Family-centered empowerment approach to optimize phosphate management among hemodialysis patients: an experimental study.

BACKGROUND: This study aimed to investigate the effect of a family-centered empowerment program on hyperphosphatemia management. METHOD: This experimental study was performed on 80 randomly selected eligible patients with hyperphosphatemia undergoing hemodialysis. Patients were assigned randomly to two groups of family-centered empowerment program (FCEPG) and control group (CG) by coin toss (40 people per group). Data collection tools were the researcher-made Phosphate Control Knowledge Scale, the researcher-made Adherence to Dietary Restriction of Phosphorus Intake Scale, the eight-item Morisky Medication Adherence Scale, and serum phosphorus measurements. Data were collected before the intervention, one month, and three months after the intervention. Patients in FCEPG participated in a family-centered empowerment program. The statistical significance level was considered to be 0.05. RESULTS: Inter-group comparisons showed no significant difference between FCEPG and CG in terms of the mean score of knowledge of phosphate control, adherence to dietary restriction of phosphorus intake, adherence to medication, and the mean serum phosphorus level before the empowerment program, but showed significant differences between them in these respects at one month after the program and three months after the program (p < 0.05). Intra-group comparisons showed a significant difference in FCEPG between the mean and standard deviation of all four variables before the empowerment program and the corresponding values one month and three months after the program (P < 0.05). CONCLUSION: The findings of this study can be used in various fields of healthcare in the hospital and community.

Effectiveness of listening to music and playing with Lego on children's postoperative pain.

PURPOSE: The present study aimed to compare the effectiveness of music and playing with Lego in postoperative management pain in children. DESIGN AND METHODS: In this three-group quasi-experimental study, the participants in this interventional study were 96 children aged 6 to 12 years admitted to the pediatric surgery ward of Mofid Hospital and Medical Center in Tehran. The participants were selected using convenience sampling. They were then randomly placed into three intervention groups. Pain intensity was measured for the participants in all three groups before the intervention. The intervention was performed in two 15-min sessions with an interval of 5 min in three intervention groups. Then pain intensity was measured using the Oucher Pain Scale before the intervention and in four intervals: Immediately after the intervention, half an hour, one hour, and 3 h after the intervention, respectively. Pain intensity was also measured at the same time intervals for the participants in the control group. The collected data were analyzed with SPSS-25 software using descriptive statistics, the Bonferroni test, and Tukey's test. RESULTS: The data showed that the three groups were identical in terms of demographic characteristics (p > 0.05).A comparison of the music listening group and the control group showed statistically significant difference in terms of postoperative pain (P < 0.05).However, the data showed significant differences between the control group and the Lego group in terms of pain intensity immediately after the intervention, half an hour, one hour, and 3 h after the intervention, respectively (p < 0.05).The data also revealed a significant difference between the children in the music group and the Lego group at all phases (p < 0.05), and the children in the Lego group reported less pain after the intervention compared to the children in the music listening group. Nevertheless, there was a statistically significant difference between the three groups in terms of reported pain intensity half an hour, one hour, and three hours after the intervention (p < 0.05). CONCLUSION: The results showed that playing with Legos had a greater effect on reducing postoperative pain in children than listening to music. Thus, nurses are recommended to make arrangements for children to play with Legos after surgery. PRACTICE IMPLICATION: Playing with Legos can be used to control postoperative pain in school-age children in medical centers and wards of pediatric hospitals.

The effect of Benson relaxation technique on the severity of symptoms and quality of life in children with irritable bowel syndrome (IBS): a quasi-experimental study.

