Fluid Restrictions Research Articles

PENGARUH TERAPI ICE CUBES TERHADAP PENURUNAN RASA HAUS PADA PASIEN GAGAL GINJAL KRONIK YANG MENJALANI HEMODIALISA DI RSU SEMBIRING

Chronic renal failure patients undergoing hemodialysis must comply with fluid restrictions, to prevent excess fluid from occurring which can worsen the condition of chronic kidney failure patients, but fluid restriction can lead to a decrease in oral intake resulting in dry mouth and tongue rarely flowing water and this condition can trigger thirst. One of the ways to manage thirst is with ice cube's therapy. The purpose of this study was to determine the effect of ice cube's therapy on reducing thirst in chronic kidney failure patients undergoing hemodialysis. Pre-experimental research design using a one group pretest-posttest design. The samples in this study amounted to 18 respondents using purposive sampling technique. The instrument for applying ice cube's therapy uses the VAS (Visual Analog Scale) for Assessment of Thirst Intensity. Ice cube's therapy is given for 5 minutes during the dialysis process. The results of the Paired T-test statistic in this study showed that there was a decrease in the intensity of thirst by an average of 2.56 with a significance value of p value = 0.000 (p <0.05). Based on the research findings, there is an effect of ice cube's therapy on reducing thirst in chronic kidney failure patients undergoing hemodialysis. The application of ice cube's therapy is proven to be able to reduce thirst so that it can be useful and applied to chronic kidney failure patients undergoing hemodialysis.

Impact d’une prise en charge par hypnose sur le vécu et l’observances des recommandations hydriques en hémodialyse : résultats d’un protocole à cas unique chez deux patients

IntroductionHemodialysis is associated with dietary and fluid restrictions, which can be a source of frustration, suffering and non-compliance in many patients. Hypnosis, a booming therapeutic tool in the health field, could improve patients’ feelings. The objective of this study is to assess the effect of hypnosis on fluid restrictions experience. MethodThe effectiveness of the hypnotic intervention was evaluated using a single-case protocol (ABA type) with two patients. A protocol in 3 phases of 3 weeks was used with three sessions of hypnosis. Several measurement tools have been used: the KDQoL-36 for quality of life, the Health-Specific Self-Efficacy Scales (adapted for dialysis patients) for self-efficacy, and numeric scales for therapeutic compliance and thirst. ResultsSome significant changes were observed with maintenance of the effects after hypnosis: improvement in the global quality of life for patient 1, improvement of self-efficacy (barrier) for patient 2. The visual analysis showed improvements but without significant effect as alleviation of thirst and discomfort, improvement of perceived compliance. ConclusionThese preliminary results concerning the effects of hypnosis on the experience of fluid restrictions are mixed reflecting variability between patients. However, these results are encouraging and show the need to continue this evaluation with more patients thanks to the advantages of the single-case protocol method.

Do the patient education program and nurse-led telephone follow-up improve treatment adherence in hemodialysis patients? A randomized controlled trial

BackgroundEnd-Stage Renal Disease (ESRD) is the final and permanent stage of Chronic Kidney Disease (CKD). Hemodialysis (HD) is the most common treatment for CKD. To have desirable therapeutic outcomes, patients have to adhere to a specific therapeutic regimen that reduces the hospitalization rate and side-effects of HD. The present study aimed to determine the effects of the patient education program and nurse-led telephone follow-up on adherence to the treatment in hemodialysis patients.MethodsThis is a randomized controlled trial in which a total of 66 patients were recruited using convenience sampling and then randomly assigned to two groups of control (n = 33) and intervention (n = 33). Data were collected using a demographic questionnaire, the laboratory results record sheet, and the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), which included four dimensions of HD attendance, medication use, fluid restrictions, and diet recommendations. The intervention group received a patient education program and nurse-led follow-up services through telephone communication and the Short Message Service (SMS) for 3 months. All participants filled in the questionnaire before and after the intervention. Data were analyzed using IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, N.Y., USA).ResultsThe results showed a significant difference in the mean scores of HD attendance, medication use, fluid restrictions, and diet recommendations between the two groups immediately, 1 month, and 3 months after the intervention (p < .001). The results also indicated a significant difference in the mean scores of four dimensions during the four-time points of measurement in the intervention group (P < 0.0005). Therefore, the level of treatment adherence in the intervention group was higher than in the control group. Moreover, there was a significant difference in the mean score of laboratory values between the two groups after the intervention, except for the level of serum sodium (P = 0.130).ConclusionImplementation of the patient education program and nurse-led follow-up can lead to better adherence to hemodialysis in four dimensions of HD attendance, medication use, fluid restrictions, and dietary recommendations in HD patients.Trial registrationIRCT registration number: IRCT20190127042512N1; Registration date: 2020-09-12; Registration timing: retrospectively registered: Last update: 2020-09-12.

