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Background & Aim: Hemodialysis centers are highly susceptible to nasocomial infections due to application of hemodialysis machines, medical equipment, and invasive techniques and devices. This research was carried out in order to evaluate methods of infection control using by staff of hemodialysis centers.

Methods & Materials: In this descriptive study, all hemodialysis units in hospitals of Tehran University of Medical Sciences (n=4) were studied. Data were gathered using a 3-section questionnaire as well as five series of check-lists that were designed to evaluate physical characteristics of the units, methods of disinfection processes of the units, hemodialysis machines, and common equipment, and finally precaution measurements using by the staff. Data were described using SPSS statistical software.

Results: Research findings showed that just one of the study units was appropriate regarding physical characteristics of the units. Method of disinfection of hemodialysis centers was appropriate in 50 per cent of the study units and it was relatively appropriate in the rest. Disinfection of hemodialysis machines was appropriate in all units. Regarding disinfection of the shared equipment, all units were relatively appropriate. In 25 per cent of the units, staff had relatively appropriate precaution measurements and the rest (75 per cent) had inappropriate measurements.

Conclusion: Results showed that the methods of infection control using by the staff of hemodialysis centers in hospitals of Tehran University of Medical Sciences were not appropriate.

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Background & Aim: Physical and psychosocial problems along with the changes in life style, put hemodialysis patients under pressure. It seems that social support decreases psychological stresses and improves quality of life. This study aimed to describe hemodialysis patients&apos perceptions on their social supports and related factors.

Methods & Materials: This descriptive-correlational study is a part of a larger study. All patients (n=202) referred to the hemodialysis units of Iran University of Medical Sciences were recruited to the study during a four-months period. Data were collected using "Personal Resources Questionnaire" (PRQ 85-PART 2) and analyzed using SPSS v.14.

Results: Findings revealed that the most patients (64.9%) had perceived social support at high levels. There were significant relationships between social support with economic status, gender and marital status (P<0.05). Findings also indicated that the statements of "I enjoy doing little extra things that make another person&aposs life more pleasant" and, "I belong to a group in which I feel important" had the highest and lowest scores respectively.

Conclusion: Regarding the variety of perceptions in hemodialysis patients on social support and its related factors, nurses can prevent social isolation of these patients through identification of high risk groups and can also reduce their stresses and help them to improve their quality of life by providing adequate supportive interventions.

 

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Background & Aim: Intradialytic hypotension is the most frequent complication in patients receiving haemodialysis (HD). This complication not only contributes to the illness of the patients, but also decreases the efficacy of the HD. So, hypotension prevention is a major challenge for medical team, especially for nurses. One of the preventive methods that have recently been presented is the use of sodium profile and ultra filtration (UF) profile. The aim of this study was to compare the effects of linear sodium + UF profile (type1) with stepwise sodium + UF profile (type3) on systolic and diastolic blood pressure in HD patients.

Methods & Materials: In this crossover design study, 26 HD patients from two dialysis centers at Esfahan University underwent three kinds of treatment: (1) control, constant dialysate sodium concentration of 138 mmol/L with constant UF (2) linear sodium profile + UF profile (type1), a linearly decreasing dialysate sodium concentration (146-138mmol/L) in combination with a linearly decreasing UF rate and (3) stepwise sodium profile + UF profile (type2), a stepwise decreasing dialysate sodium concentration (146-138 mmol/L) in combination with a stepwise decreasing UF rate. Each treatment was applied in three dialysis sessions. Data were analyzed using repeated measure ANOVA test in the SPSS.

Results: Twenty six patients participated in the study. A total of 234 dialysis sessions were analyzed. There were no significant differences in the systolic blood pressure between three groups during predialysis and first and the second hours (P>0.05). The mean of systolic blood pressures were higher in the third hour and postdialysis during two types of profiles (1&3) compared with the routine care group (P<0.05). The mean of diastolic blood pressure was also higher in postdialysis during two types of profiles (1&3) compared with the routine group (P<0.05). There was no significant difference between the profiles 1and 3 (P>0.05).

Conclusion: In conclusion, sodium profile + UF profile is a simple and cost-effective method that modulate the dialysate sodium and ultra filtration rate and preserve the homodynamic status and blood pressure of patients during dialysis. Therefore, using sodium profile + UF profile (type1 & type3) is recommended in order to prevent hypotension and reduce nursing work during hemodialysis process.

