Sleep disturbance is common in dialysis patients and is associated with the development of enhanced inflammatory responses. Cognitive-behavioral therapy is effective for sleep disturbance and reduces inflammation experienced by peritoneal dialysis patients; however, this has not been studied in hemodialysis patients. To determine whether alleviation of sleep disturbance in hemodialysis patients also leads to less inflammation, we conducted a randomized controlled interventional study of 72 sleep-disturbed hemodialysis patients. Within this patient cohort, 37 received tri-weekly cognitive-behavioral therapy lasting 6 weeks and the remaining 35, who received sleep hygiene education, served as controls. The adjusted post-trial primary outcome scores of the Pittsburgh Sleep Quality Index, the Fatigue Severity Scale, the Beck Depression Inventory, and the Beck Anxiety Inventory were all significantly improved from baseline by therapy compared with the control group. The post-trial secondary outcomes of high-sensitive C-reactive protein, IL-18, and oxidized low-density lipoprotein levels significantly declined with cognitive-behavioral therapy in comparison with the control group. Thus, our results suggest that cognitive-behavioral therapy is effective for correcting disorganized sleep patterns, and for reducing inflammation and oxidative stress in hemodialysis patients.

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There was no evidence to show that patients with a long hospital stay would gain treatment benefits over patients with short stay. This study provides evidence to support that a structured inpatient treatment plan might gain some economic benefits without compromising treatment efficacy. The admission of hospitalization repeaters should be managed optimally based on the considerations of treatment efficacy and its impact on longer hospital stay.

Inpatient suicide rates are seldom reported using age-standardized methods. This study aimed to estimate the standardized suicide rate in a general hospital. A total of 27 suicidal patients were identified by the adverse event reports during hospitalization from 1995 to 2004. Standardized suicide mortality ratios (SMR) were examined using the Poisson regression model. The SMR of inpatient suicide was 8.25 (95% CI = 5.67-12.06). Hospital suicide rates were considerably higher than the corresponding general population rates for all age groups and were particularly high in age categories of 25-29, 30-34, 40-44, and 55-59 years after controlling for sex and calendar year. Hospitalized patients had an eight times higher risk of suicide mortality than that of the general population. While the elderly are at increased risk for suicide in the general population, young- and middle-aged patients are the age group at risk for suicide mortality during hospitalization.