POS-797 "ARE YOU LISTENING TO OUR CONCERNS?": EXPLORING THE DYADIC PERSPECTIVE OF COUPLES DEALING WITH END-STAGE RENAL DISEASE

End-stage renal disease (ESRD) is a complex condition that requires lifelong renal replacement therapy to survive. As a psychosocial dyad, couples face several challenges due to the strict regime of dialysis attendance, vascular access care, fluid and dietary restrictions, adherence to poly-pharmacy protocols, disease- and/or treatment-related complications. These demands can severely impact the couple's routines, relationship dynamics and goals, increase the couples’ unmet needs, psychological distress, and burden.

POS-796 "MY PARENT HAS END-STAGE RENAL DISEASE": EXPLORING THE UNMET NEEDS OF ADULT CHILDREN CARING FOR THEIR PARENTS ON HEMODIALYSIS

In-center hemodialysis (HD) is the most common treatment for patients with end-stage renal disease (ESRD). This treatment is highly demanding and associated with complications (e.g. hypotension crises, cardiac disease) that increase patients’ dependence on family members. For older patients, adult children generally assume the role of the primary caregiver. However, caring for a parent with ESRD is a stressful experience due to the several requirements that this disease entails such as fluid and diet restrictions, vascular access care, and poly-pharmacy protocols. Also, adult children have their responsibilities to manage, namely their marital relationships, young children, and jobs. However, to date and to the best of our knowledge, the unmet needs of adult children caring for parents undergoing in-center HD have never been explored. This study aims to explore the unmet needs of adult children caring for their parents with ESRD undergoing in-center HD. A qualitative exploratory study was conducted with a purposive sample. Semi-structured face-to-face interviews were conducted with 19 adults (44.9 ± 11.7 years old) caring for their parents undergoing in-center HD for an average of 39.8 (± 36.4) months. The interviews were digitally audio-recorded, transcribed verbatim, and submitted to content analysis by two independent researchers. Six unmet needs were identified: i) lack of support and recognition of the caregiver role from other family members (n=9); ii) lack of sufficient information about nutritional restrictions (the need for written information delivered directly to the caregiver and how to develop creative meals; n=6); iii) need of first aid assistance skills (to deal with hypotension crises and hemorrhages at home; n=5); iv) need of psychological support (to help face caregiving burden and to help the patient cope with ESRD; n=5); v) improve communication skills (learn how to communicate with a difficult patient/parent and improve communication with health professionals; n=3); and vi) social and financial support (to face disease’ expenses with meal preparation and transport to dialysis; n=3). Adult children caring for a parent with ESRD have identified a multitude of unmet emotional, relational, and educational needs. The dialysis team can play an important role in mitigating those needs, by developing multidisciplinary interventions combining an educational and a supportive component. These interventions should focus on maximizing disease management skills while providing emotional support and facilitating communication with the healthcare renal team.

