Search results for: Hemodialysis Patients
5446 Interdialytic Acupuncture Is an Add-on Option for Preserving Residual Renal Function: A Case Series Report
Authors: Lai Tzu-Hsuan, Lai Jung-Nien, Lin Jaung-Geng, Kao Shung-Te, Hsuan-Kuang Jung
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Background: Whether acupuncture therapy contributes to preserving residual renal function (RRF) remains largely unknown. This case series evidenced the potential beneficial effects of acupuncture for preserving RRF in five patients with the end-stage renal disease under hemodialysis (HD) treatment. Participants: Five patients on HD receiving eight sessions of weekly 30-min interdialytic acupuncture (Inter-A) with residual urine volume (rUV) and residual glomerular filtration rate (rGFR) recorded once every two weeks were included for analysis. Outcomes: Changes in rUV and rGFR calculated using 24-hour urine collection data were analyzed to assess RRF. Variations in hemoglobin, urea Kt/V and serum albumin levels measured monthly were analyzed to evaluate HD adequacy. Results: After eight Inter-A sessions, mean (standard deviation (SD)) rUV and rGFR increased from 612 (184) ml/day and 1.48 (.94) ml/min/1.73 m2 at baseline to 803(289) ml/day and 2.04(1.17) ml/min/1.73m2 at 2- and 4-week follow-up, respectively. The mean percentage difference increased by 31% in rUV and 38% in rGFR. Routine measurements on HD adequacy also showed improvement. Conclusions: Acupuncture might be an optional add-on treatment for HD population with poor control of water; however, further well-designed controlled trials are warranted.Keywords: end-stage renal disease, hemodialysis, acupuncture, residual renal function, residual urine volume
Procedia PDF Downloads 1255445 Spectrum of Acute Kidney Injury in Obstetrics
Authors: Seema Chopra, Amandeep Kaur, Vanita Suri, Shalini Gainder, Minakshi Rohilla
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Background: Acute kidney injury (AKI) associated with pregnancy is a serious medical complication which can lead to significant maternal as well as perinatal morbidity and mortality. Material and methods: This prospective observational study was carried out in the Obstetrics and Gynaecology department and dialysis unit of Nephrology department of PGIMER, Chandigarh from July 2013 to June 2014. Forty antenatal/postnatal/postabortal patients who fulfilled the AKIN criteria were enrolled in the study. All patients were followed up till 3 months postpartum. Results: Majority of the patients 23/40 (57.5%) with AKI presented in postpartum period, 14/40 (35%) developed AKI in antenatal period, and 3/40 (7.5%) were postabortal. AKI was attributable mostly to sepsis in 11/40 (27.5%) and PPH in 5/40 (12.5%). Hypertension and its complications causing AKI included eclampsia in 5/40 (12.5%) followed by 3/40 (7.5%) as HELLP syndrome and abruption placentae in 2/40(5%) patients. Three patients each (7.5%) had AFLP, TMA, and HEV as the cause of AKI. Renal replacement therapy in the form of hemodialysis was the treatment in majority of them (28 (70%)). After the acute event, 25 (62.5%) had complete recovery of their renal functions at 3 months follow up. Maternal mortality was seen in 25% (n=10) of the study patients. Conclusion: Timely initiation of RRT in patients with AKI associated with pregnancy has a good maternal outcome in the form of complete recovery of renal functions in 62.5% (25/40) of patients.Keywords: AKI, dialysis, hypertension, sepsis, renal parameters
Procedia PDF Downloads 1575444 Fluctuation of Serum Creatinine: Preoperative and Postoperative Evaluation of Chronic Kidney Disease Patients
Authors: Chowdhury Md. Navim Kabir
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Renal impairment is one of the most severe non-communicable diseases around the world. Especially patients with diagnosed/newly diagnosed renal impairment who need surgery are more focused on preoperative and postoperative preparation. Serum creatinine is the prime biochemical marker for assessing renal function, and the level of impairment is widely measured by this marker as well as Glomerular Filtration Rate (GFR). Objective: Factors responsible for fluctuating serum creatinine during preoperative and postoperative periods and minimizing the process of serum creatinine is the ultimate goal of this study. Method: 37 patients participated in this cross-sectional study who were previously diagnosed/newly diagnosed. They were admitted to different tertiary-level hospitals for emergency or elective surgery. Fifteen patients were admitted in the renal function impairment stage and 22 were admitted as normal patients’. Values of creatinine at the pre-admission stage and 2nd/3rd post-admission follow-up were compared. Results: 0.41 was the average of 22 patients' creatinine between pre-admission and 2nd/3rd follow-up. The responsible factor like prolonged staying, immobilization, co-morbidities, different preoperative antibiotics and Non-Steroidal Anti Inflammatory Drugs (NSAIDs) were also inducers for creatinine elevation. After postoperative hemodialysis rapid decrease of creatinine is seen in normal patients, but this decrease is very much minor in Chronic Kidney Disease (CKD) diagnosed patients.Keywords: CKD, Meropenam, NSAID, comorbidities, immobilized
Procedia PDF Downloads 655443 Clinical Audit of Selected Nephrology Nursing Procedures Performed in Nephrology Unit of AIIMS with a View to Develop Nephrology Nursing Procedure Protocol
Authors: Mamta Thakur, Dr. Shashi Mawar, Ms. Levis Murry, Dr. D.k.sharma
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Aim: The aim of this study is to develop nephrology nursing procedure protocol after clinical audit of current nephrology nursing practices. Materials and methods: This descriptive observational study was conducted on 40 nurses who were working in Nephrology Department of AIIMS, New Delhi to observe their current practices to assess the existing gaps in the practice. The nurses were enrolled through total enumerative sampling. Sociodemographic profile of nurses and clinical profile for site of procedure was collected. Observation checklist was formed on the basis of standard nursing practices, which included 7 dimensions for hemodialysis procedure and 3 dimensions for procedure of assisting renal biopsy. Based on the gaps identified, nephrology nursing procedure protocol will be developed. Nurses were observed during two shifts, and each nurse was observed once. Scoring of items were done in each dimension, and for acceptable practices, nurses have to score ≥80% in each dimension. Results: Data was analyzed using descriptive statistics. Majority of nurses (73.7%) in nephrology ward and (80.9%) in hemodialysis unit have not undergone any special training in nephrology. Most of nurses (80.9%) followed the acceptable nursing practices for procedure of connection for hemodialysis. None of nurses followed the acceptable level (≥80%) of nursing practices for the procedure of predialysis assessment, the procedure for site preparation, during dialysis assessment and post dialysis assessment. None (100%) showed the acceptable level of nursing practices for all the dimensions of assisting renal biopsy procedure. Nephrology nursing procedure protocol was developed by researcher following a rigorous process, and this will reduce the gaps in the nursing practice. Conclusion: Clinical audit found that there were gaps in the existing nursing practices compared to the standardised nursing practices for procedure of hemodialysis and assisting renal biopsy, and these gaps have been addressed by the development of the protocol.Keywords: nursing practice, nephrology nursing procedure, nursing protocol, renal biopsy, hemodialysis