 

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Background & Aim: Hemodialysis patients have reduced physical capacity for various reasons resulting in increased dependence on others. The aim of this study was to investigate the effect of a designed exercise program on physical capacity using the Six-Minute Walking Test (6MWT) in hemodialysis patients.

Methods & Materials: In a quasi-experimental design, 25 hemodialysis patients were selected conveniently from three hospitals of Tehran. The patients in the experimental group (n=12) followed a designed exercise program three days per week, which lasted for 8 weeks. The participants in the experimental group had to exercise for 20 minutes immediately after dialysis sessions followed by a 10-minute bed rest and deep slow breaths, with their eyes closed. The control group (n=13) did not receive any treatment. Descriptive and inferential statistics were applied for data analysis using SPSS-18.

Results: The difference in the means of the 6MWT was not statistically significant at the start and end of the fourth and eighth weeks of the exercise program in both groups. However, comparison of these values in the experimental group before and after the intervention was clinically significant, although not statistically significant.

Conclusion: In this study, physical capacity increased after performing the exercise in the experimental group, but this value was not statistically significant. Further studies are recommended in the field.

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Background & Aim: Hemodialysis is a common replacement therapy for patients with ESRD, worldwide. Effective and adequate hemodialysis can improve quality of life and reduce complications of renal failure. Enhancing quality of dialysis results in reducing the complications and mortality rate in patients with chronic renal failure. The aim of this study was to assess the adequacy of dialysis in patients undergoing dialysis with Bicarbonate solution in hemodialysis ward of a hospital in Sary.

Methods & Materials: This cross-sectional study was conducted on 50 patients admitted in the hemodialysis ward with chronic renal failure diagnosis. A researcher-made questionnaire was used to gather data. The KT/V formula was used to assess the adequacy of hemodialysis. The URR common characteristic was also measured. Data were analyzed using statistical tests.

Results: The mean age of patients was 54.76±12.55 years. The mean of KT/V and URR were 0.26±0.92 and 0.47±0.09, respectively. The kt/v ratio was lower than 1.2 in 85.2% of the patients and the URR was lower than 65% in 97.8% of the patients.

Conclusion: The hemodialysis adequacy was low in 85.2% of the patients in the hospital and the hemodialysis efficacy indicators were lower than the standard measures. Assessment to find the reasons of low efficacy of hemodialysis is recommended.

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  Background & Aim: Patients with end-stage renal disease undergoing hemodialysis are repeatedly exposed to stress and pain from approximately 300 punctures per year to their arteriovenous fistula . Patient comfort with the procedure is therefore of greatest importance for long-term compliance with the treatment and until a successful renal transplant. This study was conducted to determine the effect of rhythmic breathing on pain intensity when the needles are inserted into vascular access for hemodialysis .

  Methods & Materials: This was a quasi -experimental one-group time-series study. Thirty five patients in hemodialysis ward of Hamadan Besat hospital entered into the study via convenient sampling method. In this study, pain intensity during the insertion of hemodialysis vascular needles was measured in six sessions through two methods of routine intervention and rhythmic breathing. The data were collected using visual analog scale. Paired t-test was used to determine pain intensity mean difference between the two conditions . 

  Results: Overall, the results showed that the mean pain intensities were 5.45±1.15 and 2.19±0.92 in two conditions including routine intervention and rhythmic breathing , respectively. Paired t-test showed a significant difference between the routine intervention and rhythmic breathing (P<0.001) .

  Conclusion: These findings showed that rhythmic breathing was effective in reducing pain when the needles were inserted into the vascular access. Therefore, it is recommended to use rhythmic breathing as a simple and non-expensive method to reduce pain in patients before insertion of hemodialysis vascular needles .

  

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  Background & Aim: Medication usage is the bases of disease management in patients who undergo hemodialysis. Non-adherence to medication regimen increases the incidence of complications among the patients . The aim of this study was to investigate the effect of a cognitive-behavioral intervention on medication adherence in patients undergoing hemodialysis .

