Background Older patients with end-stage renal disease (ESRD) have experienced diminished quality of life and debilitating symptoms. Conservative management may be a potential treatment option. Currently, limited studies have been conducted about the main outcome of conservative management, including quality of life, symptoms and sleep quality. The aim of this systematic review was to examine the quality of life, symptoms and sleep quality of elderly patients with ESRD undergoing conservative management. Methods Evidence-based medicine database (JBI and Cochrane) and original literature database (PubMed, Medline, EMbase, Web of Science) were searched up to March 12, 2018. The quality of included papers was evaluated with the Newcastle-Ottawa Scale. Results Eight studies met the inclusion criteria. The total of 1229 patients were involved with an average age of 60.6 ~ 82 years. Patients choosing conservative management were older and more functionally impaired compared to those opting for dialysis. 55% patients undergoing conservative management had stable or improved quality of life and symptoms in prospective cohort study. However, the results revealed that there were no significant differences in quality of life and symptom between conservative management and renal replacement therapy. Only one study assessed quality of life of older patients using SF-36, with a lower score in physical health subscale of conservative management patients than those of renal replacement therapy. Although more than 40% of the patients had poor sleep quality, no significant difference was found between conservative management and renal replacement therapy. Sleep disorders were associated with fatigue and other symptoms. Conclusions Although there is a limited literature, conservative management is likely to improve quality of life and alleviate symptoms of end-stage renal disease patients with considerable clinical implications mainly in elderly patients. Future study should pay more attention to the various treatment outcomes of conservative management, providing abundant evidence. Electronic supplementary material The online version of this article (10.1186/s12955-019-1146-5) contains supplementary material, which is available to authorized users.
Aim To examine the effects of a transtheoretical model‐based WeChat health education programme on self‐management in haemodialysis patients in China. Design A longitudinal experimental intervention study. Methods Patients (N = 120) who underwent haemodialysis from December 2015–November 2017 were recruited and randomly allocated to either group 1 (who received a 3‐month WeChat health education immediately after randomization) or group 2 (who was combined with group 1 and received the same intervention at the 5th month after enrolment in the study). Self‐management, knowledge and self‐efficacy were assessed at baseline (T0), 3 months after enrolment in the study (T1), 21 months after enrolment in the study (T2). Results There were significant group effects on self‐efficacy; time effects on partnership, self‐care, emotion management with total self‐management; interaction effects on problem‐solving and emotion management within total self‐management according to the two‐way repeated measures ANCOVA. Further between‐group comparisons indicated that patients in group 1 had better self‐management than those in group 2 at T1. Within‐group comparisons demonstrated that, compared with the baseline values, group 1 had significantly improved self‐management at T1; however, group 2 had improved self‐management at T2. Conclusion The transtheoretical model‐based WeChat health education programme had a potentially positive effect on improving the self‐management of haemodialysis patients. Impact Self‐management is often difficult yet crucial for haemodialysis patients. This study indicated that the transtheoretical model‐based WeChat health education resulted in improved self‐management in haemodialysis patients and can be implemented in continuing care during the interdialysis period to improve self‐management in patients. Trial registration: ChiCTR1800018172.
Self-management in hemodialysis patients is critical; however, is generally low. This study aimed to examine the effects of a theory-based micro-video health education program on the improvement of self-management, hemodialysis knowledge, and self-efficacy in hemodialysis patients. A pre-test post-test control group quasi-experimental design was used to recruit 80 hemodialysis patients in a dialysis center. The participants were assigned in a 1:1 ratio to receive routine care or a 3-month micro-video health education program. Between-group comparison showed that patients in the intervention group had significantly greater improvement in hemodialysis knowledge than those in the control group ( p < .05). However, no significant group differences were observed in terms of self-management and self-efficacy. Within-group comparison showed that the overall self-management level of patients in both groups improved significantly, particularly in problem-solving skills and self-care dimensions. Therefore, micro-video health education can improve the self-management and hemodialysis knowledge in Chinese patients undergoing hemodialysis. Trial Registration: Registered at ClinicalTrials.gov with study number (ChiCTR1800018172; http://www.chictr.org.cn/index.aspx ).
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