Procedia PDF Downloads 955442 Effect of Physical and Breathing Exercises on Quality of Life and Psychophysical Status among Haemodialysis Patients: A Scoping Review
Authors: Noof Eid Al Shammari
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Background: Living with haemodialysis (HD) can impose several physical and social restrictions on the lives of individuals. Usually, the patient has three dialysis sessions per week that each run for three to four hours. This limits the social life of patients and causes a lower quality of life, in conjunction with the fact that people with chronic kidney disease must follow strict fluid and food regimens and use multiple medications. Given these factors, patients undergoing HD generally need psychological support. Objective: This scoping review study aims to evaluate the effectiveness of physical and breathing exercises on quality of life (QOL) and psychophysical status in patients undergoing HD. Methodology: Searches for relevant studies were performed in four databases (MEDLINE, CINAHL, Google Scholar, and PubMed) for articles published between 2011 and 2021. Out of all the searched literature, ten studies met the inclusion criteria (8 randomised controlled trials, one quasi-experimental study, and one pilot study), with a total of 588 patients. Different types of physical and breathing exercises were used (breathing, cardiopulmonary, and physical exercises). Results: All included studies in this scoping review revealed that most of the aerobic or anaerobic exercises, as well as breathing exercises, had a positive effect and significantly improved patients’ QOL, physical functioning, and psychological status. Conclusions: In this review, most of the articles demonstrated a positive effect of physical and breathing exercises on the QOL and psychophysical status of HD patients. Based on the findings of these studies, physical and breathing exercises were shown to improve muscle strength and other health-related aspects of QOL, including sexual, social, cognitive, and physical functions. However, more studies will need to be conducted with a larger sample to determine the best intervention that could be implemented and standardised in nursing care for patients undergoing HD.Keywords: physical exercise, breathing exercises, quality of life, depression, hemodialysis
Procedia PDF Downloads 1045441 Impact of Clinical Pharmacist Intervention in Improving Drug Related Problems in Patients with Chronic Kidney Disease
Authors: Aneena Suresh, C. S. Sidharth
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Drug related problems (DRPs) are common in chronic kidney disease (CKD) patients and end stage patients undergoing hemodialysis. To treat the co-morbid conditions of the patients, more complex therapeutic regimen is required, and it leads to development of DRPs. So, this calls for frequent monitoring of the patients. Due to the busy work schedules, physicians are unable to deliver optimal care to these patients. Addition of a clinical pharmacist in the team will improve the standard of care offered to CKD patients by minimizing DRPs. In India, the role of clinical pharmacists in the improving the health outcomes in CKD patients is poorly recognized. Therefore, this study is conducted to put an insight on the role of clinical pharmacist in improving Drug Related Problems in patients with chronic kidney disease, thereby helping them to achieve desired therapeutic outcomes in the patients. A prospective interventional study was conducted for a year in a 620 bedded tertiary care hospital in India. Data was collected using an unstructured questionnaire, medication charts, etc. DRPs were categorized using Hepler and Strand classification. Relationships between the age, weight, GFR, average no of medication taken, average no of comorbidities, and average length of hospital days with the DRPs were identified using Mann Whitney U test. The study population primarily constituted of patients above the age of 50 years with a mean age of 59.91±13.59. Our study showed that 25% of the population presented with DRPs. On an average, CKD patients are prescribed at least 8 medications for the treatment in our study. This explains the high incidence of drug interactions in patients suffering from CKD (45.65%). The least common DRPs in our study were found to be sub therapeutic dose (2%) and adverse drug reactions (2%). Out of this, 60 % of the DRPs were addressed successfully. In our study, there is an association between the DRPs with the average number of medications prescribed, the average number of comorbidities, and the length of the hospital days with p value of 0.022, 0.004, and 0.000, respectively. In the current study, 86% of the proposed interventions were accepted, and 41 % were implemented by the physician, and only 14% were rejected. Hence, it is evident that clinical pharmacist interventions will contribute significantly to diminish the DRPs in CKD patients, thereby decreasing the economic burden of healthcare costs and improving patient’s quality of life.Keywords: chronic kidney disease, clinical pharmacist, drug related problem, intervention
Procedia PDF Downloads 1265440 Hemodialysis Technique in a Diabetic Population
Authors: Daniel Thompson, Sophie Cerutti, Muhammad Peerbux, Hansraj Bookun
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Introduction: Diabetic nephropathy is the leading cause end stage renal failure in Australia, responsible for 36% of cases. Patients who require dialysis may be suitable for haemodialysis through an arteriovenous fistula (AVF), and preoperatively careful planning is required to select suitable vessels for a long-lasting fistula that provides suitable dialysis access. Due to high levels of vascular disease in diabetic patients, we sought to investigate whether there is a difference in the types of autologous AVFs created for diabetic patients in renal failure compared to their non-diabetic counterparts. Method: Data was collected from the Australasian Vascular Audit, for all vascular surgery completed at St. Vincent’s Hospital Melbourne between 2011-2020. Patients were selected by operative type, creation of AVF, and compared in two groups, diabetic patients and patients without diabetes. Chi-squared test was utilised to determine significance. Results: Data analysis is ongoing and will be complete with updated abstract in time for the conference. Discussion: Diabetic nephropathy is the cause for roughly a third of end stage renal failure in Australia. Diabetic patients present with a unique set of challenges when it comes to dialysis access due to increased risk of peripheral vascular disease and arterial calcification. Care must be taken in the creation of fistulas to minimise complications and increase the chance of long-lasting access. Our study investigates the difference in autologous AVFs between diabetics and non-diabetics, and results may be used to influence location of fistula creation. Further research may be used to investigate patency rates of fistulas in diabetics vs non-diabetics which would further influence treatment decisions.Keywords: dialysis, diabetes, renal access, fistula
Procedia PDF Downloads 1345439 Caring for a Spinal Cord Injury Patient with Diabetic Nephropathy Receiving Hospice Palliative Care
Authors: Li-Ting Kung, Hui-Zhu Chen, Hsin-Tzu Lee, Wan-Yin Hsu