AIM: This study aimed to determine the effect of the Benson relaxation technique on the severity of symptoms and quality of life in children with irritable bowel syndrome (IBS). DESIGN: This quasi-experimental study was carried out on children with irritable bowel syndrome in Iran. METHOD: Sixty children were randomly divided into control and experimental groups. The Benson relaxation technique was implemented for three weeks for experimental group, while the control group only received the typical medical therapy with no special intervention. The questionnaire of Irritable Bowel Syndrome-quality of life-34 (IBS-QOL-34), and Bowel Symptoms Severity and Frequency Scale (BSS-FS) were used for data gathering before and three weeks after the intervention. Data were analyzed using statistics, appropriate parametric and non-parametric tests. RESULTS: According to the results, the experimental group had lower mean scores of qualities of life before the intervention (p < 0.05). The mean score of symptom severity in children with IBS was 13.88 in the experimental group, which changed to 9.83 in the post-test, indicating a significant difference (p < 0.000). The pre-test and post-test mean scores for quality of life in this group were 118.94 and 102.77, respectively, indicating a significant difference (P < 0.001). CONCLUSION: The Benson relaxation technique can be a non-pharmacological solution to reduce the severity of symptoms and improve the quality of life of children with IBS. IMPLICATION TO PRACTICE: This technique is supposed to contribute as a further intervention in clinical contexts.

Predictors of the relationship between the duration of cancer and care time with the supportive care needs of patients and the quality of life of their caregivers: a path analysis.

BACKGROUND: Breast cancer (BC) patients face various physical and psychological challenges. The mutual impacts of patients and caregivers on each other show the need for further supportive care from the community and family. This study aimed to identify the predictors of the direct and indirect relationships of the duration of cancer (CANCERT) and care time (CARET) with the supportive care needs (SCN) of the patients and the quality of life (QOL) of their family caregivers. METHODS: This descriptive study included 150 patients and their caregivers in Iran. Data were collected using the Supportive Care Needs Survey-Short Form (SCNS-SF34), the Caregiver Quality of Life Index-Cancer (CQOLC) scale, and a socio-demographic checklist. The data were then analyzed in SPSS-24 and Lisrel-8.8 software using descriptive statistics and path analysis. RESULTS: The mean age of the patients and caregivers was 45.76 ± 10.44 and 43.46 ± 9.5, respectively. The majority of patients (96%) were in stages II and III of the disease. There was no statistically significant relationship between cancer stages with SCN of the patients and also caregivers' QOL (P > 0.05). Based on the test results, the CANCERT was positively correlated with the patients' care and support needs (SN) in total effect (ß = 0.24). The patients' sexuality needs had the highest negative correlation with their CANCERT in the direct path (ß = - 0.27) and had the highest negative correlation with psychological needs in the indirect path (ß = - 0.174). The CARET (hours per day) had positive correlation with health systems and information needs in both the direct (ß = 0.26) and indirect paths (ß = 0.15). The highest positive correlation with physical needs was in the direct path (ß = 0.34). The caregivers' QOL had a negative and direct relationship with the CANCERT (ß = - 0.19), and there was a positive and direct relationship between CARET and the caregivers' QOL (ß = 0.18). CONCLUSIONS: The correlations obtained from this study are not necessarily strong, yet they are important and should be noticed and tested in the future studies. The present findings reveal the need to provide comprehensive care, planning to provide supportive care, and counseling to both BC patients and their family caregivers, especially when the duration of the disease is prolonged.

The effect of backup midwife on maternal experience after vaginal childbirth - a qualitative study.

One of the goals of reproductive health enhancement is to ensure the desired experience of safe childbirth by reducing possible complications, fears, and worries about delivery by ongoing midwife backup care. This study explains women's experiences with a backup midwife during labor and childbirth. This was a qualitative study involving 19 women who had natural childbirth in Hamadan, 2020. Purposeful sampling and data collection were performed using semi-structured in-depth interviews. Data were analyzed by conventional content analysis using MAXQDA software version 10. Data analysis showed three themes and six main categories. The themes included security, high-quality care, and respectful care, consisting of two main categories of perceived empowerment and support, physiological approach and reassuring care, and respect for the mother's privacy and optimal accountability. The presence of a backup midwife during labor caused a sense of security, control, and perceived empowerment, thus a positive childbirth experience. Therefore, it is necessary to train and employ midwifery in the healthcare system. It is recommended to train and employ midwifery graduates for this purpose and include it as one of the basic principles in the current planning to promote natural childbirth.

The effect of Triticum sativum (wheat) germ on postpartum pain: A double-blind clinical trial.

