Live Birth after Cleavage-Stage versus Blastocyst-Stage Embryo Transfer in Assisted Reproductive Technology: A Randomised Controlled Study.

BACKGROUND: Blastocyst stage transfer appears to improve pregnancy outcomes. The aim of this study is to evaluate the pregnancy results between fresh cycle blastocyst stage embryo transfer and cleavage stage embryo transfer in patients who undergo intracytoplasmic sperm injection (ICSI). MATERIALS AND METHODS: This randomised clinical trial study was conducted at the Infertility Research Centre of Milad Hospital in Mashhad, Iran from 2018 to 2020 on 240 infertile women who presented for their first ICSI procedure. These patients were assigned to receive either cleavage embryo transfer (n=112) or blastocyst stage transfer (n=107). Pregnancy outcomes were measured in both groups. RESULTS: There were no differences regarding age, body mass index (BMI), serum follicle-stimulating hormone (FSH), duration of infertility, and aetiology of infertility between the groups (P>0.05). There were more follicles, total oocytes, and metaphase II (M2) oocytes in the blastocyst stage group. Considerably more cleavage stage embryos were transferred compared to the number of transferred blastocysts (P=0.001). The blastocyst group had more vitrified embryos than the cleavage group (P=0.000). The rates of implantation (P=0.332), chemical pregnancy (P=0.165), clinical pregnancy (P=0.694), and live births (P=0.727) were higher in the blastocyst group, but they were not significantly different. The rate of abortion was also not significantly higher in the blastocyst group (P=0.296). CONCLUSION: Blastocysts transferred in the fresh cycle of an ICSI procedure may be more advantageous compared to cleavage stage embryo transfer (registration number: IRCT20181030041503N1).

Patient satisfaction with nursing care in Iran: a systematic review and meta-analysis.

Introduction: Patient satisfaction (PS) with nursing care is considered one of the most important predictors of satisfaction with hospital services. The current research was conducted to determine the level of PS with nursing care provided in hospitals in Iran. Methods: A comprehensive systematic search was conducted in various international electronic databases, such as PubMed, Scopus, Web of Science, and Persian electronic databases such as Iranmedex, and the Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as 'Patient satisfaction', 'Satisfaction', 'Nursing care', and 'Nurse' from the earliest to 27 January 2023. The risk of bias was assessed using the Joanna Briggs Institute (JBI) scale, and the analysis was performed in Stata software version 14. Subgroup and sensitivity analyses were performed to clarify the source of heterogeneity. Results: The results showed that the overall PS with nursing care in different hospitals was 0.83 (95% CI: 0.79-0.86). The proportions of complete satisfaction, partial satisfaction, and dissatisfaction were 0.38 (95% CI: 0.23-0.53), 0.45 (95% CI: 0.34-0.55), and 0.17 (95% CI: 0.12-0.21), respectively. Conclusion: However, overall satisfaction was seen in four out of five patients admitted to hospitals in Iran, complete satisfaction with nursing care was 38%. Future studies should identify the effective factors related to PS with nursing care.

Domestic violence against Iranian women during the Covid-19 lockdown: A cross-sectional study.

Background and Aims: Despite the fact that public health measures such as social isolation can help control the coronavirus disease 2019 (Covid-19) pandemic, these procedures may contribute to elevated levels of stress and escalate various forms of violence against women. The current study aimed to estimate the prevalence of domestic violence and identify factors associated with domestic violence during the Covid-19 lockdown among married women attending healthcare centers in Iran. Methods: This cross-sectional study, conducted between 2020 and 2021, focused on a sample of 5317 married women who sought healthcare services within urban centers across five major cities in Iran. Sampling was done through a multistage cluster method. The Revised Conflict Tactics Scales (CTS2) were used to assess levels of violence. The collected data was analyzed using descriptive and inferential statistics, including independent sample t-test, Chi-square, and multiple logistic regression) with the SPSS software version 22. Results: During the Covid-19 lockdown, psychological violence was reported by 66.7% of women (95% confidence interval [CI], 65.44%-67.98%), physical violence by 44.8% (95% CI, 43.43%-46.10%), sexual violence by 28.8% (95% CI, 27.60%-30.03%), and injury by 24.5% (95% CI, 23.39%-25.70%). The multiple logistic regression showed several significant factors associated with domestic violence. These included low levels of social support (p < 0.001), shorter duration of marriage (p < 0.001), unemployment of both women (p < 0.007) and their spouses (p < 0.001), poor economic status (p < 0.001), as well as substance abuse by the husband, including alcohol (p < 0.001) and drug abuse (p < 0.01), and smoking (p < 0.01). Conclusion: The findings highlighted the magnitude of domestic violence against women during the Covid-19 lockdown. It is crucial to implement comprehensive strategies that encompass preventive and responsive measures to address domestic violence not only during lockdowns but also in the post-lockdown period.

