الفهرس 
Purpose of the studyOnly 14 pages are availabe for public view
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Abstract
When the kidneys are in renal failure, hemodialysis is a technique for extracorporeal removal of waste products like creatinine and urea, as well as free water, from the blood (Putr et al., 2022).Hyperphosphatemia is common problems in hemodialysis patients, and independently associated with high mortality risk in those patients (Hassan et al., 2019). Thirst can be a bothersome sensation for those undergoing hemodialysis, as an
excessive increase in fluid intake as a consequence of thirst will cause them to gain too much weight between dialysis sessions (Ozen et al., 2021). Increased mastication, in the form of gum-chewing, can increase flow rates decrease thirst and interdialytic Weight and some studies say that chewing gum increase the saliva production which increase the excretion of phosphorus and lead to decrease level of serum phosphate (Hassan et al., 2019(. The purpose of the current study was to examine the effect of sugarless chewing gum on clinical outcomes among patients with hemodialysis. Method: To achieve the purpose of the study a quasi-experimental research design was utilized. The study was conducted in the hemodialysis unit of Menouf General Hospital. Data were collected over a period of five months from beginning of January to the end of May 2020.• Consecutive sample of 90 adult patients of both gender were divided otherwise into three equal groups 30 patients in each (study group I, II and control group).• Study group (I): patients received flavored sugarless chewing gum for fifteen minutes three times/day along with routine hospital care (instructions about diet that rich in calcium and low in phosphorus, taken phosphorus binders and benefits of phosphorus binders in decreasing complications).• Study group (II): patients who received flavored sugarless chewing gum for fifteen minutes five times/day along with routine medical care (instruction about diet that rich in calcium and low phosphorus diet, taken phosphorus binders and benefits of phosphorus binders in decreasing complications).• Control group: patients were exposed to routine hospital care only (instruction about diet that rich in calcium and low phosphorus diet, taken phosphorus binders and benefits of phosphorus binders in decreasing complications).Instruments of the study:Three instruments were used for data collection of the current study Instrument I:-Structured Interview questionnaire (appendix II):It was developed by the researcher based on extensive and relevant literature review of consulting expertise in medical and nursing field; it was designed in English language to collect socio-demographic data. It covered the following two parts:• Part one: socio-demographic characteristics: it was designed to collect specific information of the study sample such as patient’s educational level, gender, age, and occupation etc.• Part two: knowledge assessment: it was compromised of questions to assess patient’s knowledge regarding factors that lead to end stage renal disease, dialysis, and its complications and diet that lead to decrease the serum phosphorus level and increase the calcium level. 64 Instrument II:- Dialysis Thirst Inventory (appendix III): it is a five point Likert scale, Adopted by Brand (2004) and was used to quantify the perceived thirst. The Dialysis Thirst Inventory (DTI) is a questionnaire with seven items as a thirst considered problem, period of thirst per day, presence of night thirsty, feeling of thirsty before, during and after dialysis. Instrument III:-Bio-physiological measurements (appendix IV): It was developed by the researcher to assess or measure the serum phosphorus - calcium level and interdialytic weight gain.The main findings of current study were:- Alleviating thirst, significantly decreases interdialytic weight gain and was
effective in controlling serum phosphorus level and elevation of serum calcium among hemodialysis patients (study group II who practice chewing gum five times per day more than study group I who practice chewing gum three times per day) who used chewing gum than control group Conclusions: Based on the findings of the current study, it can be concluded that using sugarless chewing gum either for three or five times/ day for fifteen minutes significantly decrease the thirst sensation through increase the salivary production that reflect amount of water consumption that consumed by patients during the day in between hemodialysis sessions subsequently; decreasing the interdialytic weight.Therefore, it was effective in controlling serum phosphorus level and elevation of serum calcium among studied groups compared to control group.Recommendations:Based on the findings of the current study; the following recommendations are derived and suggested.1. Sugarless chewing gum should be encouraged and added to the management protocol for patients undergoing hemodialysis for positive effect on, alleviating thirst sensation, help compliance to fluid restriction, control of interdialytic weight gain, controlling of serum phosphorus level consequently increase serum calcium level. 2. Further research studies using a larger sample and different geographical areas.