Nurses’ experience in improving adherence to fluid intake and diet in hemodialysis patients

The objective of study is to explore nurses' experiences in their role as educators in improving adherence to fluid and dietary restrictions in hemodialysis patients. This study used a qualitative phenomenological method with a purposive sampling method. Eight nurses were selected for in-depth interviews. Data analysis was conducted using the Colaizzi method. The study found five themes. (1) Intensive interaction with patients to optimize the role of nurses. (2) Various methods are used in delivering education. (3) Various obstacles are experienced in delivering education. (4) Nurses are required to improve their abilities and (5) Benefits for nurses. It is important for nurses to improve their role continuously. Hospitals and health facilities need to encourage nurses in their efforts to develop themselves and their clinical roles, so the quality of nursing care can be improved.

15. Pilot Study: Mindful Drinking/Eating Intervention for Hemodialysis Patients With Fluid Restrictions

15. Pilot Study: Mindful Drinking/Eating Intervention for Hemodialysis Patients With Fluid Restrictions

Impact of patient counseling on treatment adherence behavior and quality of life in maintenance hemodialysis patients.

Life in end-stage renal disease (ESRD) is miserable; food and fluid restrictions are mandatory due to impaired renal function. Patient involvement forms a key role in the management of ESRD. Hence, a direct impact of patient counseling on treatment adherence and quality of life (QOL) could be established, which forms the basis of this study. We conducted a prospective interventional study of 10 months, where the ESRD-Adherence Questionnaire and Kidney Disease QOL (KDQOL) data were used to study the effect of patient counseling. A total of 121 patients enrolled in the study with mean age of 62.14 ± 11.41 years. The adherence factors indicated that 97% were adherent to dialysis sessions, followed by 67.77% toward diet and 60.33% toward fluid. On assessing the influence of counseling on QOL and adherence to various factors affecting ESRD, a positive correlation could be observed, which indicates the impact of pharmacist intervention in improving the QOL and patient compliance, thus the need for periodic counseling was established as an effective way to improve health-related QOL and awareness in ESRD.

Precipitating factors and clinical impact of early rehospitalization for heart failure in patients with heart failure in Awaji Island, Japan

BackgroundRecent reports have revealed that patients who experienced early rehospitalization for heart failure (HF) had worse prognoses in terms of all-cause and cardiovascular deaths as compared to those who did not. However, precipitating factors for early rehospitalization for HF remain unknown. In this study, we assessed the precipitating factors for early rehospitalization and their impact in patients with HF. Methods and resultsWe consecutively included 242 patients (mean age: 80.4 years, females: 46.3%) with a history of rehospitalization for HF. They were divided into 2 groups: the early rehospitalization group (71 patients who were readmitted within 3 months of discharge) and the late rehospitalization group (171 patients who were readmitted after more than 3 months following discharge). During the mean follow-up period of 1,144 days (range: 857–1,417 days), 121 patients (50.0%) died. Kaplan–Meier analysis revealed that patients in the early rehospitalization group had worse prognosis (all-cause death and cardiovascular death) than those in the late rehospitalization group (log-rank p<0.001). As the major precipitating factor for rehospitalization, poor compliance with the doctor's instructions on fluid and physical activity restrictions (determined by the patients or their families admittance of non-compliance with the instructions given at the time of discharge) was higher in the early rehospitalization group than in the late rehospitalization group [poor compliance with fluid restriction: 19.7% vs. 7.6% (p = 0.006), poor compliance with physical activity restriction: 21.1% vs. 9.4% (p = 0.013)]. ConclusionsWe concluded that early hospital readmission in patients with HF was associated with higher mortality rates. Compared to late rehospitalization, precipitating factors for early rehospitalization were more strongly dependent on the self-care behaviors of the patients. A more effective approach, such as multidisciplinary intervention, is essential to prevent early hospital readmission and subsequent poor prognosis.

