant positive impact on all health-related quality of life parameters.

Comparing the effects of face-to-face and telenursing education on the quality of family caregivers caring in patients with cancer

BACKGROUND

Taking care of patients with cancer is often done at home and by family caregivers. However, these groups do not receive the necessary education regarding care at home.

OBJECTIVES

The present study aimed to compare the effects of face-to-face and telenursing training methods on the quality of services provided by the family caregiver for patients with cancer.

MATERIALS AND METHODS

A total of 103 family caregivers of patients with cancer were randomly divided into 3 groups: control (N = 35), face to face (N = 34), and telenursing (N = 34). The control group only received the routine training, and the face-to-face and telenursing groups were trained for 12 weeks. Quality of care was measured using a questionnaire before and after intervention. Chi-square, Fisher's exact, and analysis of variance tests were used for data analysis.

RESULTS

After intervention, the average total quality score for the care of patients in face-to-face (166.13 ± 13.91) and telenursing (157.76 ± 17.24) groups was significantly higher than the control group (82.51 ± 16.84) (P < 0.001). In addition, the average psychosocial care score for face-to-face group (49.06 ± 6.05) was significantly higher than telenursing group (43.83 ± 6.15) (P < 0.001).

CONCLUSION

The results of the study showed that the two methods of training were effective on the quality of care among family caregivers of patients with cancer to a similar extent.

A holistic approach to factors affecting depression in haemodialysis patients

Depression in dialysis populations is affected by co-morbid diseases, such as cardiovascular disease, diabetes, and immune dysfunction, and it also includes high suicide risk and frequent hospitalizations. Depressive disorders have a close association with malnutrition and chronic inflammation, as well as with cognitive impairment. Impaired cognitive function may be manifested as low adherence to dialysis treatment, leading to malnutrition. Additionally, chronic pain and low quality of sleep lead to high rates of depressive symptoms in haemodialysis patients, while an untreated depression can cause sleep disturbances and increased mortality risk. Depression can also lead to sexual dysfunction and non-adherence, while unemployment can cause depressive disorders, due to patients' feelings of being a financial burden on their family. The present review provides a holistic approach to the factors affecting depression in haemodialysis, offering significant knowledge to renal professionals.

Impact of Telehealth Interventions on Processes and Quality of Care for Patients With ESRD

Caring for patients with end-stage renal disease (ESRD) requiring dialysis is intensive and expensive. Telehealth may improve the access and efficiency of ESRD care. For this perspective, we systematically reviewed studies that examined the effectiveness of telehealth versus or in addition to usual care for ESRD management. 10 studies were identified, including 7 randomized trials and 3 cohort studies. Study populations, modes of delivery (including telephone, telemetry, or videoconferencing), and the outcomes evaluated varied substantially between studies. Two studies examined telehealth interventions versus standard ESRD care and demonstrated mixed results on processes of care, no differences in laboratory surrogate markers of ESRD care, and reduced or similar rates of hospitalization. Eight studies evaluated the addition of telehealth to usual care and demonstrated no significant improvements in processes of care or surrogate laboratory measures, variable impacts on hospitalization rates, and mixed impacts on some domains of quality of life, including improvement in mental health. Although potential benefits of telehealth in ESRD care have been reported, optimal designs for delivery and elements of care that may be improved through telehealth remain uncertain.

Musical intervention on anxiety and vital parameters of chronic renal patients: a randomized clinical trial

OBJECTIVE

to evaluate the therapeutic effect of music on anxiety and vital parameters in patients with chronic kidney disease when compared to patients receiving conventional care in hemodialysis clinics.

METHOD

randomized clinical trial conducted in three renal replacement therapy clinics. Sixty people with chronic kidney disease undergoing hemodialysis were randomly allocated to an experimental group and a control group, 30 persons per group). State anxiety was evaluated in both groups by the State-Trait Anxiety Inventory. A t-test was used to verify the effect of the experimental manipulation on the variables.

RESULTS

we found a statistically significant difference between the groups regarding the degree of anxiety experienced during hemodialysis sessions. The experimental group presented a statistically significant reduction of anxiety scores (p = 0.03), systolic blood pressure (p < 0.002), diastolic blood pressure (p < 0.002), heart rate (p < 0.01) and respiratory rate (p < 0.006) after listening to music.

CONCLUSION

music represents a potential resource for nursing intervention to reduce state anxiety during hemodialysis sessions. Brazilian Registry of Clinical Trials: RBR-64b7x7.

Effect of Telenursing on Levels of Depression and Anxiety in Caregivers of Patients with Stroke: A Randomized Clinical Trial

Background:

Telenursing is a low-cost, highly accessible method that can lead to increased awareness on the principles of care, and may eventually help reduce the stress experienced by caregivers of patients with stroke. The present study aimed to investigate the effect of telenursing through phone consultation on the levels of depression and anxiety in family caregivers of patients with stroke.

