مجله دانشکده پرستاری و مامایی مشهد
پیاپی 22 (پاییز 1388)

Back ground and There are different methods of labor induction That each of These have many complication. acupressure is one the natural method for labor induction. but only limited study has been done to evaluate it’s efficiency and safety. There fore this research aimed to determine the effect of acupressure on initiating labor in pregnant women with term gestation who where submitted to the hospitals and clinics of torbat – e - heydarie in 2006 – 2007. this study is a single blined randomized clinical trial on 99 pregnant woman with the gestational age 40-40 3.7week, bishop score 4 or less, without any evidence regular uterin contraction. There wasn’t any medical or obstetrical complications toword samples. At first sampling method was purposive and then divided randomly in to three groups: pressure, touch and routin cares. In pressure group, points of GB21, LI4, SP6 were pressed. In touch group, these point were just touched and third group was without any intervention.Three groups were followed up for initiating labor after 48 and 96 hours. To gather information we used forms based on interviews, observation and physical examination and record fetal movement chart. Data were analized by statistical tests such as chisqure kruskal wallis, Anova and Regression logistics tests. Through Spss software with confidence interval of 95%. There was a significant increase in labor initiation ratio in acupressure group compare to touch group (p= 0/007) and routin group (p = 0/003). This difference has been significant in the First 48 hours and hasn’t beent significant in the second 48 hours. Conclusion and suggestion: the probability of labor initiation increase after the acupressure performance howerer more forther studies are recommended to improve it’s efficacy and safety.

Background and The pain is a main problem of patients after cesarean section. There are some factors for post cesarean pain such as surgical wound, flatulence, abdominal distention, uterus contraction, psychological stress and anxiety. Early feeding would seem to be effective on these factors, so it would affect on post cesarean pain. There are a few papers about this problem and they have reported different results. So the aim of this paper was to detect: the effect of early feeding on post cesarean pain. This study was a controlled trial. The research population was women delivered by cesarean section in Ommolbanin hospital. The samples consist of 82 women randomly assigned in two groups of study and control. The study group started oral fluids 4 hours after surgery, followed by regular diet after return of bowel sounds. The control group started oral fluids 12 hours after surgery then oral solid food was allowed after defication.The groups were compared about intensity, typical and location of pain at 4, 12,24,36,48 hours after surgery. Data was analyzed using chi-square, Fisher exact test, Kruskal walis test, t test and Mann Whitney. Results show that pain intensity 4 hours after surgery was similar in both groups (p=0.339). Pain intensity 12 hours after surgery was less in study group (p=0.010). Pain intensity 24, 36, 48 hours after surgery were less in study group (p=0.000). Pain typical at 4(p=0.991), 12(p=0.489), 24(p=0.451) and 36 hours after surgery (p=0.433) were similar in both groups. but a statistically significant difference was observed in pain typical 48 hours after surgery(p=0.017).pain location 4 and12 (p=1.000), 36(p=0.543) and 48 hours after surgery(p=0.846) were similar in both groups but a statistically significant difference was observed in pain location at 24 hours after surgery(p=0.048). Early feeding was effective on post cesarean pain because it would seem to be affect on physical and psychological aspects of mother. Early feeding has beneficial effects especially on women’s perceived pain. According it is hoped that use of this method in surgical parts increase quantity and quality of care after cesarean section, increase mothers satisfaction, decrease pain intensity and improve the relationship between mother and infant.

Mostly after some of upper gastrointestinal surgery oral feeding is withheld until the return of gastrointestinal function and in this time, gastric decompression is done. Recently, usefulness of this method has been questioned because it appears that not nasogastric decompression causes earlier postoperative ileus resolution and decrease postoperative complications. The purpose of this study was to determine the effect of no nasogastric decompression on gastrointestinal function after operation of patients with obstructive jaundice. In this clinical trial 40 patients who had been operated for obstructive jaundice were randomly divided into two groups. In experimental group (n=20) didn’t had nasogastric tube at all and in control group (n=20) gastric decompression had applied for three days after surgery. Gastrointestinal function were assessed and compared in two groups. Rates of nausea in 2nd (p<0.001) and 3rd (p<0.007) days after operation and the severity of it in 2nd (p<0.001) and 3rd (p<0.005) days was significantly increase. In experimental group, the time to return of bowel sounds (p<0.001) and first passage of flatus (p<0.007) were shorter. Application of nasogastric tube after surgery can delay normal gastrointestinal function and has no obvious effects on preventing postoperative complications. On the contrary, it may increase the incidence and severity of postoperative nausea. Findings of this study suggest that routine placement of nasogastric tube after these operations is unnecessary.

The two-stage approach to measuring blood pressure has been widely accepted as the most accurate and reliable noninvasive method. But possible venous congestion induced with this method might result in inaccurate blood pressure reading. The aim of this study is comparison of two methods to determine most accurate approach. 52 patients in intensive care unit of open heart surgery was enrolled in this study. Study cases blood pressure was measured with mercury manometer and arm cuffs compatible with arm size, first by two-stage approach and at least after 3 minutes interval, using one-stage approach. Direct blood pressure consists of mean, systolic and diastolic blood pressure recorded immediately before noninvasive reading. Paired sample t test and Pearson correlation was used for data analysis. Mean bias for two two-stage approach was -4±7.49 (p<0.001) and for one-stage was -2.25±4.93 (p=0.002) in systolic pressure and in diastolic blood pressure the mean bias was 8.35±5.17 (p<0.001) for two-stage approach and 4.42±2.71 for one-stage approach (p<0.001). By contrast there was significant differences in accuracy of diastolic blood pressure reading of two methods (p<0.001). two-stage and one-stage approach tend to underestimate direct systolic blood pressure while there are no statistical difference between two methods. Both of methods tend to overestimate diastolic blood pressure, but one-stage approach is more accurate. So with considering one-stage approach is more accurate, it is recommended to use this method as noninvasive method.

