Comparison of transcutaneous electrical nerve stimulation and lidocaine on episiotomy complication in primiparous women: A randomized clinical trial

Introduction: Transcutaneous electrical nerve stimulation (TENS) through the skin is a nonpharmacological method of pain relief. The present study aimed to compare TENS and lidocaine on episiotomy complication in primiparous women. Material and Methods: In a randomized, controlled clinical trial, 80 participants were included from March to July 2011 at the antenatal clinic and postdelivery ward in the Social Security Organization Hospital, Khorramabad, Lorestan, Iran. Data were collected using a demographic questionnaire, visual analog scale and redness, edema, ecchymosis, discharge, and approximation scales. The participants were randomized into two groups with equal number of participants. All participants received 5 cc of local infiltration of 1% lidocaine before episiotomy, and TENS electrodes were placed on He Gu and Shenmen points during the crowning of fetal head. The TENS group received TENS with 100; 250 μs, the output range of 15–20 mm amplifier from crowning of first stage of labor to the end of the episiotomy repairing. The lidocaine group received 10 cc of local infiltration of 1% lidocaine before episiotomy repair while did not receive TENS electrodes. The pain intensity during and after episiotomy repair was recorded. Results: TENS and lidocaine have similar effects on pain relief at the episiotomy cutting, the start of the episiotomy repair, and at end of the episiotomy repair; however, the pain relief of both the interventions was different during the episiotomy repair. The effect of TENS in reducing edema was statistically significant (P = 0.001). Conclusions: TENS and lidocaine are effective for the episiotomy complications during and after episiotomy repair

Effects of taping on knee joint position sense of female athletes across the menstrual cycle

Introduction: The rate of anterior cruciate ligament (ACL) tearing is more common in female athletes and one of thereasons is the effect of sex hormones. It was illustrated that knee joint position sense (JPS) isaltered across the menstrual cycle and its lowest level is at menses. Therefore, it’s important to find a method to reduce injury risk at menses. Thus, the purpose of this study was to evaluate the effect of taping as a stimulator of skin, on the knee JPS in healthy female athletes across the menstrual cycle with different levels of estrogen and progesterone. Materials and Methods: In this semi-experimental study, 16 healthy female athletes with regular menstrual cycle voluntarily participated. Knee JPS was measured at 3 menstrual cycle phases, before and after patellataping. JPS was evaluated by reproduction of the target angle (30° flexion) in standing position, from full extension. Serum estrogen and progesterone levels were collected in these 3 phases. Knee angles were measured by using a system comprised of skin markers, digital photography, and autoCAD software. Absolute error was considered as a dependent variable.Results: There was a significant difference between the knee JPS in 3 phases of measurement before taping (P=0.025), while no significant difference was found between knee JPS in 3 phases after taping (P=0.965). Conclusion: Findings of this study suggest that healthy female athletes have different levels of knee JPS across a menstrual cycle and its accuracy decreasesat menses. This differencecan be reduced by skin stimulatingmethods, such as taping. Therefore, kinesio taping would improve the knee JPSdeficiency at menses

Factors affecting maternal satisfaction with vaginal delivery: a qualitative study

Introduction: Bestowing a maternity identity, childbirth isconsidered as one of the most beautiful, though stressful,events of life for every woman. Thus, maternal satisfactionwith the experience of childbirth plays a determinativerole in maintaining the mental health of family andsociety as a decisive indicator for evaluating the quality ofchildbirth services. The present qualitative study intendedto determine factors affecting women’s satisfaction withvaginal delivery.Materials and Methodology: To this end, the presentqualitative study was conducted on hospitalized womenin Fatemieh (PBUH) hospital affiliated to Hamadan Universityof Medical Sciences, Booali private hospital andAtieh hospital affiliated to Social Security Organizationin Hamadan province. Subjects were selected based onpurposive sampling method. The required data were collectedthrough a semi-structured interview with 15 women,who had already undergone vaginal delivery. The datawere analyzed based on content analysis method.Results: Once data analyzed, seven themes on women’sexperiences of factors affecting their satisfaction withvaginal delivery were extracted from the contents. The extractedthemes included the ‘’desire to record the uniqueexperience of childbirth’’, ‘’underlying cultural beliefs onchildbirth’’, ‘’understanding the nature of labour pain’’,‘’confrontation with ignorance’’, ‘’interaction environment:from support to violence’’, ‘’confrontation with fearand anxiety’’ and ‘’desire to hug a healthy baby.’’Discussion and Conclusion: The results of the presentstudy accentuated the necessity of appropriate culturalstrategies for implementing effective interventions toenhance maternal satisfaction with vaginal delivery andpromoting them in accordance with the main objectivesof Iran health system so as to meet WHO standards ofreducing C-section delivery rates

Core components of clinical education: a qualitative study with attending physicians and their residents

Introduction: In medical education, particularly in residency courses, most of the training occurs in real clinical environments. Workplace-based learning profoundly affects students’ knowledge, attitudes, and practice; therefore, it should be properly planned. Due to the extensiveness of the clinical environment and its importance in training residents, investigating how residents learn in these environments and detecting factors that influence effectiveness will help curriculum designers to promote residents’ learning by improving their learning environment. Therefore, our qualitative content analysis study, aimed to examine the experiences and perspectives of internal and surgical residents and their attending physicians about learning in clinical settings. Methods: This qualitative content analysis study was conducted through purposeful sampling. Semi-structured interviews were conducted with 15 internal and surgical residents and 15 of their attending physicians at educational hospitals of Tehran University of Medical Sciences. Results: The main categories explored in this study were hidden curriculum, learning resources, and learning conditions. In the context of clinical environment and under its individual culture, residents learn professionalism and learn to improve their communication skills with patients and colleagues. Because of clinical obligations such as priority of treating the patients for education or workload of the attending physicians, residents acquire most of their practical knowledge from colleagues, fellows, or follow-up patients in different learning conditions (such as: educational rounds, morning reports and outpatient clinics). They see some of their attending physicians as role models. Conclusion: Changing cultural and contextual factors is of prime importance to promote a learning-oriented environment in a clinical setting. The present findings will help curriculum planners and attending physicians to improve residents’ learning by means of appropriate workplace planning and by considering the components involved in clinical learning

A Comparative Evaluation Of Sensitivity And Specificity Of Qualitative Urine Pregnancy Tests With Rapid hCG Immunoenzymatic Test

Background and Aim: Early diagnosis of pregnancy is very important to prevent fetal damage due to specific drug consumption and high-risk behaviors. The objective of this study was to compare the sensitivity and specificity of quantitative agglutination pregnancy tests in urine and rapid β hCG immunoenzymatic assay test in serum as a gold standard. Materials and Methods: This cross-sectional study was performed among 390 women who referred to healthcare centers where their urine samples were tested with latex agglutination (direct agglutination and agglutination inhibition) and the results were compared with rapid β hCG immunoenzymatic assay test in serum as a gold standard. Results: The sensitivity of direct agglutination (82.05 % ) was more than that of agglutination inhibition (81.2 % ), but the specificity of the tests were equal (99.27 % ). The agreement coefficients between direct agglutination and agglutination inhibition on the one hand and rapid β HCG immunoenzymatic assay on the other were 0.859 and 0.853, respectively. Conclusion : The possibility of negative results in direct agglutination is more than that of agglutination inhibition, but the specificity of both qualitative tests is equal. Besides, both tests may have an equal possibility of false positive results. Since the occurrence of false negative results in qualitative tests is higher than that in serum gold standard, the negative results of such tests should be confirmed with more sensitive methods such as rapid β hCG immunoenzymatic assay