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Patients with spinal cord injury combined with diabetic nephropathy may under a lot of painful conditions due to complications related to the illness itself or treatments, such as recurrent pressure ulcers, autonomic and peripheral neuropathy, as well as dialysis, for long term. This case report illustrated the nursing experience of transferring a spine cord injure patient who received hemodialysis due to adverse lifestyle-induced diabetic nephropathy to the hospice ward. Nursing care was provided in this patient from July 25th to August 30th, 2015. The tool of 'Gordon’s 11-item functional health assessment' and clinical observation, interviews as well as physical examination were used as data collections. Based on results of health assessment as above, the patient’s health problems were identified as the following: impaired skin integrity, chronic pain, and hopeless. Besides to relieve the symptom of pain due to disease or the treatment of hemodialysis and provide wound care, the first author also played a role to assist the patient to achieve his goal of receiving the hospice palliative care. Finally, with much effort of nurses to communicate with medical teams between the surgical and hospice wards, the patient was transferred to the hospice ward to have fulfilled his last wish of having a good death. We hope this nursing experience can be applied to other similar cases in the future.Keywords: diabetic nephropathy, hospice care, palliative care, spinal cord injury
Procedia PDF Downloads 1475438 Osteoprotegerin and Osteoprotegerin/TRAIL Ratio are Associated with Cardiovascular Dysfunction and Mortality among Patients with Renal Failure
Authors: Marek Kuźniewski, Magdalena B. Kaziuk , Danuta Fedak, Paulina Dumnicka, Ewa Stępień, Beata Kuśnierz-Cabala, Władysław Sułowicz
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Background: The high prevalence of cardiovascular morbidity and mortality among patients with chronic kidney disease (CKD) is observed especially in those undergoing dialysis. Osteoprotegerin (OPG) and its ligands, receptor activator of nuclear factor kappa-B ligand (RANKL) and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) have been associated with cardiovascular complications. Our aim was to study their role as cardiovascular risk factors in stage 5 CKD patients. Methods: OPG, RANKL and TRAIL concentrations were measured in 69 hemodialyzed CKD patients and 35 healthy volunteers. In CKD patients, cardiovascular dysfunction was assessed with aortic pulse wave velocity (AoPWV), carotid artery intima-media thickness (CCA-IMT), coronary artery calcium score (CaSc) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) serum concentration. Cardiovascular and overall mortality data were collected during a 7-years follow-up. Results: OPG plasma concentrations were higher in CKD patients comparing to controls. Total soluble RANKL was lower and OPG/RANKL ratio higher in patients. Soluble TRAIL concentrations did not differ between the groups and OPG/TRAIL ratio was higher in CKD patients. OPG and OPG/TRAIL positively predicted long-term mortality (all-cause and cardiovascular) in CKD patients. OPG positively correlated with AoPWV, CCA-IMT and NT-proBNP whereas OPG/TRAIL with AoPWV and NT-proBNP. Described relationships were independent of classical and non-classical cardiovascular risk factors, with exception of age. Conclusions: Our study confirmed the role of OPG as a biomarker of cardiovascular dysfunction and a predictor of mortality in stage 5 CKD. OPG/TRAIL ratio can be proposed as a predictor of cardiovascular dysfunction and mortality.Keywords: osteoprotegerin, tumor necrosis factor-related apoptosis-inducing ligand, receptor activator of nuclear factor kappa-B ligand, hemodialysis, chronic kidney disease, cardiovascular disease
Procedia PDF Downloads 3285437 Prevalence of Seropositivity for Cytomegalovirus in Patients with Hereditary Bleeding Diseases in West Azerbaijan of Iran
Authors: Zakieh Rostamzadeh, Zahra Shirmohammadi
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Human cytomegalovirus is a species of the cytomegalovirus family of viruses, which in turn is a member of the viral family known as herpesviridae or herpesviruses. Although they may be found throughout the body, HCMV infections are frequently associated with the salivary glands. HCMV infection is typically unnoticed in healthy people, but can be life-threatening for the immunocompromised such as HIV-infected persons, organ transplant recipients, or newborn infants. After infection, HCMV has an ability to remain latent within the body over long periods. Cytomegalovirus (CMV) causes infection in immunocompromised, hemophilia patients and those who received blood transfusion frequently. This study aimed at determining the prevalence of cytomegalovirus (CMV) antibodies in hemophilia patients. Materials and Methods: A retrospective observational study was carried out in Urmia, North West of Iran. The study population comprised a sample of 50 hemophilic patients born after 1985 and have received blood factors in West Azerbaijan. The exclusion criteria include: drug abusing, high risk sexual contacts, vertical transmission of mother to fetus and suspicious needling. All samples were evaluated with the method of ELISA, with a certain kind of kit and by a certain laboratory. Results: Fifty hemophiliacs from 250 patients registered with Urmia Hemophilia Society were enrolled in the study including 43 (86%) male, and 7 (14%) female. The mean age of patients was 10.3 years, range 3 to 25 years. None of patients had risk factors mentioned above. Among our studied population, 34(68%) had hemophilia A, 1 (2%) hemophilia B, 8 (16%) VWF, 3(6%) factor VII deficiency, 1 (2%) factor V deficiency, 1 (2%) factor X deficiency, 1 (2%). Sera of 50 Hemodialysis patients were investigated for CMV-specific immunoglobulin G (IgG) and IgM. % 91.89 patients were anti-CMV IgG positive and %40.54 was seropositive for anti-CMV IgM. 37.8% patient had serological evidence of reactivation and 2.7% of patients had the primary infection. Discussion: There was no relationship between the antibody titer and: drug abusing, high risk sexual contacts, vertical transmission of mother to fetus and suspicious needling.Keywords: bioinformatics, biomedicine, cytomegalovirus, immunocompromise
Procedia PDF Downloads 3525436 Factors Associated with Acute Kidney Injury in Multiple Trauma Patients with Rhabdomyolysis
Authors: Yong Hwang, Kang Yeol Suh, Yundeok Jang, Tae Hoon Kim
