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Introduction: Patients undergoing hemodialysis require direct and continuous care. Identifying the barriers to and factors facilitating hemodialysis care can improve care quality. Objectives: The aim of this study was to assess the barriers and facilitators of care for hemodialysis patients. Patients and Methods: This study was conducted as a qualitative study and it utilized content analysis approach. The study was performed in hemodialysis ward of Kowsar hospital in Semnan, in 2014. We used purposive sampling method with maximum diversity. Semi-structured interviews with open questions were used to collect data from a total of 20 participants. Results: The main topic of health care challenges was divided into two main categories, including the facilitators and barriers of hemodialysis care. The facilitators of hemodialysis care had four subcategories, including "intimate relationship", "basic knowledge", "hemodialysis skills", and "experience". The category of barriers had eight subcategories, including "shortage of nurses and heavy workload", "weak authority of the head nurse", "ignorant director of nursing", "shortage of nephrologists", "lack of vascular surgery expert", "lack of nurse’s aide and nursing assistant ", "unskilled staffs", and "interference by patients’ caregivers". Conclusion: The findings of this study showed that access to human resources and their abilities were among the factors facilitating care. However, lack of qualified medical staff at each level of care delivery was one of the barriers to hemodialysis care. Hence, it is of great importance for policy makers, managers, and program designers to recruit human resources who have the characteristics and competencies required for providing hemodialysis care.

BackgroundNephrolithiasis is a widespread multifactorial disorder. Constitutional, environmental and genetic factors play a role in stone formation. Although important advances have been made in understanding the pathophysiology of stone formation, none of the many theories have given a satisfactory explanation of this process.ObjectivesThe objective of study was to evaluate the probable relationship between cigarette smoking and nephrolitiasis in adult men.Patients and MethodsA total of 102 cases diagnosed with nepholithiasis and 121 age-matched healthy controls were recruited from June 2010 to September 2011. Smoking status and resultant data was obtained from both groups.ResultsTwenty seven (26.5%) of the patients with stones and eighteen (14.9%) of the control group were current cigarette smokers. Our findings showed that smoking significantly increases the risk of nepholithiasis (OR = 2.06, 95% CI: 1.06-4.01, P = 0.034). There was no significant difference in the number of cigarettes smoked (P = 0.830) and years of smoking (P = 0.536) between subjects with and without stones (P = 0.536).ConclusionsThis study suggests that cigarette smoking might be an independent risk factor for the development of nephrolithiasis.

The current study was conducted to assess the effects of vitamin D supplementation on insulin metabolism, lipid fractions, biomarkers of inflammation, and oxidative stress in diabetic hemodialysis (HD) patients. This randomized double-blind placebo-controlled clinical trial was carried out among 60 diabetic HD patients. Subjects were randomly allocated into two groups to intake either oral vitamin D3 supplements at a dosage of 50 000 IU (n=30) or placebo (n=30) every 2 weeks for 12 weeks. After 12 weeks of intervention, subjects who received vitamin D supplements compared with the placebo had significantly decreased serum insulin concentrations (-3.4±3.7 vs. +2.0±4.2 μIU/ml, p<0.001), homeostasis model of assessment-estimated insulin resistance (HOMA-IR) (-1.2±1.8 vs. +0.9±2.3, p<0.001), and improved quantitative insulin sensitivity check index (QUICKI) (+0.02±0.03 vs. -0.01±0.02, p<0.001). In addition, compared with the placebo, vitamin D supplementation led to significant reductions in serum high-sensitivity C-reactive protein (hs-CRP) (-1.4±2.5 vs. +1.4±4.8 mg/l, p=0.007), plasma malondialdehyde (MDA) (-0.1±0.2 vs. +0.1±0.2 μmol/l, p=0.009) and a significant increase in plasma total antioxidant capacity (TAC) concentrations (+33.8±56.7 vs. -2.0±74.5 mmol/l, p=0.04). We did not see any significant effect of vitamin D supplementation on lipid profiles and other biomarkers of inflammation and oxidative stress compared with the placebo. Overall, we found that vitamin D supplementation had beneficial effects on serum insulin, HOMA-IR, QUICKI, serum hs-CRP, plasma MDA, and TAC levels among diabetic HD patients for 12 weeks. CLINICAL REGISTRATION:: http://www.irct.ir: IRCT201611155623N92.

Background:Overweight and obesity have become a global public health over the last decades. Obesity has been suggested to be a risk factor for some infections, but studies often showed controversial findings. Few studies examined the relationship between body mass index (BMI) and urinary tract infection (UTI), showing inconsistent results.Objectives:The purpose of this study was to determine the relationship between BMI and UTI in adult patients.Patients and Methods:Adult patients (≥ 18 years old) who were referred to clinics or admitted in hospital with diagnosis of UTI were considered for participation in the study. Control group were selected from healthy adult normal population whom underwent medical check-ups at the same hospital and without history of UTI. Data about age, gender, history of diabetes mellitus and BMI were registered for individuals who met inclusion criteria.Results:A total of 116 patients with UTI and 156 people as the control group were included in the study. Two groups were matched for age, gender and history of diabetes mellitus. Mean BMI ± SD of patients was 25.2 ± 4.0 kg/m2 and the controls was 25.1 ± 3.6 kg/m2. There was no significant correlation between BMI and UTI (P = 0.757). Mean BMI ± SD of patients with upper UTI was 25.6 ± 4.1 kg/m2 and for lower UTI was 24.9 ± 4.0 kg/m2. There was no significant difference between BMI of controls and patients with any type of UTI (P = 0.573).Conclusions:Our findings did not found an association between BMI and UTI and does not support obesity as a risk factor for UTI in adult patients.