Materials and Methods:

This was a randomized clinical trial including 152 caregivers of stroke patients discharged from Mohammad Vase'ee Hospital in Sabzevar in 2016. Participants were recruited through purposive sampling method and were randomly assigned to control (n = 76) and intervention (n = 76) groups. The intervention consisted of 32 sessions of phone consultation. Research tools included demographic characteristics form, needs assessment questionnaire, Beck Depression Inventory, and Beck Anxiety Inventory. Data were analyzed with independent t test using SPSS, version 23.

Results:

Mean (SD) post-intervention anxiety scores for the intervention and the control group were statistically significant (t = 3.51, p = 0.001). However, the difference in mean depression scores after intervention was not significant (p = 0.70).

Conclusions:

Telenursing can be employed to facilitate the care of chronic patients as well as increase the psychological well-being of the caregivers through providing practical and specialized information.

The role of socio-demographic factors in depression and anxiety of patients on hemodialysis: an observational cross-sectional study

PURPOSE

Depression and anxiety have high prevalence in patients on hemodialysis and are strongly associated with socio-economic factors. The aim of this study was to evaluate the prevalence of depression and anxiety in hemodialyzed patients in Greece and its association with socio-demographic factors.

METHODS

Four hundred and fourteen (414) patients on hemodialysis (262 males and 152 females) from 24 dialysis centers in Greece participated in this observational cross-sectional study. Mean age was 63.54 (54.06-72.41), and mean time of dialysis treatment was 36 (16-72) months. Depression and anxiety were assessed by the state-trait anxiety inventory (STAI), the beck depression inventory (BDI) and the hospital anxiety and depression scale (HADS). Multinomial logistic regression was performed to estimate the factors being independently associated with anxiety and depression levels (HADS scale). Multiple linear regression was performed to estimate the factors being independently associated with BDI and STAI.

RESULTS

From a total of 414 participants, (29.4%, n = 122) had depression and 35.9% (n = 149) had anxiety. Depression and anxiety were significantly associated with females, low level of education, increased patients' age, retirement, poor financial situation, marital status and co-morbidities.

CONCLUSION

The overall study findings indicated a significant correlation between the levels of anxiety and depression in patients on hemodialysis. Patients with high levels of anxiety had higher levels of depression and those with high depression scores had higher anxiety scores.

Impact of a nurse led telephone intervention on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized clinical trial

BACKGROUND

Children suffering from rheumatic disease are faced with multidimensional challenges that affect their quality of life and family dynamics. Symptom management and monitoring of the course of the disease over time are important to minimize disability and pain. Poor disease control and anticipation of the need for treatment changes may be prompted by specialist medical follow-up and regular nurse-led consultations with the patient and families, in which information and support is provided. The purpose of this study was to evaluate the impact of a nurse-led telephone intervention or Telenursing (TN) compared to standard care (SC) on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their parents.

METHODS

A multicentered, randomized, longitudinal, crossover trial was conducted with pediatrics outpatients newly diagnosed with inflammatory rheumatic diseases. Participants were randomly assigned to two groups TN and SC for 12 months and crossed-over for the following 12 months. TN consisted of providing individualized affective support, health information and aid to decision making. Satisfaction (primary outcome) and health outcomes were assessed with the Client Satisfaction Questionnaire-8 and the Juvenile Arthritis Multidimensional Assessment Report, respectively. A mixed effect model, including a group x time interaction, was performed for each outcome.

RESULTS

Satisfaction was significantly higher when receiving TN (OR = 7.7, 95% CI: 1.8-33.6). Morning stiffness (OR = 3.2, 95% CI: 0.97-7.15) and pain (OR = 2.64, 95% CI: 0.97-7.15) were lower in the TN group. For both outcomes a carry-over effect was observed with a higher impact of TN during the 12 first months of the study. The other outcomes did not show any significant improvements between groups.

CONCLUSION

TN had a positive impact on satisfaction and on morning stiffness and pain of children with inflammatory rheumatic diseases and their families. This highlights the importance of support by specialist nurses in improving satisfaction and symptom management for children with inflammatory rheumatisms and their families.

TRIAL REGISTRATION

ClinicalTrial.gov identifier: NCT01511341 (December 1st, 2012).

Application of Holistic Nursing in Uremic Patients with Hematodialysis Related Malnutrition

BACKGROUND

We aimed to observe the effect of holistic nursing on patients undergoing hematodialysis for uremia who simultaneously were suffering from moderate to severe malnutrition.

METHODS

Eighty patients with uremia on maintenance hematodialysis with malnutrition between June 2014 and June 2015 from Yantaishan Hospital, Yantai, Shandong, China were included and equally and randomly were divided into the control group (n=43) and observation group (n=43). Routine nursing was used in the control group while holistic nursing was used in observation group (before, during and after dialysis) and the clinical effects in the two groups were compared after 3 months.

