Background: Episiotomy is the most common surgical procedure in obstetrics. It may be associated with wound infection and delayed wound healing. Objectives: This study aimed to compare the effects of honey and curcumin on episiotomy pain and wound healing. Methods: This double-blind three-group randomized controlled trial was done on 120 women admitted for vaginal delivery to Shahid Yahyanejad hospital, Babol, Iran. Participants were randomly assigned to three groups of 40 subjects and were taught to apply honey, curcumin, or placebo creams on their own episiotomy wound twice daily for 10 successive days after birth. Pain and wound healing were assessed 2 h, 5 days, and 10 days after birth via a visual analog scale and the Redness, Edema, Ecchymosis, Discharge, and Approximation scale. The primary outcomes of the study were episiotomy wound healing and pain intensity. The Chi-square test as well as the one-way analysis of variance and the repeated measures analyses of variance were conducted for data analysis. Results: The study was completed with 30 women in each of the honey and the curcumin groups and 29 in the placebo group. There were no statistically significant differences among the groups respecting the variations of pain intensity and wound healing mean scores across the three measurement time points. However, based on the complete pain relief on the 10^th day and compared with the placebo group, number-to-treat values in the curcumin and the honey groups were around 6 and 5, respectively. Moreover, compared with the placebo group, number-needed-to-treat values for complete wound healing on the 10^th day in the curcumin and the honey groups were 6 and 8, respectively. Conclusion: Curcumin and honey creams have almost the same effects on episiotomy wound healing and pain intensity.

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Background: Despite their significant roles in patient care, most nursing students have limited ability to make wise ethical decisions in difficult situations. Objectives: This study aimed to examine the effects of nursing ethics education through case-based learning (CBL) on moral reasoning among nursing students. Methods: This controlled trial was conducted in 2016–2017 on 73 4^th year nursing students recruited from Urmia Faculty of Nursing and Midwifery, Urmia, Iran. Participants were randomly allocated to an intervention (n = 37) and a control (n = 36) groups. Nursing ethics education to participants in the intervention and the control groups was provided through the case-based learning and the lecture methods, respectively. Using the Nursing Dilemma Test, participants' moral reasoning was assessed both before and 1 month after the intervention. Data were analyzed using the paired- and the independent-samples t and the Chi-square tests. Results: No statistically significant difference was found between the intervention and the control groups regarding the pretest mean score of moral reasoning (44.97 ± 7.50 vs. 43.64 ± 6.87;P = 0.44). However, the posttest mean score of moral reasoning in the intervention group was significantly greater than the control group (49.08 ± 5.74 vs. 44.67 ± 5.87;P = 0.002). Conclusion: Nursing ethics education through CBL is an effective strategy for improving moral reasoning among nursing students. Therefore, this method is recommended for ethics education to nursing students.

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Background: Research is a key prerequisite for professional development in medical sciences. There is limited authoritative information about the barriers to student research. Objective: The objective of this study was done to identify barriers to student research from the perspectives of nursing and medical science students. Methods: This cross-sectional study was done in 2017, on 250 students randomly selected among nursing, medicine, and paramedic and health sciences students. A researcher-made, barriers to student research questionnaire was used for data collection. The questionnaire contained 32 items on personal, organizational, educational, environmental, technical, and quality- and result-related barriers to student research. The possible total score of the questionnaire and its subscales was 1–5. Data were analyzed using descriptive statistics, analysis of variance, and the independent-samples t-test. Results: There were barriers in all domains; however, respectively, the most important barriers to student research were environmental (3.70 ± 0.72), technical (3.59 ± 0.6), quality- and result-related (3.29 ± 0.67) barriers. More educational barriers to research were reported by nursing students and those with less previous experience in research activities (P < 0.05). Conclusion: In order of importance, the barriers to student research are environmental, technical, quality- and result-related barriers. The findings of this study highlighted the importance of providing students with necessary facilities and counseling in the area of research.