Impact de l’éducation du patient en hémodialyse sur le respect des mesures diététiques et sur la restriction aux liquides

IntroductionMost chronic hemodialysis patients do not adhere to diet and fluid restrictions, source of clinical complications in the medium and long term, in some cases fatal, this study was conducted to investigate the effect of the training program given to these patients on their adherence to diet and fluid restrictions. Materials and methodsThe study was conducted with 50 people, split into 2 groups, set up on a control group with 25 people. No education program has been set up, and the second group with 25 people assigned to the intervention having received an education program. Data were collected using the sociodemographic characteristics questionnaire, dialysis diet and fluid non-adherence questionnaire (DDFQ), and fluid control in hemodialysis patients scale (FCHPS). ResultsThe measurements made at the end of the education program revealed a statistically significant difference in favor of the intervention group in terms of the mean values for the patients interdialytic weight gain (kg), ultrafilration volume and diastolic blood pressure. Similarly, the means of the scores for the 4 items of the DDFQ questionnaire revealed a statistically significant difference in favor of the intervention group concerning: the frequency of non-adherence to the diet, the degree of non-adherence to the diet, the frequency of non-adherence to liquid restriction and the degree of non-adherence to liquid restriction. ConclusionThis monocentric work shows that the establishment of an educational program has a positive impact on patients adherence to dietary measures and restriction of fluids.

Health literacy as predictors of fluid management in people receiving hemodialysis in China: A structural equation modeling analysis

ObjectivesTo explore the impact of health literacy (HL) on perceived benefits of fluid restriction (PBFR), self-reported fluid restriction (SRFR) and relative-interdialytic weight gain (R-IDWG) in people receiving hemodialysis (HD). MethodsWe conducted a cross-sectional study in two nephrology departments from two hospitals in Guangzhou, China (n = 226). The HL questionnaire, PBFR Subscale of Health Belief Model Constructs and Fluid Adherence Subscale of the HD Patients Therapy Adherence Scale were used. R-IDWG was calculated by the mean IDWG (from 3 consecutive HD), divided by the dry weight. ResultsIn structural equation modeling, three domains of the HL questionnaire, namely Actively Managing My Health, Social Support and Actively Engaging with Healthcare Providers (HCPs), were directly and positively associated with PBFR. Higher Actively Managing My Health predicted higher SRFR both directly and indirectly. Sufficient Social Support and adequate Actively Engaging with HCPs predicted higher SRFR indirectly. All three HL domains predicted R-IDWG indirectly. ConclusionImproving patients’ HL could increase their understanding of PBFR and be more apt to follow fluid restrictions and reduce R-IDWG. Practice implicationsA better understanding of the relationships among HL, PBFR, SRFR and R-IDWG will allow for tailored interventions to decrease R-IDWG in people receiving HD.

DETERMINANTS OF DIET AND FLUID ADHERENCE AMONG END STAGE RENAL DISEASE PATIENTS UNDERGOING HAEMODIALYSIS AT MOI TEACHING AND REFERRAL HOSPITAL, UASIN GISHU COUNTY, KENYA

Purpose: This study was conducted to establish determinants of diet and fluid adherence among ERSD patients undergoing hemodialysis at Moi Teaching and Referral Hospital- Uasingishu county. Kenya.&#x0D; Methods: A descriptive cross-sectional study design was applied. Using Fisher’s formula, a sample size of 145 participants were conveniently recruited. Data collection was done by use of modified end stage renal disease adherence questionnaire (ESRD-AQ). Chi-square (χ2) was used to test statistical significance. Frequency tables and bar graphs were used for data presentation. SPSS version 22.0 was used for data analysis.&#x0D; Results: The study revealed that knowledge on nutritional requirements for renal patients was marginally associated with dietary and fluid intake with a higher proportion of those with low nutritional knowledge (83.6%) adhering to diet and a relatively smaller proportion in the same category (58.9%) complying with fluid intake. A significant relationship with dietary adherence was observed where participants practiced fluid restrictions (p=0.003) and the frequency in which health staff talk about the importance of following proper diet (p &lt;0.0001). On social support domain, a significant association was observed in patients who agreed that various social support aspects help improve depression, self-esteem, self-management, etc. and who adhered to diet scored a significantly higher mean of 5.6 (95% CI = 5.5 – 5.6) in contrast to non-adherent counterparts who had a mean of 5.5 (p = 0.0006). Among the economic factors with significant association with diet adherence were; use of bus for transport (p=0.02); income of less than KSH. 30,000 (p=0.006); treatment cost (p=0.007) and ability to access material support that helps in adherence (p=0.003). Those who claimed that lack of transport was the main reason for missing dialysis practiced fluid adherence (p=0.01) with a smaller proportion (44%) adhering to fluid restriction in comparison to 70.8% who had transport and were non- adherent.&#x0D; Unique contribution to theory, practice and policy: The study findings are unique to the study site and it’s hoped that it can be used to inform hospital policy makers in addressing adherence challenges in ESRD patients on hemodialysis. The study recommends a holistic study on determinants of adherence to hemodialysis, medication use, dietary, and fluid compliance among patients undergoing HD at MTRH should be conducted in order to produce generalized results.