OBJECTIVE: Postpartum pain (PP pain) is a common problem after vaginal delivery. Some herbs are used to reduce PP pain. Due to the anti-inflammatory properties of Triticum sativum (wheat) germ, this study was conducted to investigate the effect of wheat germ on PP pain. MATERIALS AND METHODS: This is a randomized, double-blind, placebo-controlled clinical trial performed on 90 women who had a vaginal delivery and complained of moderate to severe PP pain. The participants were randomly divided into two groups. In the intervention group, a capsule containing 500 mg of wheat germ was taken every 6 hr for 2 days and in the control group, a placebo capsule was taken in the same order. The severity of PP pain was measured before and one hour after receiving the capsule by using the Visual Analogue Scale. RESULTS: The two groups were not different in terms of pain severity before the intervention. The PP pain in women with moderate pain was significantly reduced in both groups, the reduction was greater in the wheat germ group (GEE=0.04) but this reduction was not significant. The PP pain in women with severe pain was significantly reduced in both groups, however, the reduction was significantly greater in the wheat germ group (GEE=0.63, p=0.007). Moreover, the results showed that the use of mefenamic acid in the wheat germ group was significantly lower than the control group (p=0.04). Moreover, no side effect was reported after consuming the wheat germ. CONCLUSION: It seems that wheat germ reduces severe PP pain. Further research on this plant is recommended.

Resilience and Associated Factors in Mothers of Children with Congenital Heart Disease: A Cross-Sectional Study.

BACKGROUND: Congenital heart disease (CHD) in children affects the parents' mental and physical health and their caring and supportive functions. Resilience is an important factor in health. This study aimed to determine resilience and its associated factors in mothers of children with congenital heart disease. METHODS: This descriptive cross-sectional study enrolled 136 mothers of children with CHD. Samples were selected in two hospitals of Shahid Modarres and Children's Medical Center in Tehran, Iran, via convenience sampling from May to early October 2019. Data were collected using demographics questionnaire, Multidimensional Scale of Perceived Social Support (MSPSS), Life Orientation Test (LOT), and Wagnild and Young Resilience Scale (RS). Data were analyzed in statistical software SPSS-16 using independent t-test, ANOVA, Pearson and Spearman correlation, and multiple linear regression. The significance level was set at P<0.05. RESULTS: Mothers' total mean score of resilience was 94.08±12.81, while 14.7%, 66.2%, and 19.1% had low, moderate, and high resilience, respectively. Regression analysis showed that two variables of social support (B=2.20, P<0.001) and optimism (B=0.76, P=0.003) were associated with resilience in mothers. The duration of the child's disease was positively correlated with the mothers' resilience but did not predict it (B=-0.72, P=0.22). CONCLUSION: The level of resilience in most mothers was moderate. Social support in the dimension of significant others and optimism were associated with mothers' resilience. Therefore, holistic care and providing educational training programs that enhance these variables could be effective in promoting resilience in mothers of children with CHD.

Evaluation the effect of Silybum marianum ointment on episiotomy wound healing and pain intensity in primiparous women: a randomized triple blind clinical trial.

BACKGROUND: Episiotomy is the most commonn surgical procedure in midwifery which as any other wounds can cause infection or delay in healing. The current study aimed to determine effect of Silybum marianum ointment on pain severity and healing of episiotomy wound in primiparous women referring to Shahid Nourani Hospital at 2019. METHODS: This research was done as a randomized, triple-blind clinical trial on 87 priiparous women (44 indivdiuals in Silybum marianum ointment group and 43 indivdiuals in placebo group) referred to Shahid Nourani Hospital in Talesh (Guilan Province), Iran at September 2019. After labor and performing episiotomy, twice a day for 10 days as a fingertip size of the ointment was prescribed to be topically used on the episiotomy incision for both groups (Silybum marianum ointment or placebo ointment). Data gathering was done using demographic and midwifery information questionnaire, Episiotomy healing assessment: Redness, Edema, Ecchymosis, Discharge, Approximation)REEDA Scale (REEDA Scale: Redness(R); Edema (E), Ecchymosis(E), Discharge from the wound(D); Approximation of the perineal tissues(A))(scale, and visual analogue scale of pain. Examination of healing status of the perinea incision was performed during first 12 h, fifth day and tenth day after labor.Kolmogrov-Smirnov test was used in order to investiagte nomrality of data distribution of quantitative data, and two- independent samples t test, Chi square, repeated measures two factorial analysis of variance and Fischer's exact test were used. SPSS software version 23 was used to analyze data and 0.05 was considered as signifcance level. RESULTS: Both groups of Silybum marianum and placebo groups did not differ regarding demographic and midwifery characteristics, hygiene status prior to intervention (P > 0.05). Mean difference of pain severity and REEDA scale in Silybum marianum ointment group in 12 h after labor, at fifth day and tenth day after labor was significant comparing to control group which indicates decline in episiotomy pain severity and faster wound healing (P < 0.001). CONCLUSIONS: Silybum marianum ointment ointment accelerates episiotomy wound healing rate due to its healing properties and decreases pain severity. TRIAL REGISTRATION: This study was registered in Iranian Registry of Clinical Trials in 10/08/2019 with the IRCT ID: IRCT201811100411603N1.

