1
|
Pungchompoo W, Parinyachitta S, Pungchompoo S, Udomkhwamsuk W, Suwan P. The feasibility of integrating a home telehealth model for older persons living with hemodialysis. BMC Geriatr 2024; 24:378. [PMID: 38671357 PMCID: PMC11055365 DOI: 10.1186/s12877-024-04981-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND In Thailand, there is a rapidly increasing population of older persons living with hemodialysis (OPLWH) for whom quality of life and clinical outcomes are their main focus. This study aims to assess the feasibility of an integrated home telehealth model on quality of life and laboratory parameters of OPLWH. METHODS In this study, the second phase of a mixed methods exploratory sequential design was conducted using a repeated measures experimental design. Participants met the inclusion criteria, which included being an OPLWH at a single hemodialysis center of one hospital in Chiang Mai province, Thailand, during the experimental period between 1 April and 30 September 2018, and willing to participate in the study. The 54 participants were purposively selected and randomly assigned to receive either an intervention (n = 24) consisting of health education and health monitoring using a telehealth device (an iPad) and a web application, or usual care (n = 30). The instruments included a demographic data form, which was analyzed using the chi-square test. The health-related quality of life questionnaire (the 9-item Thai Health Status Assessment questionnaire) and blood chemistry (BUN, Cr, Hb, Hct, Alb, K, Kt/V, and nPCR) were compared and measured at baseline, and at 3 and 6 months after enrolment using independent t-test and one-way repeated measures ANOVA. RESULTS The comparison of quality of life between the two groups at the two points of repeated measurement (after 3 months) showed a statistically significant difference in mental health scores at P < 0.05. Six months after the intervention, mean scores for health outcomes and patients' quality of life improved; however, this change did not reach statistical significance. CONCLUSIONS An integrated home telehealth model implemented by a hemodialysis nurse is a feasible holistic care approach for OPLWH. However, the absence of statistical significance may partly be associated with the clinical characteristics of frailty and risk factors such as increased age, hypertension, diabetes, heart disease, longer dialysis time, and inadequacy of Kt/V. Large-scale multi-centre trials are warranted to fully examine the acceptability of the model. The duration and long-term effects of the telehealth model are also recommended for further investigation. PATIENT OR PUBLIC CONTRIBUTION The development of a home telehealth model was a collaborative process between patients, caregivers, healthcare professionals from the hemodialysis unit, and the research team.
Collapse
Affiliation(s)
- Wanicha Pungchompoo
- Department of Medical Nursing, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
| | - Saowaros Parinyachitta
- Department of Nephrology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sirirat Pungchompoo
- Department of Industrial and Manufacturing Engineering, Faculty of Engineering, Prince of Songkla University, Songkhla, Thailand
| | - Warawan Udomkhwamsuk
- Department of Surgical Nursing, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Panadda Suwan
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
2
|
Fradelos EC, Alikari V, Tsaras K, Papathanasiou IV, Tzavella F, Papagiannis D, Zyga S. The Effect of Spirituality in Quality of Life of Hemodialysis Patients. JOURNAL OF RELIGION AND HEALTH 2022; 61:2029-2040. [PMID: 33411225 DOI: 10.1007/s10943-020-01153-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
This study aimed to assess the effect of spirituality on quality of life of end-stage renal disease patients undergoing hemodialysis (HD). A cross-sectional study was carried out in six HD Units. The sample consisted of 367 patients averaging 61.8 years of age. For the measuring of spirituality and the quality of life, the FACIT-Sp-12 and the Missoula Vitas Quality of Life Index-15, respectively, were completed. Social and demographic data were, also, collected. Spirituality and its dimensions such as Meaning in Life and Peace had a positive effect on Global QoL, Symptoms, Interpersonal and in Well-being. Spirituality can have a positive effect on the QoL of HD patients. Therefore, in the context of the holistic approach of the individual, health systems can include spiritual evaluation and care of HD patients.
Collapse
Affiliation(s)
- Evangelos C Fradelos
- Department of Nursing, University of Peloponnese, Sparta, Greece.
