No abstract

Objective:To perform a diagnostic accuracy of the rapid ultrasound in shock (RUSH) to diagnose the etiology of undifferentiated shock in patients presenting to the emergency department (ED). Methods:We searched the Medline via PubMed, Scopus, and ISI Web of Knowledge till July 2017. Two independent reviewers screened studies for eligibility. Our study analysis is planned in accordance with the guidelines for meta–analysis of diagnostic studies. In the systematic search, of 397 references, 295 were excluded on the basis of the title and abstract. For the remaining 102 articles, the full text was retrieved and critically reviewed. After the selection process, five papers were included. Results:The pooled estimate of all data showed that the RUSH protocol exhibited high sensitivity (0.87, 95% Confidence Interval (CI): 0.80-0.92, I2 = 46.7%) and specificity (0.98, 95% C. I.: 0.96-0.99, I2 = 30.8%). The AUC for SROC, a global measure of the RUSH protocol performance, was 0.98 ± 0.01, indicates the high accuracy of the test. Positive and negative likelihood ratios reported from the studies ranged from 9.83 to 51.32 and 0.04 to 0.33, respectively. The pooled estimate of all data showed that the RUSH protocol exhibited high positive likelihood ratio (19.19, 95% C. I.: 11.49-32.06, I2 = 14.1%) and low negative likelihood ratio (0.23, 95% C. I.: 0.15-0.34, I2 = 18.4%). Conclusion:This meta-analysis suggests that RUSH protocol has generally good role to distinguish the states of shock in patients with undifferentiated shock referred to the emergency department.

Background & Aim: Identifying aged people at risk of falls in hospitals is particularly important for the prevention of falls. A review of the literature revealed that the association of falls and fear of falls had not been investigated extensively in previous studies in Iran. This study aimed to determine the relationship between falling and fear of falling among aged hospitalized patients. Methods & Materials: In this descriptive-correlational study, 1123 subjects were recruited. Of all subjects, 385 aged hospitalized patients, 60 years old and above, were conveniently selected based on inclusion criteria in Shahroud Imam Hossein hospital from March to December 2016. Johns Hopkins fall risk assessment tool (JHFRAT) was used to evaluate the risk of falls among older adults and the Falling Efficiency Scale (FES) was applied to assess fear of falling. SPSS software version 19with the significance level of p<0.05. Chi-Square test and exact test of Fisher and logistic regression has been used for data analysis. Results: All aged patients (n=1123) admitted in the emergency room were assessed for eligibility to inclusion in the study.  Of all subjects, 385 patients were included in this study. The subjects' mean of age was 71.68±4.32 years, age range: 60-84. Of all samples (n=385) of study 90 (23.4%), 151(39.2%) and 144 (37.4%) had a low, middle, and high risk of falls, respectively. Of all participants of the study, 193(51%) subjects were male and 192(49%) were female. One-third (36.4%) of the subjects had a fear of falls and (33.8%) experienced fall in the last six months before admission.  A statistically significant relationship was found between the incidence of falls and fear of falling (P<0.001). Conclusion: This study found JHFRAT and FES as two applicable instruments for assessment of aged people. The result of this study concluded that evaluation of fear of falling and the risk of falls among aged hospitalized patients is recommended as a routine procedure to predict the risk of falls. Nurses are in the best position to evaluate the fear of falls and risk of falls, so it is recommended considering the fear of falls as a potential risk factor for falls in the hospital.

Objective: The incidence of cesarean section (CS) was estimated as about 48% between 2000 and 2012 in Iran. This study was conducted to assess the effects of reviewing written childbirth scenarios on the selection of delivery method. Materials and Methods: This randomized controlled trial was conducted in Shohada Women’s Hospital in Behshahr, Mazandaran, Iran, from May to December 2015. A total of 223 women at 28 to 32 weeks of gestation were randomly allocated into three groups; the standard care (control), theory of planned behavior (TPB)-based education, and TPB education plus additional support via written childbirth scenarios (scenario). Participants were assessed at baseline (weeks 28-32) and intervention (week 37 of pregnancy) periods. Both intervention groups (TPB and scenario groups) participated in three learning sessions that were based on TPB, whereas the control group received routine care service. Results: The frequencies of normal vaginal delivery (NVD) in the scenario, TPB, and control groups were 73.2%, 58.5%, and 45.7%, respectively (p=0.004). The results showed that the relative risks of CS decision in the scenario and TPB groups in comparison with the control group were both 0.87 and statistically significant (p=0.018 and p=0.013, respectively). The relative risk of choosing CS after the removal of obligatory CS cases in the scenario group compared with the control was 0.85. Conclusion: Written childbirth scenarios that contain information on NVD and CS as additional support are effective educational tools for reducing CS rates.

Background Poor sleep quality consequences among shift working nurses are well recognized. Aim To investigate the impact of sleep improvement on sexual quality of life. Methods The study was a parallel randomized controlled trial, conducted among 120 female nurses in 2 educational hospitals in the Northeast of Iran, Shahroud. Using random blocks of four, 120 eligible participants were randomly assigned to study groups. Data collecting tools included a demographic data questionnaire, Pittsburgh Sleep Quality Index to assess sleep quality, and the survey of sexual quality of life-female and Sexual Self-Efficacy Questionnaire to evaluate level of sexual quality of life and sexual self-efficacy, respectively. The intervention consisted of 3 weekly sleep intervention sessions that lasted from 90 to 120 minutes. Outcomes The study's primary and secondary outcomes were sleep quality, and the level of sexual self-efficacy and sexual quality of life, respectively. Results By 3-month follow-up, the loss to follow-up rate was 5.9%. The mean sleep quality score was 7.61 ± 2.26 in the recruited participants. Following the intervention, the sleep quality score showed statistically significant differences compared to the control group [mean difference (CI 99.98%), −1.89 (−2.40, −1.38)]. Participants in the intervention group showed modest increases in both measures; sexual self-efficacy [mean difference (CI 99.98%), 8.82 (6.83, 10.81)] and sexual quality of life [mean difference (CI 99.98%), 19.64 (18.08, 21.20)]. Clinical Implications These findings suggest that sleep improvement could promote the sexual quality of life among shift working nurses. Strengths & Limitations Strengths of this study include the use of a validated outcome measure. Focusing the study on female nurses and the small size of the study population are the limitations. Conclusion Improved sleep showed an impact on sexual quality of life among rotating female shift workers.