Nurses' use of non-pharmacological pain management methods in intensive care units: A descriptive cross-sectional study.

BACKGROUND: Pain is a common and unpleasant feeling among patients in intensive care units. Therefore, the use of proper pain management methods, such as non-pharmacological interventions, is a priority in intensive care units. OBJECTIVE: This study aimed to ascertain the extent of the use of non-pharmacological pain management methods by intensive care unit nurses in Iran and to identify the obstacles that hindered the use of these methods. MATERIAL AND METHODS: This study used a descriptive cross-sectional design which involved a convenience sample of 224 nurses who worked in 16 intensive care units across northern Iran. Data were collected using the non-pharmacological pain management questionnaire and a researcher-developed checklist of the obstacles that hindered the use of non-pharmacological pain management methods. RESULTS: A moderate number of ICU nurses used non-pharmacological pain management methods (55.8 %). The most common method used by nurses was repositioning (M = 2.72), while methods such as acupuncture and reflexology were used less frequently. Furthermore, the most common obstacles to the use of non-pharmacological pain management methods were nurses' fatigue (M = 2.92) and multiple responsibilities (M = 2.91). Demographic variables such as age, gender, educational level, and work experience were not significantly associated with the use of non-pharmacological pain management methods. CONCLUSIONS: Due to factors such as fatigue, multiple responsibilities, a heavy workload, and an insufficient number of nurses per shift, the rate of utilization of non-pharmacological pain management methods among intensive care unit nurses in Iran was low. Furthermore, most of the participants in this study had not attended courses on non-pharmacological pain management.

Efficacy of Pumpkin Ointment in Treatment of Chronic Hand Eczema: A Randomized, Active-Controlled, Double Blind Clinical Trial.

BACKGROUND: Hand Eczema (HE) is chronic skin disease with a high prevalence in population. It has negative impact on the quality of life. Due to the public interest in herbal remedies, we attempt to assess the efficacy of pumpkin ointment in treatment of chronic HE in this research. METHODS: This study was conducted in an outpatient clinic at Imam-Khomeini Hospital in Tehran (Iran) from May 2015 to Nov 2016. We performed a double-blind trial on 60 patients with chronic HE randomized to four groups included pumpkin, betamethasone, eucerin and almond ointment (n=15 for each group) for 28 days. Patients were ordered to apply ointments twice a day. Hand Eczema Severity Index (HECSI) and Dermatology Life Quality Index (DLQI) of the patients were evaluated by a dermatologist on the 1st, 14th and 28th d after the start of treatment. RESULTS: Patients' DLQI scores in pumpkin and betamethasone group was significant and pumpkin group showed a better response in quality of life (P=0.001). Betamethasone and pumpkin ointment were effective and showed significant improvement compared with almond and eucerin and reduce HECSI scores (P=0.002 and P=0.012 respectively). Betamethasone ointment outcome on HECSI scores in comparison with topical pumpkin was significant (P<0.001). No clinically adverse effects were observed. CONCLUSION: Although pumpkin ointment showed a better response in patients' DLQI in HE but it was less effective than betamethasone in decreasing HECSI.

Iranian mothers' needs for reproductive health education of their adolescent daughters: a qualitative study.