- , Evdoxou 12, 11743, Athens, PC, Greece.
| | - Victoria Alikari
- Department of Nursing, University of Peloponnese, Sparta, Greece
| | | | | | - Foteini Tzavella
- Department of Nursing, University of Peloponnese, Sparta, Greece
| | | | - Sofia Zyga
- Department of Nursing, University of Peloponnese, Sparta, Greece
| |
Collapse
|
3
|
Cheawchanwattana A, Kanjanabuch T, Puapatanakul P, Narenpitak S, Halue G, Tungsanga K, Tatiyanupanwong S, Lorvinitnun P, Sritippayawan S, Chieochanthanakij R, Tungsanga S, Thamcharoen N, Krit Pongpirul MD, Shen JI, Johnson DW, Davies SJ, Finkelstein FO, Perl J, Robinson B. Spiritual Well-Being and Its Relationship with Patient Characteristics and Other Patient-Reported Outcomes in Peritoneal Dialysis Patients: Findings from the PDOPPS. Nephrology (Carlton) 2022; 27:621-631. [PMID: 35238113 DOI: 10.1111/nep.14034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/19/2022] [Accepted: 02/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spiritual well-being (SWB), an individual's understanding of the meaning and purpose of life, may help patients with chronic or terminal illnesses cope with their disease. This study aimed to assess SWB in patients on peritoneal dialysis (PD), as well as its relationship with patient characteristics and patient-reported outcomes (PRO). METHODS The data were obtained from questionnaires that formed part of the PD Outcomes and Practice Patterns Study (PDOPPS). Measures used in this study were SWB scores derived from the WHO Quality of Life, Spirituality, Religiousness, and Personal Beliefs (WHOQOL-SRPB) tool including 32 items from 8 facets; physical (PCS) and mental component summary (MCS) scores of the 12-Item Short-Form Health Survey (SF-12), Center of Epidemiologic Studies Depression Scale-10 (CES-D-10) scores, burden of kidney disease scores, and functional status scores. RESULTS Overall, 529 out of 848 participants (62%) completely responded to the questionnaires and were included in the analysis. Over two-thirds of PD patients (70%) had moderate or higher SWB scores. The SWB scores were significantly lower in patients with age > 65 years and unemployed status. SWB scores positively correlated with higher PCS, MCS, burden of kidney disease scores, and functional status scores, while negatively correlated with depression scores by CES-D-10 scale. Patients who reported significant depressive symptoms (CES-D-10 score ≥ 10) had significantly lower SWB scores. CONCLUSION Better SWB was significantly associated with better health-related QOL (HRQOL) and the absence of depressive symptoms. SWB may be an essential consideration in the delivery of high-quality PD.
Collapse
Affiliation(s)
- Areewan Cheawchanwattana
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Dialysis Policy & Practice Program (DiP3), School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pongpratch Puapatanakul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Dialysis Policy & Practice Program (DiP3), School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Surapong Narenpitak
- Renal unit, Department of Internal Medicine of Udonthani Hospital, Udon Thani, Thailand
| | - Guttiga Halue
- Department of Medicine of Phayao Hospital, Phayao, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sajja Tatiyanupanwong
- Nephrology Division, Department of Internal Medicine, Chaiyaphum Hospital, Chaiyaphum, Thailand
| | - Pichet Lorvinitnun
- Department of Medicine of Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | | | | | - Somkanya Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Natanong Thamcharoen
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - M D Krit Pongpirul
- Dialysis Policy & Practice Program (DiP3), School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of International Health and Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Jenny I Shen
- Division of Nephrology and Hypertension, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Simon J Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Fredric O Finkelstein
- Renal Research Institute, Hospital of St. Raphael, Yale University, New Haven, Connecticut, USA
| | - Jeffrey Perl
- Division of Nephrology and Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
| | | |
Collapse
|
4
|
Use of Spirituality in the Treatment of Depression: Systematic Literature Review. Psychiatr Q 2022; 93:255-269. [PMID: 35226252 DOI: 10.1007/s11126-020-09881-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 10/19/2022]
Abstract
Spirituality has been gaining recognition as a potential treatment modality. Our paper aimed to provide a systematic overview of existing research examining the use of spirituality as a treatment method for depression. All articles published between 2000 and 2018 that scientifically evaluated therapeutic interventions with elements of spirituality were included in the review. Ten studies met the inclusion criteria. Their analysis showed that there were elements of spirituality-based treatments that were repeatedly mentioned, including gratitude, forgiveness, self-acceptance, and compassion. Most often, spirituality was used together with psychotherapy. The review also noted the emergence of digital interventions.
