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Background and purpose: Postpartum hemorrhage is one of the most common causes of maternal deaths worldwide. Most deaths associated with hemorrhage occur due to delay in diagnosis and proper management of bleeding. This study aimed to evaluate the accuracy of postpartum hemorrhage estimation using artificial blood. Materials and methods: This descriptive study was performed in 92 midwifery students, in Mashhad School of Nursing, 2013. The samples were selected using convenience sampling. Data was collected through questionnaires and objective structured clinical examination. Scenes similar to postpartum hemorrhage were created using artificial blood in six stations. The students saw each station and estimated the volume of blood. Data was analyzed applying central tendency and dispersion indices, paired T-test, and chi-square in SPSS V.16. Results: Accuracy of visual estimation of blood loss was between 2- 20%. In estimation of postpartum hemorrhage it was found that about 40.21% of the students have underestimated, 10.34% had accurate estimation of blood loss and 49.45% estimated higher volume of postpartum hemorrhage than their actual volume. Conclusion: Visual estimation of blood loss was not accurate in most of the subjects. Authorities should focus more on skills and competencies required for accurate estimation of blood loss after delivery by revising the educational curriculum.

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Background and purpose: Gestational diabetes (GA) is a common complication associated with perceived stress. Patient’s commitment for self-care induces much stress in routine life which requires appropriate coping styles. The aim of this study was to determine the relationship between self-care behaviors and coping strategies in women with gestational diabetes.

Materials and methods: A predictive correlational study was done in 400 women with gestational diabetes attending the clinics and health centers affiliated with Mashhad University of Medical Sciences in Mashhad, Iran, 2015. Data was collected by recording the participants’ personal information, using self-care questionnaire retrieved from Summary of Diabetes Self-Care Activities (SDSCA), and Ways of Coping Questionnaire (WOC; Folkman & Lazarus). Data analysis was performed by Descriptive Statistics, Pearson correlation coefficients test, Liner regressions model, and Multiple regression.

Results: In this study, 312 women (78%) with gestational diabetes were using problem-focused coping styles and 261 patients (65.2%) had moderate levels of self-care. Pearson correlation coefficient showed a significant direct correlation between problem-focused coping style and self- care, (P<0.0001 and r= 0.21); but, there was no significant linear relationship between that and emotive-focused coping style (P= 0.200 and r= 0.06). According to Liner regressions model, only the problem-focused coping is considered as a predictor variable of self- care (P<0.0001, β= 0.345, and F= 20.140).

Conclusion: According to the findings, clinical staff, especially midwives can improve self-care behaviors in women with gestational diabetes by encouraging them to apply problem-focused coping strategies.

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Background and purpose: Chronic non-specific low back pain (CNLBP) is associated with decreased lumbar Multifidus (LM) muscle cross-sectional area (CSA) and Transverse abdominis (TrA) muscle strength which highly predispose the person to recurrent occurrence of disease. We compared the Pilates (PL) and McKenzie (MK) methods on LM CSA and TrA strength in these patients.

Materials and methods: In this clinical trial, 47 female patients, mean age 39.7 years, with CNLBP were allocated to one of three groups including PL training (n=16), MK exercises (n=15), and control (n=16). The measurements of LM CSA and TrA muscle strength were performed using imaging ultrasonography and Bent Knee Lowering Test, respectively at baseline, following a 6-week intervention program, and a follow-up of one month. To evaluate the changes of outcome measurements over time, repeated measures ANOVA test was applied at P< 0.05 in SPSS V. 21.

Results: Compared with MK exercises, PL training could significantly increase right and left LM CSA at L5 level (P< 0.001), while there were no significant effects on this factor in other lumbar segments (P> 0.05). Additionally, PL method significantly increased TrA muscle strength (P< 0.001), however this efficiency was not observed for MK exercises (P> 0.05). The changes were not significantly different after a one-month follow-up (P> 0.05).

Conclusion: PL training can lead to increase in LM CSA and also TrA muscle strength. These effective changes are persistent following one month.

(Clinical Trials Registry Number: IRCT201406169440N4)

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Background and purpose: Head trauma is amongst the major causes of death and morbidity caused by traumatic injuries. Assessment of trauma patients is an active process which includes initial (triage) and secondary assessments. Various triage tools are designed and used, but, so far no specific and accurate tool has been introduced for triage of head trauma. This study compared the effectiveness of ESI triage tool and nursing triage approach based on Roy Adaptation Model to predict the need for ICU admission in patients with head trauma.
Materials and methods: A clinical trial was done in 400 patients with head trauma in Emergency Department, Mashhad Shahid Kamyab Hospital, 2016. Patients were selected using block randomization and based on the day of admission. They were allocated into receiving nursing care either through ESI triage or Roy Adaptation Model. Twelve hours after triage, patients' outcome were followed based on keeping them in ICU or ward admission. Finally, the margin of error was calculated and compared between the two instruments.
Results: Kappa test did not show any significant difference between the ESI and Roy Adaptation Model triage in prediction for ICU admission at first place (P= 0.123). But, the Roy Adaptation Model was associated with significantly less errors in keeping the patient in ICU or ward admission (P = 0.012 ).
Conclusion: Compared with ESI triage, Roy Adaptation Model could result in fewer errors in predicting the consequences of head trauma patients.