Case report on chronic liver disease with portal hypertension with massive ascites

Portal hypertension is an increase in the blood pressure within the system of veins called the Hepatic portal venous system. Veins coming from the stomach, intestine, spleen, and pancreas merge into the portal vein, which then branches into smaller vessels and travels through the liver. If the vessels in the liver are blocked due to liver damage, blood cannot flow properly through the liver. As a result, high pressure in the portal system develops. This increased pressure in the portal vein may lead to the development of large, swollen veins (varices) within the esophagus, stomach, rectum, or umbilical area (belly button). Varices can rupture and bleed, resulting in potentially life-threatening complications. We present a case of portal hypertension with massive ascites- A 43-year-old female was admitted with chief complaints of abdominal distension, abdominal pain, and shortness of breath prior to 15 days of presentation and the symptoms were gradually progressive in nature. Her past medical history reveals she had similar complaints in the past and known cases of chronic liver disease. After admission, she has been diagnosed with portal hypertension along with Refractory ascites. The management included antihypertensives and human albumin, A high protein diet with salt and fluid restrictions, large-volume paracentesis procedure was carried out daily.

THE CHARACTERISTIC DESCRIPTION OF COMPLIANCE WITH FLUID LIMITATION, INTERDYALITIC WEIGHT GAIN (IDWG), AND QUALITY OF LIFE IN HEMODIALYSIS PATIENTS IN PALEMBANG CITY

Patients with hemodialysis are required to carry out routine care, diet arrangements, and fluid restrictions. The highest non-compliance in patients is fluid restriction. Excessive fluid intake can be seen from weight gain between dialysis time (IDWG). IDWG in hemodialysis patients should not be more than 3.5%, where an increase in IDWG can cause the risk of death and decreased quality of life. However, at the hospital itself, routine identification of fluid restriction non-compliance activities was not carried out, so that there were still many patients with hemodialysis who experienced an increase in IDWG in the moderate and severe categories. The purpose of this study is to explore the characteristics, fluid restriction compliance, IDWG, and quality of life in hemodialysis patients. This is done to plan the provision of further intervention in patients. The design in this study was cross-sectional with sampling techniques with simple random sampling. The results of the study characteristics of respondents at the age of 46-55 years (64.7%) more male sex (55.9%), and high school education (47.1%), all respondents were married (100%), most not working (58.8%), the average length of hemodialysis is 18 months. The mean mean liquid restriction compliance was 27.35, the mean value of IDWG was 4.97 and the mean value of quality of life was 51.72.&#x0D;

Exploring health literacy in patients with chronic kidney disease: a qualitative study