Collapse
|
5
|
Religious Service Attendance and Mortality among Adults in the United States with Chronic Kidney Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413179. [PMID: 34948788 PMCID: PMC8701022 DOI: 10.3390/ijerph182413179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022]
Abstract
Religion and related institutions have resources to help individuals cope with chronic conditions, such as chronic kidney disease (CKD). The purpose of this investigation is to examine the association between religious service attendance and mortality for adults with CKD. Data were drawn from NHANES III linked to the 2015 public use Mortality File to analyze a sample of adults (n = 3558) who had CKD as defined by a single value of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and/or albumin-to-creatinine ratio ≥17 mg/g for males or ≥25 for females. All-cause mortality was the primary outcome and religious service attendance was the primary independent variable. Cox proportional hazards models were estimated to determine the association between religious service attendance and mortality. The mortality risks for participants who attended a service at least once per week were 21% lower than their peers with CKD who did not attend a religious service at all (HR 0.79; CI 0.64–0.98). The association between religious service attendance and mortality in adults with CKD suggest that prospective studies are needed to examine the influence of faith-related behaviors on clinical outcomes in patients with CKD.
Collapse
|
6
|
Farzanegan B, Elkhatib THM, Elgazzar AE, Moghaddam KG, Torkaman M, Zarkesh M, Goharani R, Bashar FR, Hajiesmaeili M, Shojaei S, Madani SJ, Vahedian-Azimi A, Hatamian S, Mosavinasab SMM, Khoshfetrat M, Khatir AK, Miller AC. Impact of Religiosity on Delirium Severity Among Critically Ill Shi'a Muslims: A Prospective Multi-Center Observational Study. JOURNAL OF RELIGION AND HEALTH 2021; 60:816-840. [PMID: 31435840 DOI: 10.1007/s10943-019-00895-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study assesses the impact of religiosity on delirium severity and patient outcomes among Shi'a Muslim intensive care unit (ICU) patients. We conducted a prospective observational cohort study in 21 ICUs from 6 Iranian academic medical centers. Delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU) tool. Eligible patients were intubated, receiving mechanical ventilation (MV) for ≥ 48 h. Illness severity was assessed using Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. A total of 4200 patients were enrolled. Patient religiosity was categorized as more (40.6%), moderate (42.3%), or less (17.1%) based on responses to patient and surrogate questionnaires. The findings suggest that lower pre-illness religiosity may be associated with greater delirium severity, MV duration, and ICU and hospital LOS. The lower mortality in the less religiosity group may be related in part to a greater proportion of female patients, but it remains unclear whether and to what extent greater religiosity impacted treatment decisions by patients and families. Further investigation is needed to validate and clarify the mechanism of the mortality findings.
Collapse
Affiliation(s)
- Behrooz Farzanegan
- Tracheal Diseases Research Center, Anesthesia and Critical Care Department, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Alaa E Elgazzar
- Department of Chest Diseases, Zagazig University, Sharkia, Egypt
| | - Keivan G Moghaddam
- Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Torkaman
- Department of Pediatrics, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Zarkesh
- Department of Pediatrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Goharani
- Anesthesiology Research Center, Anesthesia and Critical Care Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshid R Bashar
- Anesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammadreza Hajiesmaeili
- Anesthesiology Research Center, Anesthesia and Critical Care Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedpouzhia Shojaei
- Anesthesiology Research Center, Anesthesia and Critical Care Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed J Madani
- Trauma Research Center, Medicine Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sevak Hatamian
- Anesthesia and Critical Care Department, Alborz University of Medical Sciences, Karaj, Iran
| | - Seyed M M Mosavinasab
- Anesthesiology Research Center, Anesthesia Care Department, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoum Khoshfetrat
- Anesthesiology Research Center, Anesthesia and Critical Care Department, Khatam-o-anbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ali K Khatir
- Anesthesiology Research Center, Anesthesia and Critical Care Department, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Andrew C Miller
- Department of Emergency Medicine, Vidant Medical Center, East Carolina University Brody School of Medicine, 600 Moye Blvd, Greenville, NC, 27834, USA.