INTRODUCTION: In order to be effective in discussing high-risk sexual behaviors with adolescents, mothers need to be educated about their adolescent daughters' sexual issues. As no detailed and exact knowledge on mothers' educational needs concerning adolescent girls' reproductive health is available, the current study was intended to investigate mothers' educational needs concerning their adolescent daughters' reproductive health. MATERIALS AND METHODS: This research was a qualitative content analysis. Purposive sampling was performed to the saturation point. The samples included 26 mothers and 14 key informants. Semi-structured interviews were used for data collection. Data authenticity was verified based on Lincoln and Guba's criteria and data analysis was conducted using conventional content analysis with MAXQDA10 software. FINDINGS: In this study, three themes and 13 main categories, each with a number of subcategories were extracted. The themes and main categories included: "appropriate educational content (reproductive health, sexual health, general health, psychological health, family health, social health and spiritual health)", "characteristics of the educator (communicative skill, cognitive skill and moral competence)", and "effective factors in learning (teaching method, learning conditions and environment, and the learner's readiness)". CONCLUSIONS: The results demonstrated that mothers need to be informed about sexual, reproductive, general, psychological, family, social and spiritual health in adolescent girls. Consequently, the results can help the healthcare authorities to implement need-based programs and boost the effectiveness of education about adolescent girls' reproductive health for mothers.

Admitting women in active labour: A randomised controlled trial about the effects of protocol use on childbirth method and interventions.

AIM: To determine the effects of protocol of admitting women in active labour on childbirth method and interventions during labour and childbirth. METHODS: This single-blind randomised clinical trial was conducted in a public hospital in Mazandaran province (Iran) in 2017. Two hundred nulliparous low-risk women were randomly assigned into intervention and control groups. The participant women were admitted in the intervention group using the admission protocol and to the group control by staff midwives and doctors. The admission criteria of the protocol were: the presence of regular, painful contractions, the cervix at least four cm dilated and at least one of the following cues: cervix effaced, and spontaneous rupture of membranes, or "show". The primary outcome measure was childbirth method. Data were analyzed in SPSS-22 using Mann-Whitney and Chi-square tests. The level of statistical significance was set as p<0.05. FINDING: There were significant differences between the intervention and control groups in the number of caesarian section (CS) (p<0.001). Two groups had a statistically significant difference in amniotomy (p=0.003), augmentation by oxytocin (p<0.001), number of vaginal examinations (p<0.001) and fundal pressure (p<0.001). CONCLUSIONS: Using a protocol for admission of low risk nulliparous women in active labour contributed to reduction of the primary caesarean section rate and interventions during childbirth. A risk assessment and using evidence informed guidelines in admission can contribute to reduce unsafe and harmful practices and support normalisation of birth. This is essential for demedicalisation and a useful strategy for reducing primary CS.

Investigating the Effect of Melissa Officinalis on After-Pains: A Randomized Single-Blind Clinical Trial.

Introduction: Regarding high prevalence of postpartum pain and side-effects of pharmaceutical analgesics on maternal and neonatal health, the present study aimed to explore the effect of Melissa officinalis on after-pain among mothers hospitalized in Asgariyeh Hospital, Isfahan, 2016. Methods: In this single-blind clinical trial, 110 women with moderate to severe after-pain were divided into two M.officinalis and mefenamic acid groups by random allocation. Samples in the first group received 250mg of mefenamic acid and the second group received 395mg of M.officinalis oral capsules every 6hours for 24hours following childbirth. The primary outcome (After-pain) was assessed using a numeric 10-point scale before intervention, 1,2 and 3hours after the first intervention and every 6hours to 24hours after delivery for each of second, third and fourth interventions. Data were analyzed, using SPSS by independent t-test, Mann-Whitney and chi-square test. Results: The demographic and obstetric variables and after-pain severity before the intervention in both groups were homogenous. Pain intensity wasn't significantly different between the two groups during first and second hours after the first intervention, but there was a significant difference in the third hour, The severity of pain was significantly different between the two groups in different assessments including: an hour after the second, third and fourth intervention (P<0.05). A significant difference was found between mefenamic acid and M.officinalis in pain relief. Conclusion: M.officinalis can reduce the severity of after-pain, because it eliminates the need for pharmaceutical analgesics and works much better than mefenamic acid.

Effect of Vitamin D Therapy on Sexual Function in Women with Sexual Dysfunction and Vitamin D Deficiency: A Randomized, Double-Blind, Placebo Controlled Clinical Trial.