BackgroundPatients with chronic kidney disease make day-to-day decisions about how to self-manage their disease. Chronic kidney disease (CKD) includes a risk for progression towards end-stage renal disease and the development of comorbidities, such as cardiovascular disease, which represents the leading cause of death among these patients. To reduce these risks, CKD patients are recommended to follow a healthy lifestyle with physical activity, food and fluid restrictions, and adherence to complex medication regimes throughout all phases of the disease. To manage the complexity of this health situation, health literacy (HL) is considered essential. The current prevailing understanding is that HL is a multidimensional concept and comprises a range of cognitive, affective, social, and personal skills that determine the motivation and ability to gain access to, understand, and use health information. Recently, we investigated multiple aspects of HL in CKD patients in a quantitative cross-sectional study utilizing the Health Literacy Questionnaire (HLQ) and observed that finding good health information and appraising health information were the most challenging aspects of HL. This study aimed to explore CKD patients’ lived experiences of different dimensions of HL presented in the HLQ.MethodsThis qualitative study utilized in-depth semistructured interviews. Twelve patients with different levels of HL were included. The interviews were analyzed using thematic analysis as described by Braun and Clarke.ResultsWe identified three main themes that were significant for CKD patients’ HL: 1. Variation in people’s attitudes and behavior as health information seekers, 2. The problem of fragmented healthcare in the context of multimorbidity makes the healthcare system challenging to navigate, and 3. The value of a good relationship with healthcare providers.ConclusionCKD patients take different approaches to health information. Limiting or avoiding health information may be a strategy used by some individuals to cope with the disease and does not necessarily mean that health information is inaccessible or difficult to understand. Comorbidity and a fragmented healthcare system can make the healthcare system challenging to navigate. A good and trusting relationship with healthcare providers seems to promote several aspects of HL and should be promoted to optimize CKD patients’ HL.

Automatic Reminder for Fluids Management on Confidence and Compliance with Fluid Restrictions in Hemodialysis Patients

Discharge planning has not been able to increase confidence and fluid restriction adherence in endstage renal failure patients undergoing hemodialysis. This study aimed to develop an application of discharge planning with automatic reminder of fluid management to improve fluid restriction adherence in hemodialysis patients. Research and development with the first stage was developing an application prototype by evaluating hemodialysis patients’ issues through interviews and questionnaires of 115 respondents. Focus group discussions with health professionals and expert discussions were conducted after data collecting. Second stage was a quasi-experimental study with 30 respondents in each group using simple random sampling. Research analysis used MANOVA test. The development of a prototype consisted of pooling intake, pooling output, fluid control log, education, setting and automatic fluid monitoring reminder. The results of interviews with the target users showed that the app was feasible. The effect of interventions on beliefs (perceived threat, perceived benefit, perceived barrier, and self-efficacy) with p = 0.001, fluid restriction compliance and IDWG p = 0.001 after the intervention using the development of discharge planning with automatic reminder app. Development of discharge planning with automatic reminder of fluid management consists of several menus and the main feature was an automatic fluid monitoring reminder. This app can increase self-confidence in fluid restriction and adherence in patients undergoing hemodialysis.

Psychosocial, Spiritual, and Biomedical Predictors of Hope in Hemodialysis Patients.

BackgroundHemodialysis patients deal with some psychological and social problems. These problems may be the predictors of hope. This study aimed to determine the psychosocial, spiritual, and biomedical predictors of hope in hemodialysis patients.MethodsThis cross-sectional study was conducted on 350 hemodialysis patients in hemodialysis centers affiliated to Shiraz University of Medical Sciences. Adult Hope Scale, Depression Anxiety Stress Scales, Personal Resources Questionnaire-85, Spiritual Well-Being Scale, and biomedical markers were used for data collection. The data were entered into the SPSS 22 software and were analyzed using Pearson’s correlation coefficient and linear regression analysis.ResultsThe mean score of hope was 28.54 (SD=5.27). The mean scores of depression, anxiety, and stress were 17.87 (SD=7.62), 13.12 (SD=3.47), and 12.99 (SD=3.88), respectively. The mean scores of social support and spiritual well-being were 126.35 (SD=17.53) and 74.02 (SD=5.84), respectively. The means of biomedical markers including interdialytic weight gain, urea nitrogen, creatinine, phosphate, sodium, and potassium were 2.10 (SD=1.04), 51.55 (SD=13.10), 6.98 (SD=2.48), 4.71 (SD=1.08), 139.32 (SD=4.91), and 4.87 (SD=0.93), respectively. The results revealed a significant association between hope and depression, anxiety, stress, social support, and spiritual well-being (p<0.05). In addition, stress (β=−0.14, p=0.01), anxiety (β=−0.20, p=0.002), and social support (β=0.49, p<0.001) were the predictors of hope.ConclusionThe hemodialysis patients reported moderate levels of hope, social support, anxiety, and depression. In addition, most of them adhered to dietary and fluid restrictions. Considering the association between hope and social support, spiritual well-being, anxiety, depression, and stress, using some interventions regarding the mentioned variables might increase hope among hemodialysis patients.