| |
Collapse
|
7
|
Pungchompoo W, Parinyajittha S, Pungchompoo S, Kumtan P. Effectiveness of a self‐management retraining program improving the quality of life of people receiving continuous ambulatory peritoneal dialysis. Nurs Health Sci 2019; 22:406-415. [DOI: 10.1111/nhs.12672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Wanicha Pungchompoo
- Department of Medical NursingFaculty of Nursing, Chiang Mai University Chiang Mai Thailand
| | | | - Sirirat Pungchompoo
- Department of Chemical Engineering, Faculty of EngineerRajamangala University of Technology Srivijaya Songkhla Thailand
| | - Paweena Kumtan
- Department of NephrologyFaculty of Medicine, Chiang Mai University Chiang Mai Thailand
| |
Collapse
|
8
|
Roberti J, Cummings A, Myall M, Harvey J, Lippiett K, Hunt K, Cicora F, Alonso JP, May CR. Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies. BMJ Open 2018; 8:e023507. [PMID: 30181188 PMCID: PMC6129107 DOI: 10.1136/bmjopen-2018-023507] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/28/2018] [Accepted: 08/08/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease. We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT). METHODS Systematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547. We included research published in English, Spanish and Portuguese, from 2000 to present, describing experience of illness and healthcare of people with CKD and caregivers. Searches were conducted in MEDLINE, Embase, CINAHL Plus, PsycINFO, Scopus, Scientific Electronic Library Online and Red de Revistas Científicas de América Latina y el Caribe, España y Portugal. Content was analysed with theoretical framework using middle-range theories. RESULTS Searches resulted in 260 studies from 30 countries (5115 patients and 1071 carers). Socioeconomic status was central to the experience of CKD, especially in its advanced stages when renal replacement treatment is necessary. Unfunded healthcare was fragmented and of indeterminate duration, with patients often depending on emergency care. Treatment could lead to unemployment, and in turn, to uninsurance or underinsurance. Patients feared catastrophic events because of diminished financial capacity and made strenuous efforts to prevent them. Transportation to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources. Additional work for those uninsured or underinsured included fund-raising. Transplanted patients needed to manage finances and responsibilities in an uncertain context. Information on the disease, treatment options and immunosuppressants side effects was a widespread problem. CONCLUSIONS Being a person with end-stage kidney disease always implied high burden, time-consuming, invasive and exhausting tasks, impacting on all aspects of patients' and caregivers' lives. Further research on BoT could inform healthcare professionals and policy makers about factors that shape patients' trajectories and contribute towards a better illness experience for those living with CKD. PROSPERO REGISTRATION NUMBER CRD42014014547.
Collapse
Affiliation(s)
- Javier Roberti
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Jonathan Harvey
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Kate Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Katherine Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Federico Cicora
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Juan Pedro Alonso
- Faculty of Social Sciences, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carl R May
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| |
Collapse
|
9
|
Depression and Spiritual Distress in Adult Palliative Patients: A Cross-Sectional Study. RELIGIONS 2017. [DOI: 10.3390/rel8080156] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
10
|
Rentala S, Lau BHP, Chan CLW. Association Between Spirituality and Depression Among Depressive Disorder Patients in India. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2017. [DOI: 10.1080/19349637.2017.1286962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sreevani Rentala
- Department of Psychiatric Nursing, Dharwad Institute of Mental Health and Neurosciences, Dharwad, India
| | - Bobo Hi Po Lau
- Department of Social Work & Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Cecilia L. W. Chan
- Department of Social Work & Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| |
Collapse
|