Effects of Integrated Indirect Forest Experience on Emotion, Fatigue, Stress, and Immune Function in Hemodialysis Patients

Background: Most hemodialysis patients may experience physiological and psychological stress. Exposure to nature has been reported to reduce psychological and physiological stress levels and improve immune function. This study aimed to investigate psychological and physiological effects of integrated indirect forest experience on chronic renal failure patients undergoing hemodialysis. Methods: As a quasi-experiment, this study employed a nonequivalent control group, repeated measurements, and a non-synchronized design. In total, 54 participants were included: 26 and 28 patients in the experimental and control groups, respectively. During hemodialysis, five types of forest therapy stimuli (visual, auditory, olfactory, tactile, and motor) were applied 3 times per week for 4 weeks during 15 min sessions. Results: Positive, but not negative, emotion measures differed between the groups after the intervention. Fatigue and physiological stress levels were significantly reduced in the experimental group, whereas no significant difference was found between the groups with respect to measures of psychological stress. Activation of both the parasympathetic and sympathetic nervous systems was similar in both groups, as was the number of natural killer cells. Conclusion: Integrated indirect forest experience may help increase positive emotions and reduce fatigue and stress levels during hemodialysis in patients with chronic renal failure.

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Effects of Integrated Indirect Forest Therapy on Emotion, Fatigue, Stress, and Immune Function in Hemodialysis Patients

10.20944/preprints202012.0560.v1 ◽

2020 ◽

Author(s):

Hyoyoung Kang ◽

Youngran Chae

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Immune Function ◽

Psychological Stress ◽

Physiological Stress ◽

Negative Emotion ◽

Hemodialysis Patients ◽

Control Group ◽

Significant Difference ◽

Stress Levels

(1) Background: Most hemodialysis patients may experience physiological and psychological stress. Exposure to nature has been previously reported to reduce the measures of psychological and physiological stress, and immune function. This study aimed to investigate psychological and physiological effects of integrated indirect forest therapy on chronic renal failure patients undergoing hemodialysis. (2) Methods: As a quasi-experiment, this study employed a nonequivalent control group, repeated measurements, and a non-synchronized design. A total of 54 participants were included: 26 and 28 in the experimental and control groups, respectively. During hemodialysis, five types of forest therapy stimuli (visual, auditory, olfactory, tactile, and motor) were applied 3 times per week for 4 weeks during 15-minute sessions. (3) Results: Positive but not negative emotion measures differed between the groups after the intervention. Fatigue and physiological stress levels were significantly reduced in the experimental group, whereas no significant difference was found between the groups on the measures of psychological stress. Activation of both the parasympathetic and sympathetic nervous systems was similar in both groups, as was the number of natural killer cells. (4) Conclusion: Integrated indirect forest therapy may help increase positive emotions and reduce fatigue and stress levels during hemodialysis in patients with chronic renal failure.

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PREVALENCE OF INTESTINAL PARASITISM AND ASSOCIATED SYMPTOMATOLOGY AMONG HEMODIALYSIS PATIENTS

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652013000200001 ◽

2013 ◽

Vol 55 (2) ◽

pp. 69-74 ◽

Cited By ~ 13

Author(s):

Frederico F. Gil ◽

Maxlene J. Barros ◽

Nazaré A. Macedo ◽

Carmelino G. E. Júnior ◽

Roseli Redoan ◽

...