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Introduction: Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation. Acute kidney injury is a potential complication of severe rhabdomyolysis and the prognosis is substantially worse if renal failure develops. We try to identify the factors that were predictive of AKI in severe trauma patients with rhabdomyolysis. Methods: This retrospective study was conducted at the emergency department of a level Ⅰ trauma center. Patients enrolled that initial creatine phosphokinase (CPK) levels were higher than 1000 IU with acute multiple trauma, and more than 18 years older from Oct. 2012 to June 2016. We collected demographic data (age, gender, length of hospital day, and patients’ outcome), laboratory data (ABGA, lactate, hemoglobin. hematocrit, platelet, LDH, myoglobin, liver enzyme, and BUN/Cr), and clinical data (Injury Mechanism, RTS, ISS, AIS, and TRISS). The data were compared and analyzed between AKI and Non-AKI group. Statistical analyses were performed using IMB SPSS 20.0 statistics for Window. Results: Three hundred sixty-four patients were enrolled that AKI group were ninety-six and non-AKI group were two hundred sixty-eight. The base excess (HCO3), AST/ALT, LDH, and myoglobin in AKI group were significantly higher than non-AKI group from laboratory data (p ≤ 0.05). The injury severity score (ISS), revised Trauma Score (RTS), Abbreviated Injury Scale 3 and 4 (AIS 3 and 4) were showed significant results in clinical data. The patterns of CPK level were increased from first and second day, but slightly decreased from third day in both group. Seven patients had received hemodialysis treatment despite the bleeding risk and were survived in AKI group. Conclusion: We recommend that HCO3, CPK, LDH, and myoglobin should be checked and be concerned about ISS, RTS, AIS with injury mechanism at the early stage of treatment in the emergency department.Keywords: acute kidney injury, emergencies, multiple trauma, rhabdomyolysis
Procedia PDF Downloads 3375435 Syndrome of Irreversible Lithium-Effectuated Neurotoxicity: Case Report and Review of Literature
Authors: David J. Thomson, Joshua C. J. Chew
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Background: Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT) is a rare complication of lithium toxicity that typically causes irreversible cerebellar dysfunction. These patients may require hemodialysis and extensive supports in the intensive care. Methods: A review was performed on the available literature of SILENT with a focus on current pathophysiological hypotheses and advances in treatment. Articles were restricted to the English language. Results: Although the exact mechanism is unclear, CNS demyelination, especially in the cerebellum, was seen on the brain biopsies of a proportion of patients. There is no definitive management of SILENT but instead current management is focused on primary and tertiary prevention – detection of those at risk, and rehabilitation post onset of neurological deficits. Conclusions: This review draws conclusions from a limited amount of available literature, most of which are isolated case reports. Greater awareness of SILENT and further investigation into the risk factors and pathogenesis are required so this serious and irreversible syndrome may be avoided.Keywords: lithium toxicity, pathogenesis, SILENT, syndrome of irreversible lithium-effectuated neurotoxicity
Procedia PDF Downloads 4915434 Changing Left Ventricular Hypertrophy After Kidney Transplantation
Authors: Zohreh Rostami, Arezoo Khosravi, Mohammad Nikpoor Aghdam, Mahmood Salesi
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Background: Cardiovascular mortality in chronic kidney disease (CKD) and end stage renal disease (ESRD) patients have a strong relationship with baseline or progressive left ventricular hypertrophy (LVH) meanwhile in hemodialysis patients 10% decrement in left ventricular mass was associated with 28% reduction in cardiovascular mortality risk. In consonance with these arguments, we designed a study to measure morphological and functional echocardiographic variations early after transplantation. Method: The patients with normal renal function underwent two advanced echocardiographic studies to examine the structural and functional changes in left ventricular mass before and 3-month after transplantation. Results: From a total of 23 participants 21(91.3%) presented with left ventricular hypertrophy, 60.9% in eccentric and 30.4% in concentric group. Diastolic dysfunction improved in concentric group after transplantation. Both in pre and post transplantation global longitudinal strain (GLS)- average in eccentric group was more than concentric (-17.45 ± 2.75 vs -14.3 ± 3.38 p=0.03) and (-18.08 ± 2.6 vs -16.1 ± 2.7 p= 0.04) respectively. Conclusion: Improvement and recovery of left ventricular function in concentric group was better and sooner than eccentric after kidney transplantation. Although fractional shortening and diastolic function and GLS-4C in pre-transplantation in concentric group was worse than eccentric, but therapeutic response to kidney transplantation in concentric was more and earlier than eccentric group.Keywords: chronic kidney disease, end stage renal disease, left ventricular hypertrophy, global longitudinal strain
Procedia PDF Downloads 525433 Gastrointestinal Disturbances in Postural Orthostatic Tachycardia Syndrome (POTS)
Authors: Chandralekha Ashangari, Amer Suleman
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Background and Purpose: The Postural Orthostatic Tachycardia Syndrome (POTS) affects primarily young women. POTS is a form of dysautonomia that is estimated to impact between 1,000,000 and 3,000,000 Americans, and millions more around the world. POTS is a form of orthostatic intolerance that is associated with many Gastrointestinal disturbances. The aim of this study is to determine the Gastrointestinal disturbances in Postural Orthostatic Tachycardia Syndrome (POTS) patients.2. Methods: 249 patients referred to our clinic from January to November with POTS. Reviewed the medical records of 249 POTS patients and gastrointestinal symptoms. Results: however out of 249 patients, 226 patients are female (90.76%; average age 32.69), 23 patients are male (9.24%; average age 27.91) Data analysis: Out of 249 patients 189 patients (76%) had vomiting or nausea, 150 patients (60%) had irritable bowel syndrome, 128 patients (51%) had bloating, 125 patients (50%) had constipation , 80 patients (32%) had abdominal pain, 56 patients (22%) had delayed gastric emptying, 24 patients (10%) had lactose intolerance, 8 patients (3%) had Gastroesophageal reflux disease, 5 patients (2%) had Iron deficiency anemia, 6 patients (2%) had Peptic ulcer disease, 4 patients (2%) had Celiac Disease. Conclusion: Patients with POTS have a very high prevalence of gastrointestinal symptoms however the majority of abnormalities appear to be motility related. Motility testing should be performed be performed in POTS patients. The diagnostic yield of endoscopic procedures appears to be low.Keywords: gastrointestinal disturbances, Postural Orthostatic Tachycardia Syndrome (POTS), celiac disease, POTS patients
Procedia PDF Downloads 3315432 Influence of Spirituality on Health Outcomes and General Well-Being in Patients with End-Stage Renal Disease
Authors: Ali A Alshraifeen, Josie Evans, Kathleen Stoddart