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Background: Thrombocytopenia (TCP) is a common disorder during pregnancy. Its prevalence among pregnant women is four times greater than nonpregnant women. Objectives: This study aimed at determining the global prevalence of TCP among pregnant women. Methods: This systematic review and meta-analysis was conducted in 2018. The PubMed, Scopus, Google Scholar, Magiran, and IranMedex databases were searched using the following key words: “TCP,” “pregnancy,” “pregnant,” “pregnant women,” “gestational,” and “platelets.” The titles and the abstracts of the retrieved studies were screened to identify potentially relevant studies. Articles were included if they were the reports of original researches, included data on the prevalence of TCP among pregnant women, were in English or Persian, and had been published from January 1, 2000 to September 1, 2018. Eligible studies were appraised using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Finally, a data collection form was used to extract data. The overall prevalence of TCP among pregnant women was estimated using meta-analysis and the Comprehensive Meta-Analysis Software. Heterogeneity was evaluated through the Chi-square test and the I² statistic, and funnel plot was used to evaluate the possibility of publication bias. Results: Among 1592 studies retrieved during literature search, sixteen were included in meta-analysis. The overall prevalence of TCP among pregnant women based on the random effects model was 8.4% (95% confidence interval: 6.9%–10.1%). The lowest TCP prevalence was 4.3% in Taiwan, while the highest prevalence was 15.3% in Ghana. Gestational TCP was the most common cause of TCP among pregnant women. Conclusion: With a global prevalence of 8.4%, TCP in pregnancy affects around one-tenth of pregnant women in the world. Thus, timely diagnostic, preventive, and therapeutic measures are needed to effectively manage TCP in pregnancy.

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Background: Nurses often have to care for the patients of the opposite gender. This can be challenging for both nurses and patients in Iran due to the Iranians' cultural and religious beliefs. Objectives: The aim of this study was to compare nurses' and nursing students' attitudes toward care provision to opposite-gender patients. Methods: This cross-sectional study was conducted in 2018 on a random sample of 107 nurses who worked in four teaching hospitals, and 95 bachelor's and master's nursing students from the Hamadan University of Medical Sciences, Hamadan, Iran. A 21-item researcher-made self-report questionnaire was used for data collection. The data were analyzed through the independent samples t-test and the linear regression analysis. Results: The mean scores of nurses' and nursing students' attitudes were 72.54 ± 15.47 and 66.87 ± 14.80, respectively (P = 0.02). The significant predictors of nurses' and nursing students' attitudes were their educational degree, history of care provision to opposite-gender patients, and clinical work experience. Conclusion: Many nurses and nursing students have moderate attitudes toward care provision to opposite-gender patients. Nursing students' poorer attitudes compared with nurses highlight the need for revisions to the nursing academic curriculum to prepare them for quality care provision to the patients of both genders.

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Background: More than 60% of fall incidents among older adults are multifactorial. Objectives: This study aimed to investigate the effects of a multicomponent fall prevention intervention on fall prevalence, depression, and balance among nursing home residents. Methods: This pretest-posttest quasiexperimental study was conducted in 2014 on 160 residents of a nursing home in Tehran, Iran. A 4-month multicomponent fall prevention intervention was implemented with a 2-month follow-up. The intervention consisted of educations for nursing home residents and staff, environmental modifications, and stretching, strengthening, and balance-improving exercises for residents. A fall frequency form, the performance-oriented mobility assessment, the timed up and go test, the geriatric depression scale, the Katz index of independence in activities of daily living, and the mini-mental state examination test were used for data collection both before and 6 months after the intervention onset. Data analysis was done using the paired-sample t, independent-sample t, Wilcoxon signed-rank, Mann–Whitney U, and Kruskal–Wallis tests as well as the one-way analysis of variance. Results: The mean scores of fall frequency, mobility, balance, and depression among nursing home residents significantly changed from 2.40 ± 0.93, 17.93 ± 4.69 and 20.77 ± 6.91, and 10.14 ± 6.85 at pretest to 0.20 ± 0.55, 24.53 ± 1.78 and 14.11 ± 3.74, and 8.23 ± 5.17 at posttest, respectively. Conclusion: Multicomponent intervention is effective in significantly reducing fall prevalence and depression and improving balance and mobility among older adults. Nurses can use such interventions to enhance older adults' mobility, improve their balance, relieve their depression, and reduce their risk of fall.