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Intestinal Parasites ◽

Hemodialysis Patients ◽

Parasitic Infections ◽

Control Group ◽

Community Group ◽

Pathogenic Potential ◽

Asymptomatic Patients ◽

Significant Difference

Intestinal parasites are an important cause of morbidity and mortality. Immunocompromised individuals may develop more severe forms of these infections. Taking into account the immunity impairment in patients suffering from chronic renal failure (CRF), we will determine the prevalence and associated symptoms of intestinal parasites in these patients. Controls without CRF were used for comparison. Stool samples were collected and processed for microscopic identification of parasites using the Formalin-ether concentration method. For Cryptosporidium diagnosis, the ELISA technique was used. One hundred and ten fecal samples from hemodialysis patients were analyzed, as well as 86 from a community group used as control group. A result of 51.6% of intestinal parasites was observed in hemodialysis patients and 61.6% in the control group. Cryptosporidium and Blastocystis were the most common infections in patients with CRF (26.4% and 24.5%, respectively). Blastocystis was the most common infection in the control group (41.9%), however no individual was found positive for Cryptosporidium. Among the CRF patients, 73.6% were symptomatic, 54.3% of these tested positive for at least one parasite, in contrast to 44.8% in asymptomatic patients (p = 0.38). The most common symptoms in this group were flatulence (36.4%), asthenia (30.0%) and weight loss (30.0%). In the control group, 91.9% were symptomatic, 60.8% of these tested positive for at least one parasite, in contrast to 71.4% in asymptomatic patients (p = 0.703). A significant difference between the two groups was observed with regard to symptoms, with bloating, postprandial fullness, and abdominal pain being more frequent in the control group than in the hemodialysis group (all p < 0.05). Comparing symptomatic with asymptomatic, there was no association in either group between symptoms or the prevalence of parasitic infection, nor with the type of parasite or with multiple parasitic infections. Patients with chronic renal failure are frequent targets for renal transplantation, which as well as the inherent immunological impairment of the disease itself, results in immunosuppression by medication. For this reason, carriers of intestinal parasites with pathogenic potential can develop serious clinical complications influencing the success of transplantation. This fact, coupled with the high prevalence of intestinal parasites and the dissociation between symptoms and infection in CRF patients, suggests that the stool test should be incorporated in routine propedeutics. Furthermore, preventive measures for the acquisition of parasites through the fecal-oral contamination route should be introduced.

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PENGARUH KOMUNIKASI TERAPEUTIK TERHADAP HARGA DIRI KLIEN DENGAN GAGAL GINJAL KRONIS

Fundamental and Management Nursing Journal ◽

10.20473/fmnj.v1i1.12129 ◽

2019 ◽

Vol 1 (1) ◽

pp. 28

Author(s):

Juniyaska Hari Pratama ◽

Ninuk Dwi Kurniati ◽

Abu Bakar

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Treatment Group ◽

Healing Process ◽

Self Esteem ◽

Communication Intervention ◽

Rank Test ◽

Control Group ◽

Therapeutic Communication ◽

Significant Difference

Introduction: Chronic renal failure is clinical syndrome caused by declining renal function, lasting progressively and irreversible. Physical change due to organ function decline will affect client psychologicaly and socially. These changes cause self esteem disorder where client tend to use maladaptive coping with manifestation of frequent irritating, angry, anxiety, and depression. Therapeutic communication between nurse and client that lead to client healing process which planned in conscious, purposive manner and this activity is centered on client. Method: This research used quasi experimental. Total sample in this research was 12 clients with chronic renal failure that meet inclusion criteria grouped in two groups: treatment group and control group. Independent variable was therapeutic communication while dependent variable was self esteem. In this research data analysis used was Wilcoxon Sign Rank Test with significance α ≤ 0,05 and Mann Whitney Test with significance α ≤0,05. Result: Result obtained after therapeutic communication intervention provided was p = 0,002 where there is significant difference on client self esteem before and after therapeutic communication intervention given. Result showed that there is significant difference between treatment group and comparative group with p = 0.026. Discussion: It is concluded that therapeutic communication has effect on improving self esteem in client with chronic renal failure. Therapeutic communication helps client to express his/her feeling and problems clients self esteem were improved.

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Evaluation of the cognitive and affective status in hemodialysis patients with chronic renal failure

Medicinski pregled ◽

10.2298/mpns1808222j ◽

2018 ◽

Vol 71 (7-8) ◽

pp. 222-226

Author(s):

Aleksandra Jakovljevic ◽

Vojkan Nestorovic ◽

Mirjana Dejanovic ◽

Zoran Bukumiric ◽

Aleksandar Jakovljevic ◽

...