Lived experience caring for a child with Covid-19 disease: A phenomenological study.

Background: Caregivers of COVID-19 patients, including mothers with an infected child, are affected by adverse physical and psychological effects. Since mothers perform an important role in caring for a child with Covid-19, explaining their challenges and experiences positively affects the health conditions of children and society, in general. Aim: This study aimed to explain mothers' experiences with children diagnosed with COVID-19, who were referred to Bandar Abbas Children's Hospital. Method: The present study was qualitative and used the Van-Manen method. The statistical population included 13 mothers with children hospitalized for coronary heart disease and COVID-19, who were selected by purposive sampling. Semi-structured interviews were implemented to collect data until saturation. Data analysis was performed using MAXQDA 10 software. Lincoln and Guba's criteria were used to evaluate the data's accuracy and strength. Results: The mean age of mothers participating in the study was 37.92 ± 4.87. On the other hand, the mean age of children was 5.15 ± 2.07 years. Three main themes and 13 sub-themes were extracted from the data analysis. The main themes were "Inability to Caring", "Mental and Physical drain" and "Conflict of Roles and Responsibilities". In this study, when a child develops COVID-19 disease, the mother experiences a series of negative emotions, which lead to feelings of helplessness and inability to care for the child. Conclusion: Mental and physical manifestations strains were the most important issues that the mothers experienced. The majority of the participants need psychological support to cope with the disease. Therefore, it is recommended to make a proper design to psychologically and socially support these mothers, while alleviating the physical manifestations of their children's disease.

Comparison of tamoxifen and hormone replacement cycle (HRT) in frozen embryo transfer. A randomized controlled trial.

OBJECTIVE: The use of frozen embryos in the treatment of infertility with assisted reproductive techniques has been increased. Different methods are used to prepare the endometrium for frozen embryo transfer (FET). The aim of this study was to compare pregnancy outcomes after treatment with tamoxifen and hormonal replacement therapy (HRT) in FET. METHODS: This randomized clinical trial was carried out with 214 infertile women in the infertility research center of Milad Hospital in Mashhad during 2018-2020. We had 84 patients receiving tamoxifen and 92 took HRT. Endometrial thickness (ET) and pregnancy outcome were measured in both groups. RESULTS: Mean infertility duration (p=0.328), number of embryos (p=0.649), FSH (p=0.390), LH (p=0.051) and LH/FSH ratio (p=0.287) as well as type of infertility (primary or secondary) (p=0.295), causes of infertility (p=0.750) and pattern of menstruation (p=0.676) were not significantly different in the two groups. Mean ET in the TMX and HRT groups were 8.72±1.45mm and 9.00±1.69mm, respectively (p=0.423). There was no statistically significant difference between chemical pregnancy (p=0.663), clinical pregnancy (p=0.994) and ongoing pregnancy (p≥0.999) in the TMX and HRT groups. CONCLUSIONS: Treatment with tamoxifen can be as effective as GnRH agonist for endometrial preparation in FET.

Effects of Whistling Compared with Buzzy Device During Blood Sampling on Pain and Fear in Children's Emergency Department.

Blood sampling from a peripheral vein in children can be significant. Pediatric nurses should be able to use the techniques which decrease the pain and fear duration of the blood sampling. This research studied the effect of vibration bee and whistling (concentrate on breathing) blood sampling on pain and fear in the children's emergency. In this randomized clinical trial study, 120 children ages 3-6 years referred to a pediatric ward in Najaf, Iraq, using Random Blocking Method, were divided into three groups; vibration bee, whistling, and control group. A musical vibration bee, with the cold bag attached to it, was closed for 5 minutes at approximately 5-10 cm above the blood sampling site. A final minute, the vibration was applied; then, the procedure was done. The pain severity was measured by Wong Baker Faces scale. Data were analyzed by SPSS19 software at the significant level of 95%. There was a significant difference in pain intensity between the control groups and the intervention groups (p = .000). Moreover, there was a significant difference in children's medical fear scale between the control groups and the intervention groups (p = .000). Whistling (concentrate on breathing) may be an easily accessed, inexpensive, and effective technique to control or reduce pain and fear in young children. But, vibration bee with cold has a greater effect for reducing pain and fear. It is suggested to use vibration bee (with cold) in painful aggressive procedures in children.

The Effects of Electrical Stimulation of Lower Extremity Muscles on Balance in Stroke Patients: A Systematic Review of Literatures.