  Methods & Materials: In this clinical trial, 70 patients were selected from Imam Reza and Valiasr hospitals. Patients were assigned into two intervention (n=35) and control (n=35) groups. The intervention group received a cognitive-behavioral intervention including six steps: 1) Identifying the problem 2) Creating confidence and commitment 3) Increasing awareness of behavior 4) Developing and implementing the action plan 5) Evaluating the plan and 6) Maintaining the desired behavior. Adherence to medication regimen was assessed using a self-report questionnaire before and immediately after the intervention. Data were analyzed using the independent t-test . 

  Results: At baseline, there was no significant difference in adherence to medicine regimen between the intervention (20.77 ± 4.56) and control (22.34 ± 3.65) groups (P=0.1). After the intervention, significant difference was observed between the two groups in adherence to medication regimen (P<0.001) .

  Conclusion: Cognitive–behavioral intervention could improve medication adherence in patients undergoing hemodialysis. It is recommended for nurses to use this approach to improve medical care among the patients .

  

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Background & Aim: Restless leg syndrome (RLS) is one of the common complications in patients under treatment with hemodialysis. Progressive muscle relaxation is a method which has been designed for reducing patients’ stress, pain and anxiety. The present study aimed to determine the effect of progressive muscle relaxation on the severity of RLS in hemodialysis patients.

Methods & Materials: In this quasi-experimental study (IRCT2015102824769N1), 74 hemodialysis patients were selected by convenience sampling method and divided into intervention and control groups based on records numbers. The intervention group was trained in progressive muscle relaxation technique in two half-hour sessions and they were asked to practice it twice a day for one month. RLS severity was measured using the standardized RLS questionnaire. Data were analyzed by descriptive and inferential statistical tests (independent and paired t-test, analysis of co-variance) using SPSS software version 23.

Results: There was no significant difference in the distribution of variables in the intervention and control group before intervention (P>0.05). Before the intervention, RLS severity score was 28.24±7.33 in the intervention group and 25.57±9.85 in the control group (P=0.189). After the intervention, the score for the intervention group was reduced to 10.67±5.66 (P>0.001) while there was no significant change in the control group after the intervention (26.16±9.69). Also, a significant difference was observed between the two groups in the mean score of RLS severity after removing the effect of RLS severity on pretest (P>0.0001).

Conclusion: The use of progressive muscle relaxation technique reduces RLS severity in patients under treatment with hemodialysis. Therefore, this technique is recommended to be used as one of the non-pharmacological methods to improve RLS in these patients.

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Background & Aim: Concerns about death may negatively affect health-related quality of life. However, little is known about the relationship between death anxiety and quality of life in life-threatening illnesses especially in hemodialysis patients. This research aimed to determine the relationship between death anxiety and quality of life in hemodialysis patients.

Methods & Materials: In this descriptive correlational study, 200 hemodialysis patients were selected via stratified random sampling from hospitals affiliated with Zanjan University of Medical Sciences from April to May 2016. Data collection instruments included a demographic questionnaire, the Templer Death Anxiety Scale and the McGill Quality of Life questionnaire. Data analysis was performed by descriptive statistics, correlation test and linear regression model using SPSS v.22.

Results: The average score of death anxiety and quality of life were respectively 46.54±10.85 and 82.55±19.01. There was not a significant relationship between death anxiety and quality of life (P>0.05, r=0.044). In the regression analysis, gender was the only significant predictor for death anxiety. This model explained 11.3% of the variance of death anxiety. Moreover, the results of regression model indicated that social support and religious beliefs were only significant predictors for quality of life in hemodialysis patients, and 17.2% of its variance was explained by this model.

Conclusion: In the current study, no significant relationship was observed between death anxiety and quality of life in hemodialysis patients. Therefore, it is suggested that further research should be conducted in this area.

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Background & Aim: Promoting hope in hemodialysis patients is very important. Various methods have been suggested in order to raise hope in patients with chronic diseases. The aim of this study was to investigate the effect of an illness perception-based intervention on hope in patients with hemodialysis.
Methods & Materials: This is a randomized clinical trial (IRCT2016103130609N1) on 120 hemodialysis patients admitted in the dialysis department of Bou Ali Sina hospital in Qazvin from December to February 2016. The samples were randomly assigned into control and intervention groups. Before the intervention, questionnaires including demographic information, the Herth hope scale and a summarized form of illness perception were completed. The intervention group received the illness perception-based intervention in three sessions of 30 minutes each, prior to hemodialysis. Four weeks later, the Herth hope scale and illness perception questionnaire were re-completed by the both groups. Data were analyzed by descriptive statistics, t-test and ANCOVA using the SPSS software version 23.
Results: Results showed no statistically significant differences in hope scores between the two groups (P=0.5589) but after the intervention, hope scores significantly increased in the experimental group (36.54±2.98) compared to the control group (33.88±3.76) (P<0.001).
Conclusion: The result of the present study indicated the illness perception-based intervention was effective in enhancing hope in the patients underwent hemodialysis. Therefore, this intervention is recommended for hemodialysis patients.
 