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Reaction Time ◽

Beck Depression Inventory ◽

Simple Reaction Time ◽

Hemodialysis Patients ◽

Cognitive Status ◽

Control Group ◽

Simple Reaction ◽

Before And After

Introduction. Hemodialysis patients with chronic renal failure, suffer from affective dysfunction to a variable extent. The aim of our study was to evaluate the cognitive and affective status in patients before and after hemodialysis. Apart from this, the goal of the study was to examine and compare the cognitive status of patients on dialysis in relation to the control group, but also in relation to laboratory parameters. Material and Methods. This research was a prospective study including 30 hemodialysis patients with chronic renal failure treated at the Department of Nephrology of the Health Center in Kosovska Mitrovica. The cognitive status of the subjects was evalueted by determining the simple reaction time to auditory and visual stimuli before and after hemodialysis sessions and using the Mini Mental Status Examination, while the affective status was evalueted by using the Beck Depression Inventory. Results. The analysis of the obtained results showed a statistically significantly lower auditory and visual simple reaction times (p = 0.014) after dialysis (p = 0.023). The results have confirmed a statistically significantly decreased simple reaction time to visual stimuli (p = 0.001), while a statistical significance (p = 0.137) was not obtained for the auditory stimuli when compared to the control group. The Mini Mental Status Examination and the Beck Depression Inventory did not indicate a significant cognitive status damage or presence of depression. Conclusion. The importance of hemodialysis in the improvement of cognitive function is clearly evident, even though the general state of cognitive status in patients on hemodialysis is lower compared to the healthy population. Evaluation of the cognitive and affective status using simple reaction time, Folstein?s Mini Mental State Examination and the Beck Depression Inventory, should be used on daily basis in hemodialysis patients.

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Omega 3 Fatty Acids Effect on the Vascular Calcification Biomarkers Fetuin A and Osteoprotegerin in Hemodialysis Patients.

10.21203/rs.3.rs-392860/v1 ◽

2021 ◽

Author(s):

Rehab H. Werida ◽

Sohaila Abou-Madawy ◽

Mohamed Abdelsalam ◽

Maged Helmy

Keyword(s):

Fatty Acids ◽

Renal Failure ◽

Chronic Renal Failure ◽

Vascular Calcification ◽

Standard Care ◽

Hemodialysis Patients ◽

Control Group ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

Fetuin A

Abstract Chronic Renal failure patients on dialysis are at a high risk of death due to vascular calcification (VC). This study aimed at investigating the effect of omega3- fatty acids on the vascular calcification biomarkers fetuin-A and Osteoprotegerin (OPG) in patients with chronic renal failure (CRF) who are undergoing hemodialysis. This prospective, open-label, controlled, parallel study included 60 hemodialysis patients who were randomized to receive either omega-3 fatty acids capsule along with their standard care of treatment (omega-3 group) or their standard care of treatment only (control group). Serum levels of fetuin-A, OPG, calcium, phosphorus, hemoglobin, parathyroid hormone (PTH), blood urea nitrogen (BUN), albumin (ALB), serum creatinine (SCr), and serum triglycerides (TG) were measured at baseline and after six months of intervention and follow-up of both groups. Significantly increased levels of fetuin-A and OPG (p<0.001) were observed in the omega-3 group six months after the intervention compared with the control group. Levels of calcium, phosphorous, hemoglobin, parathyroid hormone, BUN, albumin, SCr, and TG were not significantly changed in the omega-3 group or the control group after six months of intervention. Our study concluded that omega-3 may have a clinically beneficial effect in decreasing cardiovascular events by increasing the levels of the protective vascular calcification inhibitors fetuin-A and osteoprotegerin in chronic renal failure patients who are undergoing hemodialysis.

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Changes of Intestinal Flora and Lymphocyte Subsets in Patients with Chronic Renal Failure

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/4288739 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Yan Lv ◽