RESULTS

At follow-up visits, serum creatinine and urea nitrogen levels of the patients in the two groups were decreased, whereas hemoglobin and albumin levels were increased. In addition, these improvements were greater in the observation group and the differences were statistically significant (P<0.05). Furthermore, during follow-up visits, MQSGA and MIS scores of the two groups were lower and the scores of the observation group were lower than those in the control group were, and the differences were statistically significant (P<0.05).

CONCLUSION

Holistic nursing is able to improve significantly malnutrition in patients with uremia on hematodialysis.

Effect of Self Care Education with and without Telephone Follow-Up on the Level of Hope in Renal Dialysis Patients: A Single-Blind Randomized Controlled Clinical Trial

BACKGROUND

Various strategies such as teaching self care to hemodialysis patients have been employed to increase the level of their hope. This study aimed at examining the effects of a telephone follow-up program on the level of hope in a self care education program.

METHODS

In this single-blind randomized controlled clinical trial, 75 hemodialysis patients, selected by convenient sampling, were randomly assigned to 3 groups (n=25 each) including a control, a self care education, or a self care education with telephone follow-up. The control group received the routine care. The self care education group received 5 instruction sessions. The telephone follow-up group had similar instructional sessions followed by telephone calls during the subsequent 2 months. Data, collected using demographic information list and Miller's hope questionnaire, were analyzed using Chi-Square, t-test, and one-way ANOVA followed by Scheffee test.

RESULTS

There was no significant difference among the scores of hope in the three groups before the intervention (P=0.40). However, after the intervention, the level of hope in the self care education group and self care education plus telephone follow-up groups were significantly higher than that of the control group (P=0.001). Moreover, the level of hope in the group with self care education plus telephone follow-up was significantly (P=0.001) more than that of the self care education group.

CONCLUSION

Our findings indicated that teaching followed by telephone follow-up was associated with higher levels of hope. Therefore, such a strategy may be employed to improve the quality of life of patients with renal dialysis.

TRIAL REGISTRATION NUMBER

IRCT2014042617440N1.

The Effect of Stress Management Training on Hope in Hemodialysis Patients

INTRODUCTION

Chronic renal failure exposes patients to the risk of several complications, which will affect every aspect of patient's life, and eventually his hope. This study aims to determine the effect of stress management group training on hope in hemodialysis patients.

METHOD

In this quasi-experimental single-blind study, 50 patients with renal failure undergoing hemodialysis at Motahari Hospital in Jahrom were randomly divided into stress management training and control groups. Sampling was purposive, and patients in stress management training group received 60-minute in-person training by the researcher (in groups of 5 to 8 patients) before dialysis, over 5 sessions, lasting 8 weeks, and a researcher-made training booklet was made available to them in the first session. Patients in the control group received routine training given to all patients in hemodialysis department. Patients' hope was recorded before and after intervention. Data collection tools included demographic details form, checklist of problems of hemodialysis patients and Miller hope scale (MHS). Data were analyzed in SPSS-18, using Chi-square, one-way analysis of variance, and paired t-test.

RESULTS

Fifty patients were studied in two groups of 25 each. No significant difference was observed between the two groups in terms of age, gender, or hope before intervention. After 8 weeks of training, hope reduced from 95.92±12.63 to 91.16±11.06 (P=0.404) in the control group, and increased from 97.24±11.16 to 170.96±7.99 (P=0.001) in the stress management training group. Significant differences were observed between the two groups in hope scores after the intervention.

CONCLUSION

Stress management training by nurses significantly increased hope in hemodialysis patients. This low cost intervention can be used to improve hope in hemodialysis patients.

Effect of Self-Care Education by Face-to-Face Method on the Quality of Life in Hemodialysis Patients (Relying on Ferrans and Powers Questionnaire)

INTRODUTION

One of the most common methods to control chronic renal failure, Hemodialysis creates numerous changes in the style and the quality of life in patients. Educating patients is one of effective factors to improve the quality of life. The present study aims to investigate influences of self-care education by face-to-face method on determining quality of life in hemodialysis patients in Jahrom, Iran, during 2014-2015.

METHODS

This is a quasi-experimental, single-blind study in which 50 patients undergoing hemodialysis at Shahaid Mottahari Hospital, Jahrom. The patients were placed in two groups of 25 individuals: the face to face educational group and the control group. The control group received only routine care in hemodialysis unit. The face to face educational group received 8 instruction sessions of 60 minutes before starting dialysis and received an instruction booklet. Data collection tools were a questionnaire consisting of demographic characteristics, a checklist of needs assessment for hemodialysis patients and a quality of life questionnaire, whose reliability and validity were previously approved. The questionnaires were completed face to face, before and after the intervention.

RESULTS

The results show that the research units did not have any significant difference in terms of demographic variables. Also increase in various aspects of the quality of life compared with the control group is observed after the intervention in the face to face educational group (p<0.001).

DISCUSSION & CONCLUSION

Given the results, representation of adequate training in hemodialysis ward can cause improve in physical function, mental health and thus increase the quality of life in hemodialysis patients, through raising the awareness level.