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Background: Despite caring being an important aspect of health-care providers' work, there is a growing concern about the lack of suitable caring behaviors in childbirth settings in developing countries. Objective: The objective is to design, implement, and evaluate an educational workshop to improve the caring behavior of midwives working in the labor ward of a large Jordanian public hospital. Methods: This is a pre- and post-interventional study. A workshop focused on teaching specific caring behaviors was held for 20 midwives who worked in the labor ward at one public hospital in Jordan and evaluated against women's ratings of midwives' caring behaviors and satisfaction with care after the intervention and 3 years later. Results: Significant increases were observed in the overall scores of midwives caring behaviors and women' satisfaction 6 weeks and 3 years after the intervention compared with prior scores. Women postintervention perceived midwives to be more caring than women before the intervention (P = 0.001). There were significant positive changes from preintervention scores at 6-week postintervention and 3-year postintervention on seven out of eight items of the “caring behavior scale.” Increased overall satisfaction scores were observed 6 weeks and 3 years after the intervention compared with the scores before the intervention (P < 0.001). Conclusion: The study can inform midwifery educators on the importance of teaching and learning of caring behaviors to future midwives in their preservice preparation. The program that was developed can be used with some modification, as part of midwifery students' educational program or as an in-service program for employed midwives.

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Background: Religious restrictions and moral grounds, such as fear over committing a sin, are the major causes of opposing therapeutic abortions. Objectives: This study aimed to describe pregnant women's justifications for deciding on pregnancy termination due to beta thalassemia major (β-TM) in the sociocultural context of Sistan and Baluchestan province, Iran. Methods: In this qualitative study, in-depth semi-structured interviews were conducted with 27 pregnant women and their husbands. Purposive sampling was used to recruit pregnant women who were able to speak and understand Persian, had no known mental illnesses or psychiatric problems and had fetuses with β-TM. Data were analyzed using narrative thematic analysis. Results: At the time of receiving, the results of chorionic villus sampling for β-TM screening, the age and the gestational age ranges of the participants were 19–42 years and 11–18 weeks, respectively. Women's justifications for deciding on pregnancy termination due to β-TM were explained in three main themes, namely, child's physical suffering, negative psychological consequences, and attempting to be good parents. Conclusion: Providing families with information about the long-term effects of β-TM on the child and family members can help them make informed decisions on pregnancy continuation or termination.

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Background: Prenatal screening for birth defects is turning into a main component of prenatal care. The success of prenatal screening programs greatly depends on health-care providers' knowledge about it. Objectives: This study aimed to assess health-care providers' knowledge about prenatal screening. Methods: This cross-sectional study was conducted on June–October 2016 in Sari, a large city in the North of Iran. A sample of 472 obstetricians, general physicians, and midwives was recruited through quota and convenience sampling. Data on participants' knowledge about prenatal screening were collected through a 35-item self-administered knowledge questionnaire which contained the four domains of time, technique, legal issues, and follow-up assessment. The total score of the questionnaire could range from 0 to 35, with higher scores representing greater knowledge. Descriptive statistics measures, Mann–Whitney U-test and Kruskal–Wallis test, Spearman's correlation analysis, and multiple linear regression were used to analyze the data. Results: The mean score of participants' knowledge about prenatal screening was 18.34 ± 9.34. The lowest and the highest mean scores of knowledge were obtained by obstetricians and general physicians, respectively (P < 0.001). The number of participants who correctly answered more than half of the questions of the knowledge questionnaire was 266 (56.35%) for the time domain, 259 (54.87%) for the technique domain, 237 (50.21%) for the legal issues domain, and 200 (42.37%) for the follow-up assessment domain. Regression analysis revealed that the significant predictors of prenatal screening knowledge were participants' profession, employment setting, and history of providing screening-related counseling (R² = 0.515; P < 0.001). Conclusion: Health-care providers have limited knowledge about prenatal screening. Thus, well-designed need-based educational interventions are needed to fulfill their educational needs and advance their knowledge about prenatal screening.

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