OBJECTIVE: Stroke is one of the main causes of disability and the second common cause of mortality in the world. Stroke causes relatively permanent motor defects, including balance disorder, and thus affects an individual's functional capacity and independence. Many clinical types of research have been conducted to evaluate the effect of functional electrical stimulation (FES) on balance in post-stroke patients. The objective of this study was to systematically review the effect of functional electrical stimulation (FES) on balance as compared to conventional therapy alone in post-stroke. METHODS: The databases of Google Scholar, PubMed, Scopus, ScienceDirect and ProQuest were searched using selected keywords. The randomized controlled trials were searched for published original articles before February 2019 in English language and included if they assessed the effect of FES on balance ability compared to conventional therapy alone in adult post-stroke. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality. RESULTS: Nine papers were included in this review (median PEDro scale =7/11). The total number of participants in this review study was 255. The age of participants ranged from 20 to 80 years. Stroke patients were in chronic phase (n = 5) and in subacute phase (n = 4). various parameters, including the target muscles, the treatment time per session (20 min-2 h), number of treatment sessions (12-48) and FES frequency (25-40 Hz), were assessed. Among the studies, significant between-group improvement favoring FES in combination with conventional therapy was found on the Berg Balance Scale (n = 7) and Timed Up and Go Scale (n = 4) when compared to conventional therapy alone. There was no adverse effect reported by any studies. CONCLUSION: FES was reported to be more beneficial in balance improvement among stroke patients when combined with conventional balance therapy. The studies were limited by low-powered, small sample sizes ranging from 9 to 48, and lack of blinding, and reporting of missing data.

The effects of abdominal "I LOV U" massage along with lifestyle training on constipation and distension in the elderly with stroke.

INTRODUCTION: Constipation and distension are dominant gastrointestinal problems after stroke in the elderly. Always they are treated by the use of laxatives and fibers. Abdominal massage along with a healthy lifestyle can be a solution. PURPOSE: This study aimed to investigate the effect of abdominal massage and lifestyle training on constipation and distention of the elderly with stroke. METHOD: This study was a randomized clinical trial that was conducted on elderly patients with stroke at Qaem hospital of Mashhad, Iran. 68 patients were randomly allocated into control (n = 34) and intervention (n = 34) groups in 2017-2018. Finally 29 elderly in the intervention and 34 in the control group completed the study. Intervention included the abdominal massage by using "I LOV U" method along with lifestyle education. Each abdominal massage lasted for 15 min, twice daily for ten days that was performed at first session by the researcher and then continued by the key care giver. Data were collected by the demographic form, constipation assessment score (CAS), distension measurement tool (meter), and food tolerance evaluation checklist. RESULTS: The results indicated that both groups were homogeneous in demographic variables (P > 0.05). The repeated ANOVA showed a more significant decrease in abdominal circumference of the intervention group during the 10- days study (P = 0.029).The Friedman test showed a significant difference in frequency of defecation in two groups in 10- day study (P < 0.0001). Therefore the CAS Score was significantly decreased in intervention group more than the control group (0.30 < 0.98 < 1.59, P = 0.001, EF = 0.44). The food tolerance frequencies through Gavage (P = 0.20), and also orally (P < 0.001) were significantly improved in the intervention group. CONCLUSION: According to results, the abdominal massage along with lifestyle training could improve constipation and distension and also increase food intake tolerance in the elderly patients with stroke.

Effects of Motivational Interviewing on Adherence to Treatment Regimens Among Patients With Type 1 Diabetes: A Systematic Review.

BACKGROUND: Motivational interviewing (MI) is a strategy for promoting adherence to treatment regimens among patients with diabetes. However, limited evidence exists regarding its effectiveness in reducing A1C. OBJECTIVE: To identify and synthesize evidence about the effectiveness of patient, provider, and health system interventions to improve diabetes care among patients with type 1 diabetes. DESIGN: This was a systematic review of randomized controlled trials. METHODS: A search was conducted of the scientific databases MEDLINE, Elsevier, CINAHL, Google Scholar, ProQuest, Ovid, and PubMed without imposing any time limit. Only four documents met the inclusion criteria and were included in the final analysis. The methodological quality of these four articles was reviewed by three reviewers using the Jadad Scale. The main intervention and the primary outcome in this study were MI or motivational enhancement therapy and A1C, respectively. RESULTS: The retrieved studies reported that MI promotes self-monitoring of blood glucose and reduces A1C. CONCLUSION: MI is effective in enhancing patients' adherence to the treatment regimen and thereby decreasing A1C. Given the fact that the reviewed studies had not eliminated the effects of confounding factors, further studies are needed to assess the pure effects of MI on adherence to treatment regimens and A1C levels.

Impact of vitamin C supplementation on post-cardiac surgery ICU and hospital length of stay.