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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. No studies exist to explore the influence of spirituality on the health outcomes and general well-being in patients with end-stage renal disease receiving hemodialysis (HD) treatment in Scotland. This study was conducted to explore spirituality in the daily lives of among these patients and how it may influence their QOL and general well-being. The study employed a qualitative method. Data were collected using semi-structured interviews with a sample of 21 patients. A thematic approach using Framework Analysis informed the qualitative data analysis. Participants were recruited from 11 dialysis units across four Health Boards in Scotland. The participants were regular patients attending the dialysis units three times per week. Four main themes emerged from the qualitative interviews: ‘Emotional and Psychological Turmoil’, ‘Life is Restricted’, ‘Spirituality’ and ‘Other Coping Strategies’. The findings suggest that patients’ QOL might be affected because of the physical challenges such as unremitting fatigue, disease unpredictability and being tied down to a dialysis machine, or the emotional and psychological challenges imposed by the disease into their lives such as wholesale changes, dialysis as a forced choice and having a sense of indebtedness. The findings also revealed that spirituality was an important coping strategy for the majority of participants who took part in the qualitative component (n=16). Different meanings of spirituality were identified including connection with God or Supernatural Being, connection with the self, others and nature/environment. Spirituality encouraged participants to accept their disease and offered them a sense of protection, instilled hope in them and helped them to maintain a positive attitude to carry on with their daily lives, which may have had a positive influence on their health outcomes and general well-being. The findings also revealed that humor was another coping strategy that helped to diffuse stress and anxiety for some participants and encouraged them to carry on with their lives. The findings from this study provide a significant contribution to a very limited body of work. The study contributes to our understanding of spirituality and how people receiving dialysis treatment use it to manage their daily lives. Spirituality is of particular interest due to its connection with health outcomes in patients with chronic illnesses. The link between spirituality and many chronic illnesses has gained some recognition, yet the identification of its influence on the health outcomes and well-being in patients with ESRD is still evolving. There is a need to understand patients’ experiences and examine the factors that influence their QOL and well-being to ensure that the services available are adequately tailored to them. Hence, further research is required to obtain a better understanding of the influence of spirituality on the health outcomes and general well-being of patients with ESRD.Keywords: end-stage renal disease, general well-being, quality of life, spirituality
Procedia PDF Downloads 2245431 Systemic Factors, Intraocular Lens, and Ocular Abnormalities in Patients with Intraocular Lens Glistening at a Tertiary Hospital in Semarang
Authors: Azmi Ilmi Aziz, Wisnu Sadasih, Rizal Fanany
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Purpose: This study describes systemic factors, intraocular lens (IOL), and ocular abnormalities in patients with IOL glistening at a tertiary hospital in Semarang. Methods: A retrospective, with a descriptive approach on patients with IOL glistening who visited the eye clinic between August 2019 to June 2023. Results: Twenty-five patients were examined; 11 patients (44%) had IOL glistening in their right eye, 4 patients (16%) in their left eye, and 10 patients (40%) in both eyes. The gender of patients consisted of 12 male patients (48%) and 13 female patients (52%). The median age of the patients was 68 years. The mean onset was 4.44 years after the first cataract surgery. Hypertension was found in 13 patients (52%), and diabetes was found in 9 patients (36%). Nine patients (36%) were identified with a foldable IOL with a closed loop design, and 1 patient (4%) with a PMMA IOL with an iris-fixated IOL design, while 15 other patients’ IOL were unrecorded. Glaucoma was found in 3 patients (12%). Conclusions: The result of this study showed that more than half of the patients were hypertensive, and some were glaucomatous, which had been discussed relevant in previous studies. Most IOL that could be identified was foldable IOL with a closed loop design. To our knowledge, the design of an IOL to glistening had never been explored. A longer study involving larger subjects is needed to better describe the systemic factors, IOL, and ocular abnormalities in patients with IOL glistening.Keywords: glistening, intraocular lens, foldable IOL, PMMA IOL
Procedia PDF Downloads 805430 L-Carnitine vs Extracorporeal Elimination for Acute Valproic Acid Intoxication: A Systemic Review
Authors: Byung Keun Yang, Jae Eun Ku, Young Seon Joo, Je Sung You, Sung Phil Chung, Hahn Shick Lee
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The purpose of this study is to review the evidence comparing the efficacy and safety between L-carnitine and extracorporeal elimination therapy in the management of acute valproic acid L-carnitine vs Extracorporeal Elimination for Acute Valproic acid Intoxication. PubMed, Embase, Cochrane library, Web of Science, KoreaMed, KMbase, and KISS were searched, using the terms carnitine and valproic acid. All studies, regardless of design, reporting efficacy or safety endpoints were included. Reference citations from identified publications were reviewed. Both English and Korean languages were included. Two authors extracted primary data elements including poisoning severity, presenting features, clinical management, and outcomes. Thirty two articles including 33 cases were identified. Poisoning severity was classified as 3 mild, 11 moderate, and 19 severe cases. Nine cases were treated with L-carnitine while 24 cases received extracorporeal therapy without L-carnitine. All patients except one expired patient treated with hemodialysis recovered clinically and no adverse effects were noted. A case report comparing two patients who ingested the same amount of valproic acid showed increased ICU stay (3 vs. 11 days) in case of delayed extracorporeal therapy. Published evidence comparing L-carnitine with extracorporeal therapy is limited. Based on the available evidence, it is reasonable to consider L-carnitine for patients with acute valproic acid overdose. In case of severe poisoning, extracorporeal therapy would also be considered in the early phase of treatment.Keywords: carnitine, overdose, poisoning, renal dialysis, valproic acid
Procedia PDF Downloads 3605429 Bivariate Time-to-Event Analysis with Copula-Based Cox Regression
Authors: Duhania O. Mahara, Santi W. Purnami, Aulia N. Fitria, Merissa N. Z. Wirontono, Revina Musfiroh, Shofi Andari, Sagiran Sagiran, Estiana Khoirunnisa, Wahyudi Widada
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For assessing interventions in numerous disease areas, the use of multiple time-to-event outcomes is common. An individual might experience two different events called bivariate time-to-event data, the events may be correlated because it come from the same subject and also influenced by individual characteristics. The bivariate time-to-event case can be applied by copula-based bivariate Cox survival model, using the Clayton and Frank copulas to analyze the dependence structure of each event and also the covariates effect. By applying this method to modeling the recurrent event infection of hemodialysis insertion on chronic kidney disease (CKD) patients, from the AIC and BIC values we find that the Clayton copula model was the best model with Kendall’s Tau is (τ=0,02).Keywords: bivariate cox, bivariate event, copula function, survival copula
Procedia PDF Downloads 715428 Kidney Supportive Care in Canada: A Constructivist Grounded Theory of Dialysis Nurses’ Practice Engagement
Authors: Jovina Concepcion Bachynski, Lenora Duhn, Idevania G. Costa, Pilar Camargo-Plazas