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Background & Aim: Spiritual care along with other nursing interventions balance body and soul. This study aimed to determine the effect of spiritual care on death anxiety in hemodialysis patients with end-stage of renal disease.
Methods & Materials: A clinical trial (IRCT2016308226961N1) was performed in Hamadan’s Shahid Beheshti and Besat hospitals in 2016. A total of 60 hemodialysis patients with end-stage of renal disease were randomly assigned into two groups of intervention (30 patients) and control (30 patients). In the intervention group, the spiritual care program consisted of protective care, supporting the patient’s rituals and using the support systems, was performed in hemodialysis ward at the patient’s bedside. The control group only received routine nursing care. The Templar’s death anxiety questionnaire was completed by both groups before and after the intervention. Data were analyzed by descriptive and inferential statistics using the SPSS software version 16.
Results: The average score for death anxiety before the intervention between the intervention group (8.10±2.26) and control group (8.53±2.47) had not significant difference (P=0.482), while the average score for death anxiety after the intervention had statistically significant difference (P=0.004) between the intervention group with median value of 8.0 (6.00-8.25) and control group with median value of 9.0 (7.00-10.25), and the patients’ death anxiety reduced in the intervention group.
Conclusion: Spiritual care program reduced death anxiety in hemodialysis patients with end-stage of renal disease. Nurses can use spiritual care program to reduce patients’ death anxiety.
 

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Background & Aim: One of the important issues that affects the quality of hemodialysis is recirculation. Some researchers have suggested that the direction and distance of needle cannulation can affect the amount of recirculation. Therefore, this study aimed to investigate the effect of direction and distance of needle cannulation on recirculating of arteriovenous fistula in hemodialysis patients.
Methods & Materials: This clinical trial was performed on patients referred to the dialysis ward of Kamkar-Arabnia hospital affiliated to Qom University of Medical Sciences in 2016. The amount of recirculation was measured in 22 patients by urea based method, in four consecutive sessions. In each session, the distance and direction of the needles were three centimeters in opposite direction, three centimeters in same direction, six centimeters in opposite direction, and six centimeters in same direction. Data were analyzed using Stata and GEE test.
Results: The average age of participants was 53(16±0.75) years. In 41 dialysis cases (out of 88), the amount of recirculation was higher than 10%. The odds ratio for more than 10% recirculation for a distance of three centimeters compared to six centimeters was 2.05 (1.07-3.93) and for same direction compared to opposite direction was 1.98 (1.03-3.78).
Conclusion: The results of this study showed that the insertion of needles at a distance of six centimeters in opposite position had the lowest chance of recirculation. Therefore, the attention to proper insertion of needles can be effective in reducing recirculation and increasing the quality of dialysis.
Clinical trial registry: IRCT2016082929581N1
 

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Background & Aim: Providing self-care education to patients and their family leads to improvement in the quality of life and increase in participation in self-care programs. The aim of this study was to compare the effect of education by peer and nurse on self-care in hemodialysis patients.
Methods & Materials: In this quasi-experimental study, 105 hemodialysis patients from three selected hospitals in three cities of Isfahan province (Zarinshahr, Falavarjan and Mobarakeh) were selected by the simple random sampling method from February 2016 to September 2016. Three centers were randomly assigned to three groups including education by peer, education by nurse and control. The individual face-to-face education was provided by the peer or the nurse to hemodialysis patients, and the control group only received routine education. Data gathering tool was the hemodialysis patients’ self-care questionnaire which was completed for three groups before and one month after education. The data were analyzed using the SPSS software version 18 through Chi-square test, paired t test, the analysis of variance and Tukey’s post-hoc test at the significance level of P<0.05.
Results: There were no significant differences between the three groups in age, duration of dialysis, gender, and level of education (P>0.05). The Tukey’s multiple comparisons tests showed that the effect of nurse intervention on self-care improvement was significantly more than peer intervention and the control group (P<0.001) and also the effect of peer intervention on self-care improvement was significantly more than the control group (P<0.001).
Conclusion: Education by a nurse is effective in the self-care behaviors of hemodialysis patients and will improve these behaviors. Also, using peer experiences has advantages for hemodialysis patients such as easy, low-cost and effective education, based on life experiences and lack of need for special equipment.
 