Concerns of hemodialysis patients

Introduction: Hemodialysis, which is the most common treatment in individuals with end stage renal disease, includes a series of limitations and modifications in daily life that adversely affect patients' physical and psychological state. Eliciting and addressing patients’ concerns is a key aspect of patient-centered treatment. Unaddressed concerns may lead to lower satisfaction and lower quality of medical care.Aim: To explore concerns of hemodialysis patients. Method and material: A Descriptive study on a convenience sample of patients undergoing hemodialysis in dialysis centers in Athens. Data was collected by the completion of a questionnaire which included the patients' concerns. Categorical variables are presented by absolute and relative frequencies (percentages).Results: In the present study were enrolled 100 patients, of whom 73% were male, 55% were&gt;60 years old, 66% were married and 30% of primary level of education. Regarding patients' concerns, 36% of participants were bothered to spend time on dialysis center, 65% and 49% were concerned about a possible discontinue of fistula and hemodialysis machine respectively, while 59% were concerned about restrictions in social life, 39% in their role as a spouse, 71% about fluid restrictions, 55% about diet restrictions and 53% were concerned about transport "to and from" hemodialysis unit. In terms of limitations due to hemodialysis, 30% reported limitation in clothes, 69% in going for holidays and 67% in sexual life.Conclusions: Expanding nurses knowledge about patients' concerns is essential to implement individualized effective therapeutic strategies.

Extracorporeal Life Support Organization (ELSO): Guidelines for Neonatal Respiratory Failure.

Extracorporeal Life Support Organization (ELSO): Guidelines for Neonatal Respiratory Failure.

Burden of living with multiple concurrent symptoms in patients with end-stage renal disease.

To explore the experience of multiple concurrent symptoms over time and their impact on daily living in patients with end-stage renal disease undergoing dialysis. Patients undergoing dialysis experienced multiple concurrent symptoms because of the disease and treatment. Evidence suggests that these symptoms cluster around and have a significant impact on quality of life. However, the experience of this impact remained not clear. A longitudinal descriptive qualitative study. Ten patients were purposely selected from the cohort of a longitudinal quantitative study in Hong Kong. A total of 28 face-to-face semi-structured interviews were conducted between July 2017andJuly 2018. Interviews were audiotaped, transcribed and analysed using a thematic analysis approach. Findings were reported following the COREQ checklist. Four themes emerged from the data. The first theme "complex symptom experience" described a dynamic pattern of symptoms among patients. Although patients were unaware of the relationships among symptoms, a cluster of tiredness, breathlessness, dizziness and sleep disturbance was identified in the narratives of individual symptoms. The report of symptom experience and its change revealed a unique pattern of symptom perception. The three other themes illustrated the impact of multiple concurrent symptoms on daily living, namely "decreased physical functioning," "changes in social functioning" and "diet and fluid restrictions." Patients perceived dynamic and complex symptom experiences. This perception appears to be modulated by a number of factors. In addition, these experiences had negative and positive effects on patients' daily living. Patients perceived unique impact of symptoms on daily living. Therefore, a nurse-led person-centred approach of care is warranted. In addition to routine symptom assessment, nurses need to capture the specific impact of symptoms on day-to-day life. Based on this assessment, symptom management interventions (e.g. health education, referral) can be tailor-made and prioritised.