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Kidney failure is a life-limiting condition for which treatment, such as dialysis (hemodialysis and peritoneal dialysis), can exact a tremendously high physical and psychosocial symptom burden. Kidney failure can be severe enough to require a palliative approach to care. The term supportive care can be used in lieu of palliative care to avoid the misunderstanding that palliative care is synonymous with end-of-life or hospice care. Kidney supportive care, encompassing advance care planning, is an approach to care that improves the quality of life for people receiving dialysis through early identification and treatment of symptoms throughout the disease trajectory. Advanced care planning involves ongoing conversations about the values, goals, and preferences for future care between individuals and their healthcare teams. Kidney supportive care is underutilized and often initiated late in this population. There is evidence to indicate nurses are not providing the necessary elements of supportive kidney care. Dialysis nurses’ delay or lack of engagement in supportive care until close to the end of life may result in people dying without receiving optimal palliative care services. Using Charmaz’s constructivist grounded theory, the purpose of this doctoral study is to develop a substantive theory that explains the process of engagement in supportive care by nurses working in dialysis settings in Canada. Through initial purposeful and subsequent theoretical sampling, 23 nurses with current or recent work experience in outpatient hemodialysis, home hemodialysis, and peritoneal dialysis settings drawn from across Canada were recruited to participate in two intensive interviews using the Zoom© teleconferencing platform. Concurrent data collection and data analysis, constant comparative analysis of initial and focused codes until the attainment of theoretical saturation, and memo-writing, as well as researcher reflexivity, have been undertaken to aid the emergence of concepts, categories, and, ultimately, the constructed theory. At the time of abstract submission, data analysis is currently at the second level of coding (i.e., focused coding stage) of the research study. Preliminary categories include: (a) focusing on biomedical care; (b) multi-dimensional challenges to having the conversation; (c) connecting and setting boundaries with patients; (d) difficulty articulating kidney-supportive care; and (e) unwittingly practising kidney-supportive care. For the conference, the resulting theory will be presented. Nurses working in dialysis are well-positioned to ensure the delivery of quality kidney-supportive care. This study will help to determine the process and the factors enabling and impeding nurse engagement in supportive care in dialysis to effect change for normalizing advance care planning conversations in the clinical setting. This improved practice will have substantive beneficial implications for the many individuals living with kidney failure and their supporting loved ones.Keywords: dialysis, kidney failure, nursing, supportive care
Procedia PDF Downloads 975427 Use of Beta Blockers in Patients with Reactive Airway Disease and Concomitant Hypertension or Ischemic Heart Disease
Authors: Bharti Chogtu Magazine, Dhanya Soodana Mohan, Shruti Nair, Tanwi Trushna
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The study was undertaken to analyse the cardiovascular drugs being prescribed in patients with concomitant reactive airway disease and hypertension or ischemic heart diseases (IHD). Also, the effect of beta-blockers on respiratory symptoms in these patients was recorded. Data was collected from medical records of patients with reactive airway disease and concomitant hypertension and IHD. It included demographic details of the patients, diagnosis, drugs prescribed and the patient outcome regarding the exacerbation of asthma symptoms with intake of beta blockers. Medical records of 250 patients were analysed.13% of patients were prescribed beta-blockers. 12% of hypertensive patients, 16.6% of IHD patients and 20% of patients with concomitant hypertension and IHD were prescribed beta blockers. Of the 33 (13%) patients who were on beta-blockers, only 3 patients had an exacerbation of bronchial asthma symptoms. Cardioselective beta-blockers under supervision appear to be safe in patients with reactive airway disease and concomitant hypertension and IHD.Keywords: beta blockers, hypertension, ischemic heart disease, asthma
Procedia PDF Downloads 4425426 Study of Contrast Induced Nephropathy in Patients Undergoing Cardiac Catheterization: Upper Egypt Experience
Authors: Ali Kassem, Sharf Eldeen-Shazly, Alshemaa Lotfy
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Introduction: Contrast-induced nephropathy (CIN) has been the third leading cause of hospital-acquired renal failure. Patients with cardiac diseases are particularly at risk especially with repeated injections of contrast media. CIN is generally defined as an increase in serum creatinine concentration of > 0.5 mg/dL or 25% above baseline within 48 hours after contrast administration. Aim of work: To examine the frequency of CIN for patients undergoing cardiac catheterization at Sohag University Hospital (Upper Egypt) and to identify possible risk factors for CIN in these patients. Material and methods: The study included 104 patients with mean age 56.11 ±10.03, 64(61.5%) are males while 40(38.5%) are females. 44(42.3%) patients are diabetics, 43(41%) patients are hypertensive, 6(5.7%) patients have congestive heart failure, 69(66.3%) patients on statins, 74 (71.2 %) are on ACEIs or ARBs, 19(15.4%) are on metformin, 6 (5.8%) are on NSAIDs, 30(28.8%) are on diuretics. RESULTS: Patients were classified at the end of the study into two groups: Group A: Included 91 patients who did not develop CIN. Group B: Included 13 patients who developed CIN, of which serum creatinine raised > 0.5mg/dl in 6 patients and raised > 25% from the baseline after the procedure in 13 patients. The overall incidence of CIN was 12.5%. CIN increased with older age. There was an increase in the incidence of CIN in diabetic versus non-diabetic patients (20.5% and 6.7%) respectively. (p< 0.03). There was a highly significant increase in the incidence of CIN in patients with CHF versus those without CHF (100% and 71%) respectively, (P<0001). Patients on diuretics showed a significant increase in the incidence of CIN representing 61.5% of all patients who developed CIN. Conclusion: Older patients, diabetic patients, patients with CHF and patients on diuretics have higher risk of developing CIN during coronary catheterization and should receive reno-protective measures before contrast exposure.Keywords: cardiac diseases, contrast-induced nephropathy, coronary catheterization, CIN
Procedia PDF Downloads 3065425 Characterization of Coronary Artery Obstruction and Related Findings in Ischemic Heart Patients Using Cardiac Scintigraphy
Authors: Yousif Mohamed Y. Abdallah, Eltayeb Wagi Allah Eltayeb, Mohamed E. Gar-elnabi, Mohamed Ahmed Ali
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To characterize coronary artery obstruction and related findings in ischemic heart patients using cardiac scintigraphy for the identification of myocardial ischemia, 146 patients were studied at basal conditions and also asked for fasting after night till the intravenous injection of the radiopharmaceutical. After the injection time about 15 to 20 minutes, the patient should eat a fatty meal and chocolate for the good excretion of the gall bladder, to evaluate the performance and regional wall motion of the left ventricle (LV). The results showed that the body mass index percentage in this sample was in range of 43.05 to 61.05. The number of patients who were catheter candidates were 56 with 43% and the patients that were not candidate to cathode were 74 patients with 57% of all patients. For the group of patients where type of ischemia was assessed, 29.5% of patients had reversible posterior and inferior wall, 15.1% of patients had fixed large from apex to base, 9.6% of patients had mild basal inferior wall, 4.8 % of patients had mild anterior wall, 6.2% of patients had antro-septal and 34.9% of patients had moderate ischemia.Keywords: myocardial ischemia, myocardial scintigraphy, contrast ventriculography, coronary artery obstruction