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Background & Aim: Self-care plays an important role in the management of care for patients with chronic renal failure. In order to provide effective education, it is necessary to identify problems, concerns and challenges in this group of patients. The aim of this study was to explore the challenges of self-care in the patients undergoing hemodialysis.
Methods & Materials: This study is part of a research project on adherence to treatment regimen in hemodialysis patients referred to hospitals affiliated to Tehran University of Medical Sciences in 2019. Patients with the highest and lowest mean (SD) scores of self-care were selected by the purposeful sampling method and finally, 22 in-depth semi-structured interviews were performed with 18 interviewees. All data were recorded, transcribed and analyzed using the conventional content analysis approach proposed by Graneheim and Lundman.
Results: Findings from the data analysis included four categories: "the mismatch between the view of patient and the view of nurse", "missing loop training", "culture: a double sword ", and "dual role of religious beliefs".
Conclusion: The results of the present study showed that patients undergoing hemodialysis faced many challenges in self-care. They had difficulty in understanding the meaning of self-care and its implications. There is a need to plan for educating these patients and also changing their religious and cultural beliefs.
 

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Background & Aim: Dialysis headache is one of the most common complications of hemodialysis and is often a challenge for nephrologists, neurologists and headache specialists. Therefore, this study was conducted to investigate the effect of inhalation aromatherapy using lavender on the severity of headache in hemodialysis patients.
Methods & Materials: In this randomized clinical trial, 82 patients from hemodialysis wards of Golestan Hospital in Ahvaz and Shahidzadeh Hospital in Behbahan in 2019 were selected and randomly assigned to either intervention or control groups using the stratified permuted block randomization. For the intervention group, cotton soaked in three drops of lavender essential oil 20% was attached to the collar of the patient and he/she was asked to inhale it for 30 minutes. For the control group, distilled water was used. The intervention was repeated for four weeks (three days per week). The severity of dialysis headache was measured using the Numeric Rating Scale.
Results: In the intervention group, both the severity and the frequency of dialysis headache decreased during 12 sessions of aromatherapy, compared to the control group (placebo), and the decrease was statistically significant (P˂0.001).
Conclusion: Due to the fact that complementary medicine has increasingly become a part of nursing care, aromatherapy with lavender can be used as a complementary measure reducing the severity and frequency of dialysis headaches.
Clinical trial registry: IRCT20190718044263N1
 

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Background & Aim: Fatigue and sleep disorders are the most common physical complaints in hemodialysis patients. It seems necessary to find effective, low-complication and cost-effective treatments to alleviate these problems. The aim of this study was to examine the effect of slow-stroke back massage on the level of fatigue and sleep quality in hemodialysis patients.
Methods & Materials: In this randomized controlled trial, 82 hemodialysis patients hospitalized in Shahid Beheshti hospital in Abadan in 2018, were selected based on the inclusion criteria and were allocated to either the intervention or control group using permuted block randomization (4 blocks). The intervention group underwent massage therapy for 12 sessions. The numerical rating scale for measuring fatigue and the Pittsburgh Sleep Quality Questionnaire were completed 14 times and three times respectively, by both groups. Data were analyzed through the SPSS software version 22 using descriptive statistical tests, independent t-test and repeated measures analysis of variance.
Results: The results showed that before the intervention, there was no statistically significant difference in demographic variables between the intervention and control groups (P>0.05). Significance of group and time interactions for fatigue score showed that the trend of changes in mean fatigue scores was different in the two groups and over the study time period (P<0.001). Also, there was a statistically significant difference between the two groups in the total score of sleep quality and all sleep components except two components (mental quality of sleep and sleep disorders) (P<0.05).
Conclusion: This study showed that slow-stroke back massage improves fatigue and sleep quality in hemodialysis patients. Therefore, it is recommended as an inexpensive, effective and uncomplicated method in hemodialysis patients.
Clinical trial registry: IRCT20181119041702N1
 