Life passing and hormonal changes, especially, estrogen declining in this period, leads to in some complications in three dimension: vasomotor, psychological, and physical. There were accomplished some efforts to decrease the complications of menopause. One of this ways is the regular aerobic exercise that, there hasn’t been any researches accomplished in Iran yet. So, this study was designed to determine effect of the regular aerobic exercises on Physical fitness level in post menopausal women. This clinical experimental research was accomplished with 50 volunteer post- menopausal women were divided randomly into two groups. Physical fitness tests were used to assess physical fitness in both groups, both before and after 6 weeks. The study group participated in an exercise program, which was composed of sub-maximal aerobic exercises for a 6-week period 3 times a week. Data were analyzed by utilizing the independent t-test, Chi-square, Mann whitney, Wilcoxon, and two way ANOVA analysis tests. At the end of 6 weeks exercise period, when the two groups were compared after the exercise period, we found statistically significant differences in Vo2max, endurance, flexibility and balance parameters in the exercise group (p<0.05). A regular and controlled exercise program of 6 weeks, with moderate-intensity, could be improved physical fitness in post menopausal women and increase their health. It is proposed that, an optimal diet and suitably vigorous activity are advisable for all women as they enter the postmenopausal phase of life.

Growth charts are widely used to monitor childhood growth. Racial differences necessitate using local growth charts. This study was designed to provide standardized growth curves of weight for northeast Iranian children, and compare them to the WHO reference. A total of 67558 apparently healthy boys and girls aged 0 to 60 months recruited in July 2004 for 20 days from those attending community clinics for routine health checks. The selected cohort was an 11% sample of preschool boys and girls were born in Khorasan. Anthropometric measurements were done by trained health staff using WHO methodology. The LMSP method with maximum penalized likelihood, the Generalized Additive Model, the BCPE distribution, the AIC and GAIC (3) criterion, and the Worm plot and Q-tests as goodness of fit tests were used to construct the centile reference charts. Derived centiles were compared with WHO reference data. Sex-specific centile curves of weight for age of boys and girls aged from 0 to 60 months were derived recruiting a population of big khorasan province in the northeast of Iran. Among all age groups from birth to 60 months the median values of Iranian children were lower than corresponding values in WHO reference data. The differences were more dominated after the age of 24 months. Similarly, the weight curves of boys were higher than girls in all age groups. Significant differences between growth patterns of Iranian children versus international ones necessitate using local and regional standards and growth charts. International norms may not properly recognize population at risk for growth problems in Iranian children and therefore they may be misleading for our healthcare system.

Multiple sclerosis (MS) is one of the most common chronic neurological diseases in young adults and like other chronic diseases affects different aspects and quality of patient's life. The present research attempted to investigate the effect of family-centered empowerment model on the quality of life (QOL) patient with multiple sclerosis. The present clinical trial practical research is performed on 30 (test group) and 32 (control group) patient with M.S. The research tools included the questionnaires of demographic information, multiple sclerosis quality of life (MSQOL-54). After the collection of pre-test data, the family-centered empowerment model was implemented for patient and active member of family in test group according to its four steps (perception threat, problem solving, educational participation and evaluation). The post test was carried out 1.5 months after the intervention. χ2 test showed that there was no significant difference between the test and control groups in terms of demographic characteristics (P=0.05). Also before intervention we observed no significant difference in the QOL of the patient both in general independent t-test. While, after the intervention, independent t-test showed a significant difference between the two groups in terms of the difference of means of MSQOL-54 dimension before and after the intervention. Also, the paired t-test showed a significant difference before and after the intervention in the test group in terms of the MSQOL-54 dimension (P=0.05). Our findings showed that the family-centered empowerment model was effective on increasing the quality of life of patient with multiple sclerosi.

This study's purpose was to compare the efficacy of the behavioral intervention program and vaginal cones on stress urinary incontinence.: In this single-blind randomized clinical trail 60 eligible women aged 25-65 years with stress urinary incontinence randomly divided in two groups, behavioral intervention program(n=30) and vaginal cones(n=30). Women in behavioral intervention instructed pelvic floor exercise and bladder control strategies. Women in vaginal cones group were allocated to using vaginal cones, women in both group were followed up every two week. They were treated for 8 week. The subjective changes in severity of SUI were measured using a Detection SUI Severity Questionnaire and leakage index and 3-day urinary dairy. The objective changes were measured using pad test. Data analyzed by statistic methods (chi-square, Mann-Whitney, t student test, paired t test, Wilcoxon test with spss software. Characteristic of both study groups was comparable. 51 women who completed this study, 25 in vaginal cones group, 26 in behavioral intervention program. The changes in three parameters after 8 week intervention, leakage rate on pad test, leakage index, severity of SUI were statistically significant in both group(p<0/001). Changes in leakage rate on pad test, leakage index in behavioral intervention program were statistically significant higher than vaginal cones (p=0/006, p= 0/025). Severity of SUI wasnt significantly difference between two group after 8 week (p=0/08). vaginal cones and Behavioral intervention program both are effective to treatment of mild to moderate SUI, in comparison of effectiveness, cost and side effects behavioral intervention program is superior to vaginal cones in treatment of mild to moderate stress urinary incontinence.