Procedia PDF Downloads 5795424 Procalcitonin and Other Biomarkers in Sepsis Patients: A Prospective Study
Authors: Neda Valizadeh, Soudabeh Shafiee Ardestani, Arvin Najafi
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Objectives: The aim of this study is to evaluate the association of mid-regional pro-atrial natriuretic peptide (MRproANP), procalcitonin (PCT), proendothelin-1 (proET-1) levels with sepsis severity in Emergency ward patients. Materials and Methods: We assessed the predictive value of MRproANP, PCT, copeptin, and proET-1 in early sepsis among patients referring to the emergency ward with a suspected sepsis. Results-132 patients were enrolled in this study. 45 (34%) patients had a final diagnosis of sepsis. A higher percentage of patients with definite sepsis had systemic inflammatory response syndrome (SIRS) criteria at initial visit in comparison with no-sepsis patients (P<0.05) and were admitted to the hospital (P<0.05). PCT levels were higher in sepsis patients [P<0.05]. There was no significant differences for MRproANP or proET-1 in sepsis patients (P=0.47). Conclusion: A combination of SIRS criteria and PCT levels is beneficial for the early sepsis diagnosis in emergency ward patients with a suspicious infection disease.Keywords: emergency, prolactin, sepsis, biomarkers
Procedia PDF Downloads 4315423 Role of von Willebrand Factor and ADAMTS13 In The Prediction of Thrombotic Complications In Patients With COVID-19
Authors: Nataliya V. Dolgushina, Elena A. Gorodnova, Olga S. Beznoshenco, Andrey Yu Romanov, Irina V. Menzhinskaya, Lyubov V. Krechetova, Gennady T. Suchich
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In patients with COVID-19, generalized hypercoagulability can lead to the development of severe coagulopathy. This event is accompanied by the development of a pronounced inflammatory reaction. The observational prospective study included 39 patients with mild COVID-19 and 102 patients with moderate and severe COVID-19. Patients were then stratified into groups depending on the risk of venous thromboembolism. vWF to ADAMTS-13 concentrations and activity ratios were significantly higher in patients with a high venous thromboembolism risks in patients with moderate and severe forms COVID-19.Keywords: ADAMTS-13, COVID-19, hypercoagulation, thrombosis, von Willebrand factor
Procedia PDF Downloads 815422 Investigation of Chronic Drug Use Due to Chronic Diseases in Patients Admitted to Emergency Department
Authors: Behcet Al, Şener Cindoruk, Suat Zengin, Mehmet Murat Oktay, Mehmet Mustafa Sunar, Hatice Eroglu, Cuma Yildirim
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Objective: In present study we aimed to investigate the chronic drug use due to chronic diseases in patients admitted to emergency department. Materials-Methods: 144 patients who applied to emergency department (ED) of medicine school of Gaziantep University between June 2013 and September 2013 with chronic diseases and use chronic drugs were included. Information about drugs used by patients were recorded. Results: Of patients, half were male, half were female, and the mean age was 58 years. The first three common diseases were diabetes mellitus, hypertension and coronary artery diseases. Of patients, %79.2 knew their illness. Fifty patients began to use drug within three months, 36 patient began to use within the last one year. While 42 patients brought all of their drugs with themselves, 17 patients brought along a portion of drugs. While three patients stopped their medication completely, 125 patients received medication on a regular basis. Fifty-two patient described the drugs with names, 13 patients described with their colors, 3 patients described by grammes, 45 patients described with the size of the tablet and 13 patients could not describe the drugs. Ninety-two patients explained which kind of drugs were used for each diseases, 17 patient explained partly, and 35 patients had no idea. Hundred patients received medication by themselves, 44 patients medications were giving by their relatives and med carers. Of medications, 140 were written by doctors directly, three medication were given by pharmacist; and one patient bought the drug by himself. For 11 patients the drugs were not harmonious to their diseases. Fifty-one patients admitted to the ED two times within last week, and 73 admitted two times within last month. Conclusion: The majority of patients with chronic diseases and use chronic drugs know their diseases and use the drugs in order, but do not have enough information about their medication.Keywords: chronic disease, drug use, emergency department, medication
Procedia PDF Downloads 4555421 C-Reactive Protein in Patients with Type 2 Diabetes Mellitus
Authors: Athar Hussain Memon
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Objectives: We tried to determine the frequency of raised C-reactive protein (CRP) in patients with type 2 diabetes mellitus. Patients and Methods: This cross-sectional descriptive study of six months study was conducted at Liaquat University Hospital Hyderabad from March 2013 to August 2013. All diabetic patients of ≥35 years age of either gender for >01 year duration visited at OPD were evaluated for C-reactive protein and their glycemic status by hemoglobin A1c. The data was analyzed in SPSS and the frequency and percentage were calculated. Results: During six month study period, total 100 diabetic patients were evaluated for C-reactive protein. The majority of patients were from urban areas 75/100 (75%). The mean ±SD for age of patients with diabetes mellitus was 51.63±7.82. The mean age ±SD of patient with raised CRP was 53±7.21. The mean ±SD for HbA1c in patients with raised CRP is 9.55±1.73. The mean random blood sugar level in patients with raised CRP was 247.42 ± 6.62. The majority of subjects were of 50-69 years of age group with female predominance (p=0.01) while the CRP was raised in 70 (70%) patients in relation to age (p=0.02) and gender (p=0.01), respectively. Both HbA1c and CRP were raised in 64.9% (p=0.04) in patients with type 2 diabetes mellitus. The mean ±SD of CRP was 5.8±1.21 while for male and female individuals with raised CRP was 3.52±1.22 and 5.7±1.63, respectively. Conclusions: The raised CRP was observed in patients with type 2 diabetes mellitus.Keywords: diabetes mellitus, C-reactive protein, hemoglobin A1c, diabetes and metabolism
Procedia PDF Downloads 4075420 Hypoglycemic Coma in Elderly Patients with Diabetes mellitus
Authors: D. Furuya, H. Ryujin, S. Takahira, Y. Sekine, Y. Oya, K. Sonoda, H. Ogawa, Y. Nomura, R. Maruyama, H. Kim, T. Kudo, A. Nakano, T. Saruta, S. Sugita, M. Nemoto, N. Tanahashi
