Ask an answerable question (PICO)：
Uremia pruritus could affect the quality of life of hemodialysis (HD) patients and causes secondary skin infections. Studies have also confirmed that it is positively correlated with the mortality of HD patients. However, the effectiveness of traditional treatment on uremia pruritus is limited, and studies have proved that acupressure can effectively relieve uremia pruritus. The purpose of this study is to apply the evidence-based practice method to explore the effectiveness of acupressure on alleviating uremia pruritus in HD patients. The results can be used as a reference for caring for such patients.
The Method and Analysis of Literature Review：
This study established keywords and synonyms with PICO and MeSH term, and then cooperated with Boolean logic principles to systematically search for the research evidence. Databases such as Cochrane library, Embase, PubMed and CEPS were searched for literatures. A total of 93 literatures that matched the search criteria were then extracted. One randomized controlled trial study and one systematic review with meta analysis were selected for critical appraisal of the validity, relevance, and applicability of the research evidence.
Critical Appraisal：
The two studies reviewed were identified as Level 1and Level 2 according to the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence. The validity, importance and practicability were critically appraised with the use of CASP checklists. The purpose of both studies was to investigate the relief of uremia pruritus in dialysis patients after receiving acupressure. The VAS scale was used to measure the degree of pruritus before and after intervention. Both studies revealed good validities. With the aspect of importance, the RCT study showed that applying the acupressure or transcutaneous electrical acupoint stimulation 3 times per week for 4 week duration had significantly better effects (p<.05) than routine care in uremia pruritus relief. The result of SR showed that acupuncture or acupressure was effective in treatment of uremic pruritus (pooled mean difference= -1.994; 95% confidence interval, -2.544 to -1.445). It was also found that acupressure combined with other drugs had better effect in uremia pruritus relief than routine care. For the aspect of applicability, acupressure is a non-invasive approach with little adverse reaction. Its usage can also reduce the dosage use of antihistamine. Thus, the benefits of acupressure are worth the harms and costs.
Results, Conclusions and Recommendations：
According to the critical appraisal results, acupressure had better effect in uremia pruritus relief than routine care. Therefore the use of acupressure on the relief of uremia pruritus for HD patients is recommended to be translated into clinical practice.