Gang Ren ◽

Xiaojun Ren

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Immune Function ◽

Lymphocyte Subsets ◽

Diversity Index ◽

Pearson Correlation ◽

Intestinal Flora ◽

Illumina Miseq ◽

Shannon Index ◽

Control Group

Objective. To explore the changes of intestinal flora and lymphocyte subsets in patients with chronic renal failure (CRF). Methods. 60 CRF patients who were treated from June 2018 to June 2019 were selected; 60 healthy persons were selected as the control group. 16S rDNA was used to detect the expression of Lactobacillus, Enterobacteriaceae, Enterococcus, Bacteroides, Clostridium, and Bifidobacterium in the feces of the two groups. Illumina Miseq sequencing (Solexa sequencing technology) method was used to analyze the structural differences and species diversity of intestinal flora, including species richness index (Chao) and diversity index (Shannon, Simpson). Flow cytometry was used to detect the levels of lymphocytes and their subgroups of the two groups. Pearson correlation analysis was used to analyze the correlation between Chao and lymphocyte subsets. Results. The number of Enterobacteriaceae and Enterococcus in CRF group were higher than those in the control group ( P < 0.05 ), while the Lactobacillus, Bacteroides, Clostridium, and Bifidobacterium were opposite ( P < 0.05 ). The Simpson index of the CRF group was lower than that of the control group, while the Chao index and Shannon index were opposite ( P < 0.05 ). The levels of CD3+, CD4+, CD8+, and CD4+/CD8+ in the CRF group were lower than those in the control group, while the levels of CD14+, CD19+, and CD16+/CD56+ were opposite ( P < 0.05 ). The intestinal flora Chao index of CRF group was negatively correlated with the levels of CD3+, CD4+, and CD8+ (r = −0.692, P = 0.019 ; r = −0.669, P = 0.021 ; r = −0.603, P = 0.028 ). The intestinal flora Chao of CRF group is positively correlated with the level of CD14+ and CD16+/CD56+ (r = 0.615, P = 0.026 ; r = 0.758, P = 0.016 ). Conclusion. There are intestinal flora disorder and the imbalance of immune function in CRF patients, which are mainly manifested in the change of intestinal flora structure, the increase of richness and diversity of intestinal flora, and the decrease of lymphocyte subgroups. There is correlation between the imbalance of intestinal colony and the imbalance of immune function.

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CHRONIC RENAL FAILURE;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.10.707 ◽

2017 ◽

Vol 24 (10) ◽

Author(s):

Noor Un Nisa Memon ◽

Santosh Kumar ◽

Bhagwan Das

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Thyroid Hormone ◽

Local Population ◽

Antithyroid Drugs ◽

Control Group ◽

Hormone Levels ◽

Significant Difference ◽

Healthy Control ◽

Thyroid Hormone Levels

Objectives: To compare thyroid hormone levels in apparently healthy individualsand un-dialyzed chronic renal failure patients in local population. Study Design: Crosssectional,descriptive, observational study. Setting: OPD patients in BMSI Biomedical ScienceInstitute of Medical Jinnah Medical Karachi. Period: June 2010 to December 2010 in BMSIJPMC, Karachi. Methods: Ninety individuals including 30 healthy control and 60 patients ofchronic renal failure were included in this study. Individuals were grouped based on severity ofdiseases (stages) as healthy (control) group and the diseased group. Patients with un-dialyzedCRF on conservative management, GFR < 60 ml/mint/1.73m2, age between 20 to 60 years inboth sexes were included in this study. Patients already taking thyroxine or antithyroid drugs,history of thyroid surgery and neck radiation and patients on maintenance haemodialysis wereexcluded. Measurement of thyroid hormone levels were done through Radio Imune Assay (RIA)method and GFR by Cock Craft Gualt formula. Results: Serum FT3 significantly low in patientswith CRF of stage III 1.27±0.12, stage IV 1.04±0.09 vs 2.80±0.09 in controls, p=0.001. TSHwas significantly high in patients of CRF as compared to control 4.41±0.87 and 3.3±0.34 vs1.97±0.16, P=0.001. No significant difference was seen in serum FT4 levels. Conclusion: Inlocal population thyroid hormone level of FT3 declines with the severity of Glomerular FiltrationRate as compare to healthy individuals. However, TSH level increases with this severity as alsoreported in other countries. Additionally, FT3 level is helpful for early detection and preventionof complications. Local population need awareness to prevent CRF by reporting to hospitalbefore stage 3.

