Journal of North Khorasan

Abstract Background & Objectives:Saleint decrease in physical activity, including problems that are frequently observed in hemodialysis patients. Inversely, the performance level of hemodialysis patients related to with major health consequences such as health care costs and mortality. This study determined the Effect of Care Plan Based on the ROY ADAPTATION MODEL on Activities of Daily Living of hemodialysis Patients Material & Method: This clinical trial research was performed on 54 hemodialysis patients (28 intervention and 26 control patients). The intervention group received the RAM program through a face to face process with 4 sessions at 3- week interval followed by a follow-up period of 4 weeks, while the control group received the regular services from hospital. The data collected by using of patient identification form, Inventory of Functional Status-Dialysis and Roy assessment tool. Data were analyzed with SPSS. Results: The results indicate that the between two groups were not different on Activities of Daily Living (p=0.060) before the intervention but they were significantly different after the intervention. Patients’ Activities of Daily Living improved in patients in the intervention group. Conclusion: The findings of this study indicate that the Care Plan Based on the ROY ADAPTATION MODEL is a low cost nursing intervention for Activities of Daily Living improved in Hemodialysis Patients

Abstract Background & Objectives: One of the major causes of morbidity and mortality in dialysis patient is cardiovascular disease.The prevalence of cardiovascular diseases is estimated to be between 10 to 30 times higher than general population. Some of the known risk factors for calcification are hypetcalcemia and hyperphosphatemia, increased parathyroid hormone(iPTH), increased CRP and dyslipidemia. Materials and Methods: We selected 30 dialysis patients and 30 healthy persons among persons admitted to the Imam Ali’s hospital of Bojnurd. 5 ml blood was obtained from all subjects. Parathyroid hormone(iPTH) and hs-CRP were measured with ELISA (Enzyme-Linked Immuno Sorbent Assay) reader. Other biochemical factors were measured with autoanalyser. Results: it was found that Parathyroid hormone (iPTH), mean LDL, calcium-phosphorus products and hs-CRP, between patient group and control group, were significantly different (p<0.001) .We also found significant direct relationship between the disease and increased risk factors for vascular calcification. Conclusion: These results support a role for serum iPTH, hs-CRP, ca*P ratio and LDL level as risk factors for cardiovascular disease in hemodialysis patients

Abstract Background &objective: Heamodialysis is one of the most common replacement treatment of renal transplantation. Effective and adequate heamodialysis could improve the quality of life of patients. Inadequite heamodialysis can lead to multiple uremic complications.The aim of this study was to determine dialysis adequacy of hemodialytic patients based on urea kinetic modeling in hemodialysis center in Bojnourd. Materials&Methods: This descriptive study was carried out on 63 patients who were under dialysis treatment (at least 3 month and once a week) in Imam Ali hospital,Bojnurd. Hemoglobin , hematocrit ,cholesterol and BUN were measured before and after heamodialysis. Adequacy of dialysis was calculated by Daugirddas II. Data were analyzed by SPSS software 15 and presented with chi square, independent a paired t-test, ANOVA. Results: Our results showed that %36.1 of individuals have URR>65% and %47.7 individuals have KT/V >1.2.After dialysis mean blood pressure,weight,BUN showed meaningfull reduction.There was a significant difference between mean of BUN post dialysis and KT/V and URR. There wasn’t significant between KT/V URR and Hb Hct,Alt,cratinen,Chlostrol. Conclusion: According to this study the adequacy of dialysis in patients was lower than those of same reported studies .we suggest more study in order to determine the underlying reasons for dialysis inadequacy in these patients

Abstract Introduction: Given the effect of psychological factors on patients with chronic renal failure, it has been received more attention recently. Depression is one of the most common disorders in patients with chronic renal failure. This study aimed at examining the prevalence of depression and its associated factors in hemodialysis patients in the hospital of Bojnurd. Material: In this case - control study 120 cases of hemodialysis patients in the hospitals of Imam Ali and Iran Mehr were selected in 2012. Data collecting tools were demographic sheet and the Beck Depression Inventory questionnaires. Data were analyzed by SPSS software (V18) and presented with statistical t-test, and Pearson correlation Results: The results showed that the severity of depression and depression rate in the studied population are 93.3 % (BDI more often than nine) and 90.8 (BDI more than fifteen) respectively.42.7 % of them were women and 57.3% were men. There was meaningful association between gender, age, education level, marital status, history of drug use and underlying disease with degree of depression (p <0/05). There was not significant relationship between occupation, history of kidney transplant and income. Conclusions: Our findings indicate that a significant percentage of hemodialysis patients are depressed. Therefore psychological assessment should be performed in patients with early stage and the presence of a psychiatrist, psychologist and social worker and psychiatric consultation services in hospitals are strongly recommended.