BACKGROUND: Prolonged intensive care unit (ICU) and hospital stay after cardiac surgery is vitally important and is influenced by both intraoperative and postoperative factors. OBJECTIVES: This randomized clinical trial study was designed to assess whether vitamin C supplementation could reduce the length of ICU and hospital stay in post-cardiac surgery patients. PATIENTS AND METHODS: Two hundred and ninety patients scheduled for adult cardiac surgery including coronary, valve and congenital operations were randomized into two groups: an intervention group, who received 2 g of vitamin C (ascorbic acid) intravenously, immediately before surgery in the operating theatre, followed by 1 g daily oral doses for the first 4 postoperative days; and a placebo group, who received an equal number of identical tablets in the same shape and size. RESULTS: Hospital length of stay was significantly different between the two groups (10.17 ± 4.63 days in the intervention group vs. 12 ± 4.51 days in the placebo group; P = 0.01), while there was no significant difference in the ICU stay between the groups (3.42 ± 1.06 days in intervention group vs. 3.43 ± 1.09 days in the placebo group; P = 0.88). There were significant differences in the intubation time and the drainage volume in the ICU and the first 24 postoperative hours between the two groups (P for both = 0.003). CONCLUSIONS: Vitamin C can decrease the length of hospital stay, drainage volume in the ICU and in the first 24 postoperative hours, intubation time and some complications in patients after cardiac surgery; perhaps by decreasing inflammatory factors.

Neonate pain management: what do nurses really know?

PURPOSE: The purpose of this study was to determine knowledge, attitude, and performance vis-à-vis pain management in neonates by nurses working in neonatal units in Bandar Abbas University hospitals. METHOD: This descriptive and analytical study was executed from March-August 2011 in the neonatal units and NICU in Bandar Abbas educational hospitals. A total of 50 nurses and nurse assistants working in the neonatal units participated in the study. The data collection tool was a structured questionnaire investigating knowledge (28 items), attitude (20 items) and practices (5 items). Data was analyzed using descriptive statistical tests (Frequency, Mean and Standard deviation tables) and inferential statistic (T-test, Variance analysis). RESULTS: The knowledge scores of participants had a mean value of 13.51 (48.2%) out of 28. The mean score of attitude was 54.22 out of 60 and the mean score for the nurses' level of practices was found to be 4.22 out of 10. There was a significant relationship between nurses' knowledge scores and the level of education, i.e. nurses with more education had more knowledge. CONCLUSION: Results showed that the nurses had poor performance regarding the assessment, measurement, and relief of pain. However, they showed positive attitudes towards pain control in neonates.

Re-birth after coronary bypass graft surgery: a hermeneutic-phenomenological study.

Although coronary artery bypass graft surgery has significant effects on reducing the symptoms of coronary artery disease, there is not enough knowledge and understanding of lived experience of patients after surgery. Understanding lived experience of this group of patients would be helpful for healthcare staff to provide better services to the patients. The aim of this study was to describe with a deeper understanding, the lived experiences of patients after Coronary Artery Bypass Graft Surgery. Using a hermeneutic phenomenological approach and a Van-Manen analysis method, in-depth semi-structured interviews were conducted with eleven participants who had lived experienced of at least six months post - coronary artery bypass graft surgery. Re-birth was the main theme that emerged in the process of data analysis. This theme was derived from four sub-themes including "feels younger", ''vigorous heart'', ''intrepid life'' and ''oriented to be healthy''. Life after a coronary artery bypass graft surgery is often appreciated as a re-birth by persons with these experiences as surgery did not only provide a feeling of wellness, but also added a sensation of youthfulness and improvement in the quality of life for these participants. In addition, they would actively participate in health promotional activities such as; adherence to medication and diet regimes, changes in lifestyle to maintain their health.

Disciplined care for disciplined patients: experience of hospitalized blind patients.

Blindness is a permanent condition that alters daily life of blind people. Interpretive phenomenology was used to understand lived experiences of the hospitalized blind people. "Disciplined care for disciplined patients" was one of the themes that emerged from the data. Provision of disciplined care can help health care professionals provide a holistic and comprehensive competent care for blind patients.

Effect of distraction on children's pain during intravenous catheter insertion.

PURPOSE: This study examined the effect of pressing a soft ball during intravenous catheter insertion (IVCI) on the intensity of pain in children ages 4-6 years. DESIGN AND METHODS: In this quasi-experimental study, children in the intervention group were asked to press a soft ball with the opposite hand during IVCI and to immediately mark the Wong-Baker FACES Pain Rating Scale. RESULTS: There was a significant difference in the intensity of pain between the control group (n = 30) and the intervention group (n = 30; p =.012). PRACTICE IMPLICATIONS: Pressing a soft ball during IVCI may be an easily accessed, inexpensive, and effective technique to control or reduce pain in young children.