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The Effect of Stress Management Training on Hope in Hemodialysis Patients

Global Journal of Health Science ◽

10.5539/gjhs.v8n7p165 ◽

2015 ◽

Vol 8 (7) ◽

pp. 165 ◽

Cited By ~ 4

Author(s):

Farzad Poorgholami ◽

Sareh Abdollahifard ◽

Marzieh Zamani ◽

Marzieh Kargar Jahromi ◽

Zohreh Badiyepeyma Jahromi

Keyword(s):

Renal Failure ◽

Stress Management ◽

Low Cost ◽

Management Training ◽

Training Group ◽

Hemodialysis Patients ◽

Control Group ◽

Chi Square ◽

Stress Management Training ◽

Significant Difference

INTRODUCTION: Chronic renal failure exposes patients to the risk of several complications, which will affect every aspect of patient's life, and eventually his hope. This study aims to determine the effect of stress management group training on hope in hemodialysis patients.METHOD: In this quasi-experimental single-blind study, 50 patients with renal failure undergoing hemodialysis at Motahari Hospital in Jahrom were randomly divided into stress management training and control groups. Sampling was purposive, and patients in stress management training group received 60-minute in-person training by the researcher (in groups of 5 to 8 patients) before dialysis, over 5 sessions, lasting 8 weeks, and a researcher-made training booklet was made available to them in the first session. Patients in the control group received routine training given to all patients in hemodialysis department. Patients' hope was recorded before and after intervention. Data collection tools included demographic details form, checklist of problems of hemodialysis patients and Miller hope scale (MHS). Data were analyzed in SPSS-18, using Chi-square, one-way analysis of variance, and paired t-test.RESULTS: Fifty patients were studied in two groups of 25 each. No significant difference was observed between the two groups in terms of age, gender, or hope before intervention. After 8 weeks of training, hope reduced from 95.92±12.63 to 91.16±11.06 (P=0.404) in the control group, and increased from 97.24±11.16 to 170.96±7.99 (P=0.001) in the stress management training group. Significant differences were observed between the two groups in hope scores after the intervention.CONCLUSION: Stress management training by nurses significantly increased hope in hemodialysis patients. This low cost intervention can be used to improve hope in hemodialysis patients.

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PENGARUH COACHING: SELF HEALING TERHADAP TINGKAT STRES DAN KADAR KORTISOL PADA PASIEN GAGAL GINJAL KRONIS DENGAN HEMODIALISIS

Jurnal Kesehatan Kusuma Husada ◽

10.34035/jk.v11i2.450 ◽

2020 ◽

pp. 218-226

Author(s):

Nita Arisanti Yulanda ◽

H Herman

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Stress Level ◽

Hemodialysis Patients ◽

T Test ◽

Control Group ◽

Self Healing ◽

Control Group Design ◽

Purposive Sampling ◽

Group Design

Gagal Ginjal Kronis (GGK) merupakan gangguan fungsi renal yang progresif dan irreversible yang memerlukan tindakan hemodialisis dan memiliki keterbatasan dalam kehidupannya. Keterbatasan ini mengakibatkan pasien rentan terhadap stres. Salah satu terapi self healing: mind body and spirit menggunakan do’a dan zikir mampu meningkatkan spiritual value dan mempengaruhi peningkatan kepribadian. Terapi ini mampu merubah stres negatif (distres) menjadi stres positif (eustres) dan perubahan respon biologis oleh potensi penurunan kortisol. Tujuan penelitian menganalisis pengaruh self healing terhadap tingkar stres dan kadar kortisol pasien gagal ginjal yang menjalani hemodialisis. Desain penelitian ini adalah quasy eksperimental (pre post test with control group design). Populasi penelitian adalah pasien gagal ginjal yang menjalani hemodialisis di dua Rumah Sakit yang berbeda di Kalimantan Barat namun memiliki tipe yang sama, yaitu tipe B. Jumlah sampel 40 responden yang terbagi menjadi 2 kelompok (intervensi dan kontrol) masing – masing kelompok penelitian terdapat 20 responden yang sesuai dengan kriteria inklusi penelitian. Tehnik pengambilan sampel menggunakan purposive sampling. Pengumpulan data menggunakan instrumen DASS 42 dan pengukuran kadar kortisol dengan Elisa Kit. Hasil uji Independent T-test kedua kelompok pada variabel tingkat stres memiliki hubungan bermakna (p=0,004) sedangkan pada kadar kortisol memiliki hubungan tidak bermakna (p=0,148). Terdapat pengaruh self healing pada tingkat stres pasien hemodialisis. Sebagai seorang perawat dalam melaksanakan asuhan keperawatan juga harus memperhatikan kebutuhan spiritual klien yang mampu menurunkan tingkat stres klien selama perawatan di rumah sakit. Chronic Renal Failure (CRF) is a progressive and irreversible renal function disorder that requires hemodialysis and CRF patients have several life limitation which make them vulnerable to stres. The self healing treatment:mind body and spirit therapy using prayers can increase spiritual value and influence personality improvement so that it changes negative stress (distress) to positive stress (eustress) and changes in biological responses by the effect for decreased cortisol. The purpose of the study was to analyze the effect of self healing on stress level and hemodialysis patient levels of cortisol in chronic renal failure patients. The design of this study is quasy experimental pretest-posttest with control group design. The population was hemodialysis patients in Hospitals Type B in West Kalimantan. The number of sample was 40 respondents who were divided into 2 groups (intervention and control). Purposive sampling technique was used to select the respondents. Data collection used DASS 42 instrument and measurement of cortisol levels. The results of the independent t-test of two groups on the stress level variable had a significant relationship (p = 0.004) whereas on cortisol levels the relationship was not significant (p = 0.148). There is a significant effect of self healing therapy on the stress level of hemodialysis patients. As a nurse in carrying out nursing care must also consider the spiritual needs of clients who are able to reduce the level of client stress during treatment in the hospital.