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Purpose: To study the clinical characteristics of hypoglycemic coma in adult patients with type 1 or type 2 diabetes mellitus (DM). Methods: Participants in this retrospective study comprised 91 patients (54 men, 37 women; mean age ± standard deviation, 71.5 ± 12.6 years; range, 42-97 years) brought to our emergency department by ambulance with disturbance of consciousness in the 7 years from April 2007 to March 2014. Patients with hypoglycemia caused by alcoholic ketoacidosis, nutrition disorder, malignancies and psychological disorder were excluded. Results: Patients with type 1 (8 of 91) or type 2 DM (83 of 91) were analyzed. Mean blood sugar level was 31.6 ± 10.4 in all patients. A sulfonylurea (SU) was more commonly used in elderly (>75 years old; n=44)(70.5%) than in younger patients (36.2%, p < 0.05). Cases showing prolonged unconsciousness (range, 1 hour to 21 days; n=30) included many (p < 0.05) patients with dementia (13.3%; 0.5% without dementia) and fewer (p < 0.05) patients with type 1 DM (0%; 13.1% in type 2 DM). Specialists for DM (n=33) used SU less often (24.2%) than general physicians (69.0%, p < 0.05). Conclusion: In cases of hypoglycemic coma, SU was frequently used in elderly patients with DM.Keywords: hypoglycemic coma, Diabetes mellitus, unconsciousness, elderly patients
Procedia PDF Downloads 4825419 Operating Model of Obstructive Sleep Apnea Patients in North Karelia Central Hospital
Authors: L. Korpinen, T. Kava, I. Salmi
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This study aimed to describe the operating model of obstructive sleep apnea. Due to the large number of patients, the role of nurses in the diagnosis and treatment of sleep apnea was important. Pulmonary physicians met only a minority of the patients. The sleep apnea study in 2018 included about 800 patients, of which about 28% were normal and 180 patients were classified as severe (apnea-hypopnea index [AHI] over 30). The operating model has proven to be workable and appropriate. The patients understand well that they may not be referred to a pulmonary doctor. However, specialized medical follow-up on professional drivers continues every year.Keywords: sleep, apnea patient, operating model, hospital
Procedia PDF Downloads 1235418 Clinical Features of Acute Aortic Dissection Patients Initially Diagnosed with ST-Segment Elevation Myocardial Infarction
Authors: Min Jee Lee, Young Sun Park, Shin Ahn, Chang Hwan Sohn, Dong Woo Seo, Jae Ho Lee, Yoon Seon Lee, Kyung Soo Lim, Won Young Kim
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Background: Acute myocardial infarction (AMI) concomitant with acute aortic syndrome (AAS) is rare but prompt recognition of concomitant AAS is crucial, especially in patients with ST-segment elevation myocardial infarction (STEMI) because misdiagnosis with early thrombolytic or anticoagulant treatment may result in catastrophic consequences. Objectives: This study investigated the clinical features of patients of STEMI concomitant with AAS that may lead to the diagnostic clue. Method: Between 1 January 2010 and 31 December 2014, 22 patients who were the initial diagnosis of acute coronary syndrome (AMI and unstable angina) and AAS (aortic dissection, intramural hematoma and ruptured thoracic aneurysm) in our emergency department were reviewed. Among these, we excluded 10 patients who were transferred from other hospital and 4 patients with non-STEMI, leaving a total of 8 patients of STEMI concomitant with AAS for analysis. Result: The mean age of study patients was 57.5±16.31 years and five patients were Standford type A and three patients were type B aortic dissection. Six patients had ST-segment elevation in anterior leads and two patients had in inferior leads. Most of the patients had acute onset, severe chest pain but no patients had dissecting nature chest pain. Serum troponin I was elevated in three patients but all patients had D-dimer elevation. Aortic regurgitation or regional wall motion abnormality was founded in four patients. However, widened mediastinum was seen in all study patients. Conclusion: When patients with STEMI have elevated D-dimer and widened mediastinum, concomitant AAS may have to be suspected.Keywords: aortic dissection, myocardial infarction, ST-segment, d-dimer
Procedia PDF Downloads 3935417 Awareness and Willingness of Signing 'Consent Form in Palliative Care' in Elderly Patients with End Stage Renal Disease
Authors: Hsueh Ping Peng
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End-stage renal disease most commonly occurs in the elderly population. Elderly people are approaching the end of their lives, and when facing major life-threatening situations, apart from aggressive medical treatment, they can also choose treatment methods such as hospice care to improve their quality of life. The purpose of this study was to investigate factors associated with the awareness and willingness to sign hospice and palliative care consent forms in elderly with end-stage renal disease. This study used both quantitative, cross-sectional study designs. In the quantitative section, 110 elderly patients (aged 65 or above) with end-stage renal disease receiving conventional hemodialysis were recruited as study participants from a medical center in Taipei City. Data were collected using structured questionnaires. Study tools included basic demographic data, questionnaires on the awareness and perception of hospice and palliative care, etc. After collecting the data, data analysis was conducted using SPSS 20.0 statistical software, including descriptive statistics, chi-square test, logistic regression, and other inferential statistics. The results showed that the average age of participants was 71.6 years old, more males than females, average years of dialysis was 6.1 years and most subjects rated their self-perceived health status as fair. Results of the study are summarized as follows: Elderly people with end-stage renal disease did not have sufficient knowledge and awareness about hospice and palliative care. Influencing factors included level of education, marital status, years of dialysis and age, etc. Demographic factors influencing the signing of consent forms included gender, marital status, and age, which all showed significant impacts. Factors taken into consideration when signing consent forms included awareness of hospice care, understanding the relevant definitions of hospice care, and understanding that consent may be modified or cancelled at any time; it was predicted that people who knew more about ways to receive hospice care or more related definitions were more willing to sign the consent forms. In the qualitative study section, 10 participants who signed the consent form, five male, and 5 female, between the ages of 65-90, have completed the semi-structured interviews. Analysis of the interviews revealed six themes: (1) passing away peacefully, (2) autonomy on arrangements of life and death, (3) unwillingness to increase family and social burden, (4) friends and relatives’ experience influencing the decision to give consent, (5) sharing information to facilitate the giving of consent, (6) facing each day with ease, to reflect the experience and factors of consideration for elderly with end-stage renal disease when signing consent forms. The results of this study provides the awareness, thoughts and feelings of elderly with end-stage renal disease on signing consent forms, and serve as a future reference for the dialysis unit to enhance the promotion of hospice and palliative care and related caregiving measures, thereby improving the quality of life and care for elderly people with end-stage renal disease.Keywords: end-stage renal disease, hemodialysis, hospice and palliative care, awareness, willingness
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