PURPOSE: We investigated the effect of vitamin D therapy on sexual function in women with low vitamin D levels and sexual dysfunction. MATERIALS AND METHODS: We performed this randomized, double-blind, placebo controlled trial in women 18 to 45 years old with sexual dysfunction, defined as a FSFI (Female Sexual Functioning Index) score less than 26.55, and serum 25[OH]D less than 30 ng/ml. Participants received an intramuscular injection of 300,000 IU cholecalciferol or a placebo at baseline and then after 4 weeks. Sexual function was evaluated with the FSFI at baseline, and 4 and 8 weeks. The serum level of 25[OH]D was measured and depression symptoms were evaluated by the BDI (Beck Depression Inventory) at baseline and 8 weeks. RESULTS: A total of 38 women in each group completed the study. Serum 25[OH]D levels increased only in the cholecalciferol group by a mean ± SD of 14.4 ± 3.2 ng/ml (p <0.001). The FSFI score was higher in the intervention group at study week 4 (19.6 vs 16.3, p = 0.002) and week 8 (25.0 vs 17.1, p <0.001). The BDI score was significantly decreased only in the cholecalciferol group by a mean of -21.0 ± 12.3 (p <0.001). The effect of treatment on sexual function was independent of its effect on depression symptoms. CONCLUSIONS: Vitamin D therapy in women with sexual dysfunction and vitamin D deficiency can improve sexual function. This effect does not seem to be mediated by an improvement in depression symptoms.

[Salvia officinalis Reduces the Severity of the Premenstrual Syndrome].

BACKGROUND: This study aims to investigate the effects of Salvia officinalis on the severity of the premenstrual syndrome (PMS). METHODS: This was a triple-blinded randomized clinical trial on 90 college students in Tehran, Iran. The participants were randomly divided into 2 groups who were treated with 500-mg Salvia officinalis capsules or placebo once a day for 2 consecutive months. Data were collected using a questionnaire and a daily form for recording symptoms of PMS. RESULTS: The mean decreases in severity of the symptoms in the Salvia officinalis extract-treated group during the first and second months after treatment were 19.84% and 23.42%, respectively. The comparison of the PMS physical and psychological symptoms demonstrated a decrease following treatment in both groups, with more remarkable reduction in the Salvia officinalis group (p < 0.001). CONCLUSION: Salvia officinalis is an effective alternative agent to reduce the severity of psychological and physical symptoms of PMS.

The Effect of Prangos Ferulacea Vaginal Cream on Accelerating the Recovery of Bacterial Vaginosis: A Randomized Controlled Clinical Trial.

BACKGROUND: The present study was conducted on the effect of prangos ferulacea vaginal cream on accelerating the recovery of bacterial vaginosis. METHODS: This randomized controlled clinical trial was conducted on 100 non-pregnant women referring to health centers affiliated to Lorestan University of Medical Sciences in 2016 with the diagnosis of bacterial vaginosis based on the patient's complaints, Amsel's clinical criteria, and the Nugent microscopic criteria. The women were randomly divided into two groups of 50. One group was treated with oral metronidazole plus Prangos ferulacea vaginal cream and the other with oral metronidazole plus a placebo vaginal cream for seven days. The patient's complaints, Amsel's clinical criteria and the Nugent microscopic criteria were assessed seven days after treatment. The data were analyzed using SPSS, version 20, with a significance level of 0.05. RESULTS: The response to oral metronidazole plus Prangos ferulacea vaginal cream treatment was 94% according to Amsel's clinical criteria and 88% according to the Nugent microscopic criteria. The response to oral metronidazole plus placebo vaginal cream treatment was 94% according to Amsel's criteria and 86% according to the Nugent criteria. The analysis of the patients' complaints, Amsel's clinical criteria and the Nugent microscopic criteria showed significant differences in each group before and after the treatment. CONCLUSION: This trial showed that Prangos ferulacea vaginal cream accelerated the recovery of bacterial vaginosis of patients with bacterial vaginosis. It can be used effectively as a complementary treatment with oral metronidazole in cases of medication resistance and also in people wishing to use herbal remedies Trial Registration Number: IRCT2016042327534N1.