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Recommend a simple, sustained and sufficient perioperative calcium regulation therapy and analysis of related factors during perioperative period for secondary hyperparathyroidism

10.21203/rs.3.rs-41873/v2 ◽

2020 ◽

Author(s):

WeiBin Zhang ◽

Jia Dong ◽

YunFei Wu ◽

Bin Zheng ◽

Jin Dai ◽

...

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Secondary Hyperparathyroidism ◽

Calcium Regulation ◽

Control Group ◽

Observation Group ◽

Blood Calcium ◽

Regulation Scheme ◽

Preoperative Serum ◽

Significant Difference

Abstract Background: Patients of secondary hyperparathyroidism (SHPT) with chronic renal failure treated by long-term dialysis have received surgical treatment. The severe complications, especially severe hypocalcemia, would endanger lives during perioperative treatment. Therefore, this study aims to recommend a simple, sustained and sufficient perioperative calcium regulation scheme, and analysis of preoperative related indicators, the patient's condition for a preliminary assessment, thus guiding the postoperative calcium regulation, to avoid the occurrence of serious complications.Methods: We reviewed the clinical data of 136 patients with chronic renal failure in uremic stage, who received dialysis treatment for a long time and finally diagnosed as SHPT, from Jan 2017 to Dec 2019, were accepted different operations to treat hyperparathyroidism, were given corresponding calcium regulation therapy to avoid serious complications, and were divided into the observation group and the control group according to the mean time of postoperative calcium regulation time.Results: According to the median time of adjusting the pump calcium(7.67 + 2.823)d, the patients were divided into two groups: the observation group (≤7d) and the control group (> 7d). Compared with the control group, the observation group were elder (54.01±9.215, P<0.01), shorter preoperative dialysis time (5.05±2.855, P<0.01), significant difference in operation mode (P=0.026), positive preoperative oral calcium(c2=9.941, P=0.002), higher preoperative calcium value (t=4.795, P<0.001), lower preoperative Parathyroid Hormone(PTH) value (t=6.327, P<0.001), lower preoperative Alkaline phosphatase (ALP) value (t=3.527, P=0.001). Multivariate analysis showed that age, preoperative calcium value, preoperative PTH value and preoperative ALP value were independent risk factors for postoperative calcium regulation therapy. Those factors, Gender, preoperative dialysis mode, complications, preoperative Hemoglobin(HB) value, were not related to postoperative calcium regulation. There was no significant difference between the two groups (P>0.05).Conclusion: The simple, sustained and sufficient calcium regulation scheme can maintain a stable level of blood calcium in SHPT, and be able to avoid the occurrence of severe hypocalcemia and increase the curate. Especially for the younger, the lower preoperative serum calcium, the higher blood PTH and ALP, should lengthen the calcium pump time appropriately, until the right time and stop the medicine. This is more safe.

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