Ask an answerable question (PICO)：
According to USRDS Annual Data Report, the incidence and prevalence of End Stage Renal Disease(ESRD) in Taiwan has been ranked among all over the world in these years. When disease is progressing or worsening, the ESRD patients will get severe physical problems. And other studies have found an inverse correlation between severe physical problems and quality of life. In clinical practice, we find many ESRD patients undergoing hemodialysis express an experience of thirst. Thirst is one of the important and commonly observed symptom. However, the effectiveness of traditional treatment like applying ice cubes on thirst is limited. And some scholars pointed out that the salivary glands could also be stimulated by chewing gum to increase saliva flow. Therefore, the purpose of this study is to apply the evidence-based practice method to explore the effects of chewing gum to relieve thirst in hemodialysis patients. The results can be used as a reference for providing practical care to patients.
The Method and Analysis of Literature Review：
We sought to summarize results of all published studies of treatments with established keywords and synonyms with PICO and MeSH term, and then cooperated with Boolean logic principles. The search strategy was tailored for each medical databases: Cochrane Library, PubMed, MEDLINE, CINAHL, Embase, Airiti Library(CEPS). Additionally, there are some restrictions were placed on the search, like language(English), publication date(2010~2021), age(adult), non-randomized controlled trials(RCTs) and non-systematic reviews(SR). After all, two RCTs study was selected for critical appraisal.
Critical Appraisal：
The study was identified as Level 2 according to the 2011 Oxford CEBM 2011 Levels of Evidence. The validity, importance and practicability were critically appraised with the CASP checklists. The purpose of this study was the effects of chewing gum to relieve thirst in hemodialysis patients. And the data were collected with the Visual Analogue Scale (VAS) and saliva samples before and after intervention. After the following for 2~3 months, the results showed that applying chewing gum was statistically significantly better than routine care in thirst relief. Apart from the higher salivary flow rate, there are more benefits like the compliance with fluid control, no change in interdialytic weight gain.
Results, Conclusions and Recommendations：
In short, chewing gum had better effect in thirst relief than routine care. These two studies were conducted with patients who had been treated with sessions 3 days a week for 4 hours at two HD units, and gum was chewed for 10 minutes six times a day, three of them are performed after the main meal, the rest are when thirsty, lasts one month. Accordingly, the use of chewing gum will raise nurses’ awareness and recommended to be clinical interventions to prevent or treat thirst.