Abstract Background & Objective: Despite the multiple benefits of exercise on mental and physical health of dialysis patients, unfortunately, the level of physical activity in these patients is very limited. With this respect, it is essential to identify the barriers and motivations to exercise in these patients for care planning principles. The purpose of this study was to identify barriers and motivations to exercise and evaluate their association with activity levels in hemodialysis patients. Materials and Methods: This descriptive study was carried out on 47 hemodialysis patients selected by purposefully sampling in Imam Khomeini Hospital in Tehran. The data collection tools were demographic and Barriers and motivations to exercise questionnaire and a standard questionnaire to record physical activity GLTEQ. Data were analyzed using the software SPSS and presented with sign tests and correlation coefficient. Results: The majority of hemodialysis patients participated in the study were inactive. Motivations such as faith in healing by exercise, sense of well-being, anxiety and depression reduction had a direct correlation with the level of activity. Barriers such as fear of falling, fatigue, shortness of breath, depression and anxiety had an inverse correlation with the level of activity(P<0/05).There was a direct correlation between the frequency and severity of barriers and an inverse relationship between activity level with intensity and frequency of barriers(P<0/05). There was a direct correlation between the frequency and severity of motivations and a direct relationship between activity level with intensity and frequency motivations (P<0/05). Conclusions: Activity reduces the complications of hemodialysis and increase the health and prevent situations threatening the physical and mental health

Background & Objectives: Kidney patients in each dialysis cycle are exposed to extremely large volume of water, which is in direct contact with the patient’s blood . Therefore, water used for this purpose should be treated with advanced methods before use for dialysis. The objective of this study was to assess the efficiency of reverse osmosis systems to improve water quality used for dialysis fluid.

Material & Methods: This is a descriptive-analytic study to Evaluation of Reverse Osmosis System of water treatment system for dialysis centers in Imam Ali  Bojnurd ciry during 2015on 36 samples of water from the municipal water was reverse osmosis. Post-harvest and transport of samples to the laboratory using the latest according to the standard methods for water and wastewater examination.

Results: The results of this study showed that the reverse osmosis systems significantly reduce the

amount of sulfate, nitrate, fluoride, hardness, sodium, potassium.  These amounts were lower than AAMI and EPH standards.

Conclusion: Reverse osmosis systems could improve the quality of water used for hemodialysis. Based on the results of this study, it can be concluded that ahh the measured parameters in the hospitals werw below the standard levels. , indicating that removal efficiency reverse osmosis system parameters is desirable.

Keywords :hemodialysis centers, reverse osmosis, bojnurd

Background &Objectives: The hemodialysis effectiveness is depended on adherence to the therapeutic regimen recommendations. Every aberration from the therapeutic regimens, results to the severe clinical outcomes. Therefore, finding an effective teaching method is essential. The aim of this study was to assess the impact of training through text messaging via cell phones on the compliance of therapeutic regimens by the hemodialysis patients.

Materials and Methods: In this before and after quasi-experimental study, thirty hemodialysis patients had been selected through Simple Random Sampling method who were referred to Emam Ali Hospital of Bojnurd  in 2016. One therapeutic regimen recommendation text message was sent for 4 weeks (28 Persian text messages per day). Data about the amount of serum phosphorus and potassium, interdialytic weight gain, and patient’s absence in the sessions were collected before and after sending messages. Statistical tests such as paired t-test were performed using the SPSS v 20.

Results: There were significant differences in compliance of diet (p=0.002), medication regimen (p=0.003), and regular attendance at dialysis sessions (p=0.000) before and after training by text messaging via cell phones. There wasn’t any significant difference between fluid limitation compliance before and after training by text messaging via cell phones (p=0.759).

Conclusion: Regarding the effectiveness of text messaging and availability of this method for the majority of patients, planning for using this training method can be beneficial for the education of patients.

Background & Objectives: Chemical quality of water entering the dialysis machine in hemodialysis patients is of great importance especially in terms of heavy metals. The study was performed on the concentration of heavy metals (cadmium, copper, chromium, lead and zinc) in water of dialysis machine in Teaching Hospital of North Khorasan University of Medical Sciences in 1394.

Material & Methods: Eighteen municipal water samples and 18 samples of effluent water from reverse osmosis systems of Imam Ali dialysis centers were analyzed. Association for the (advancement of medical instrumentation) AAMI and (Epidemiology and Public Health) EPH were compared.

Results: The mean concentrations of cadmium, copper, chromium, lead, and zinc were 0.47± 0.19, 0.1 ± 0.03, 0.016 ± 0.012, 2.72 ± 0.4, 0.03± 0.01, respectively.

Conclusion: The average concentration of heavy metals in the drinking water for Imam Ali hemodialysis machines comply with existing standards and therefore does not threaten the safety of dialysis patients.