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Background & Aim: Pain during vascular access is an integral part of the life of hemodialysis patients. The aim of this study was to determine the effect of topical ginger on pain following needle insertion into the arteriovenous fistula in hemodialysis patients.
Methods & Materials: In this clinical trial, 100 hemodialysis patients were selected from two hospitals in Shahroud in 2019 and were randomly assigned to intervention or control groups. For the intervention group, ginger ointment was used 20 minutes before needle insertion into the arteriovenous fistula. The control group only received routine care. Patients' pain after needle insertion was assessed using the Numerical Pain Rating Scale. Data was analyzed using the SPSS software version 18 and Chi-square, Fisher, and independent t-tests.
Results: There was a statistically significant difference in the mean and standard deviation of pain scores between the control (8.46±1.26) and intervention (5.08±1.29) groups (P<0.001). While most people in the intervention group experienced moderate pain, most people in the control group had severe pain.
Conclusion: According to the results of the study, the use of topical ginger, which is cheap with almost no side effects, can reduce the severity of pain following needle insertion into the arteriovenous fistula in hemodialysis patients, and its use in hemodialysis wards is recommended.
Clinical trial registry: IRCT20190825044608N1
 

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Background & Aim: Today, COVID-19 has become a serious threat to global health. Due to their certain conditions, hemodialysis patients are more at risk than others. Therefore, self-care in these patients is more necessary. We aimed to assess the self-care of hemodialysis patients against COVID-19 disease and the factors influencing self-care.
Methods & Materials: In this cross-sectional study, 219 patients referred to the dialysis ward of selected public hospitals in Lorestan province, were selected by the census method and examined. Patients' information was collected by a demographic questionnaire and a researcher-made questionnaire on self-care against COVID-19. Data were analyzed using the SPSS software version 22, with the significance level of 0.05.
Results: The mean score of self-care against COVID-19 in patients was 186.33, and most patients had a good level of self-care. There was a significant relationship between the self-care score and place of residence (P<0.001), and comorbidity (P=0.044). Among the multiple sources of information, there was a significant difference in the self-care score between cyberspace (P=0.047), and family and relatives (P<0.001). Also, comorbidity, urban residence, and academic education level significantly predicted self-care.
Conclusion: According to the results of this study, developing proper training programs is suggested considering the factors influencing self-care. Also, capacities such as cyberspace and patients' families should be used to make the training more effective.

 

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Background & Aim: Pain and inflammation caused by needle insertion into the fistula is a common problem in hemodialysis patients. The aim of this study was to evaluate the effect of topical application of Rosemary essential oil on inflammation and pain severity caused by needle insertion into arteriovenous fistula in patients undergoing chronic hemodialysis.
Methods & Materials: In this clinical trial, 60 hemodialysis patients from the hemodialysis ward of Golestan hospital and Imam Khomeini hospital in Ahvaz were randomly assigned to two groups using block randomization. The intervention group received rosemary essential oil, while the control group received distilled water applied to the needle insertion site 5 minutes before each hemodialysis session. Pain severity was assessed using the VAS scale and inflammation severity was determined using the Phlebitis checklist at baseline and during six sessions. Data were analyzed using t-test, chi-square test and repeated measures analysis of variance (ANOVA) on SPSS software version 22.
Results: The results showed that the mean score for pain increased in the control group from 5.13±1.74  to 5.93±1.67, while it decreased in the intervention group from 5.83±1.53 to 3.77±1.43 (P=0.003). Additionally, the mean score for inflammation increased during the sessions in the control group, ranging from 1.27±1.20 to 2.07±1.08. However, in the intervention group, the mean score for inflammation decreased from 2.57±1.92 to 1.33±1.44. Nevertheless, this difference was found to be statistically insignificant (P=0.267).
Conclusion: The findings of the present study showed that the topical application of rosemary essential oil had a significant effect on reducing pain resulting from needling. However, its effect on reducing the severity of arteriovenous fistula inflammation in patients undergoing hemodialysis was not statistically significant. Based on these results, it is recommended to provide training to nursing staff and hemodialysis patients regarding the use of rosemary essential oil as a means to alleviate pain experienced during the procedure. Further research is required to investigate its potential for reducing the severity of fistula inflammation.
Clinical trial registry: IRCT2019102804526N1