Introduction: A clinical practice guideline (CPG) is developed with the aim of improving the quality of Health care and reducing unnecessary interventions, hospitalization time, and related costs.Objective: This study attempted to design a standard protocol for gastrointestinal bleeding (GIB) patients.Methods: This was a cross-sectional study conducted during 2013 and 2014 in an educational medical center in Isfahan, Iran. A checklist containing questions about waiting time for the services, hospitalization time, and costs was completed for the GIB patients. After this primary data gathering, a CPG was designed, codified, underwent several revisions, and finally implemented. Thereafter, the checklist was completed by GIB patients and compared with the previous ones.Results: Fifty patients in each of the two phases were included. The mean age and sex of the studied patients were not different.The time from emergency departments (ED) arrival until the first visit (14±9.8 Vs.19.4±13.4 minutes; p=0.03), hospitalization (73.7±49.2 Vs.116.2±7.2 hours; p=0.003) and costs (1.3±0.81 Vs.3.68±3.51 million rials; p<0.001) were significantly reduced following the CPG implementation. The time from admission until conducting endoscopy was not different in the two study periods (16.5±7.8 Vs.23.9±24.5 hours, p=0.89).Conclusion: The implementation of the CPG for the management of GIB patients in the ED resulted in a reduction in the waiting time for the services and, further, reduction of hospitalization time and related costs.

Background and Objectives: Positive Youth Development (PYD) is a strength–, based construct of development that can be defined as engaging in pro–, social behaviors and avoiding Health–, compromising behaviors and future jeopardizing behaviors. Contrary to other views, PYD does not consider adolescence as a turbulent and dangerous stage and should be managed,rather, it addresses this period as the source of fundamental changes and catches for the individual. Instead of focusing on adolescence deficits and the potential for risks and crises, such as stress, anger, etc., PYD focuses on adolescents' strengths and abilities,therefore, considering the large population of adolescents in Iran and the critical role of the family and its structure in preventing crises and the emergence of problems for adolescents, comprehensively examining the family structure and its role in adolescent development is essential. Therefore, this study aimed at investigating the relationship between Family Structures (FSs) and PYD. Methods: This was a descriptive and correlational study. The statistical population consisted of all students aged 11 to 18 years from sixth to twelfth grades in Tehran City, Iran, in 2016–, 2017 who were selected using the multistage cluster sampling method (N=300,137 girls & 163 boys) with a mean±, SD age of 15. 59±, 1. 67 years. Accordingly, the research objectives and the subjects' expectations were discussed. The questionnaires were administered in a quiet room away from disturbing visual–, auditory stimuli in schools and individually by the researcher and a research assistant. The study lasted two months. Research tools included the Family Adaptability and Cohesion Evaluation Scale (FACES IV,Olson et al., 2006) and Positive Youth Development Scale (PYDS,Geldhof et al., 2014). Research data were analyzed by descriptive statistics (frequency, mean, SD) and inferential statistics (Pearson correlation coefficient & multivariate linear regression analysis) in SPSS at the significance level of 0. 05. Results: The obtained findings suggested a positive and significant relationship between competence with family cohesion (r=0. 32, p=0. 04), flexibility (r=0. 33, p=0. 02), family satisfaction (r=0. 21, p=0. 04(, and family communication (r=0. 33, p=0. 03). There was a negative and significant relationship between competence and enmeshed style (r=–, 0. 21, p=0. 04) and chaotic style (r=–, 0. 22, p=0. 03). There were positive and significant relationships between connection with family cohesion (r=0. 35, p=0. 03), flexibility (r=0. 38, p=0. 02), family satisfaction (r=0. 35, p=0. 03), and family communication (r=0. 33, p=0. 03). There was a negative and significant relationship between the connection with enmeshed styles (r=–, 0. 24, p=0. 04), chaotic (r=–, 0. 19, p=0. 03) and rigid (r=–, 0. 16, p=0. 04) aspects. Furthermore, there was a positive and significant relationship between a character with family cohesion (r=0. 30, p=0. 04) and flexibility (r=0. 31, p=0. 04). There were negative and significant relationships between the dimension of character with enmeshed styles (r=–, 0. 23, p=0. 04), chaotic (r=–, 0. 23, p=0. 03), Rigid (r=–, 0. 19, p=0. 04) and communication (r=–, 0. 14, p=0. 04). Moreover, there was a positive and significant relationship between care and family cohesion (r=0. 14, p=0. 04), flexibility (r=0. 27, p=0. 03), and family satisfaction (r=0. 26, p=0. 03). There was a negative and significant relationship between care with enmeshed (r=–, 0. 26, p=0. 03), chaotic (r=–, 0. 14, p=0. 04), and relationship (r=–, 0. 22, p=0. 04). There was no significant relationship between the confidence dimension in the positive youth development and any family styles. According to the stepwise regression analysis data, among the family styles, two balanced cohesion and chaotic styles, altogether, accounted for 16% of the change in the competence dimension. In sum, balanced flexibility and family satisfaction styles predicted and explained 19% of the variance connection dimension. Family satisfaction and chaos altogether accounted for 13% of the changes in the character dimension, and the family relationship accounted for 7% of the changes in the caring dimension. Conclusion: The present study findings suggested a significant relationship between FS and PYD. Thus, these findings can effectively design and facilitate studying educational protocols to reduce problems and prevent crises in Iranian adolescents and families.

Placenta plays a vital role in normal fetal development and failure of placenta to gain weight and insufficiency of its function can result in fetal disorders. We performed this study to determine placental weight and factors associated with low weight placentas. In a longitudinal cross-sectional study, women with single pregnancy, and gestational age between 37-42 weeks were studied. The subjects were categorized in high (>750 g), normal (330-750 g), and low placental weights (<330 g). The placental weight, birth weight, maternal age, gestational age, parity, pre-eclampsia, history of maternal diabetes, delivery approaches, infants’ gender; and Apgar score in 5th minutes after delivery were examined. One thousand-eighty eight pregnant women were included in the study. The mean and standard deviation for maternal ages and gestational ages at deliveries were 25.35±5.6 and 247.51±9.56 days, respectively. The mean and standard deviation of neonates’ weights at birth and placental weights were 3214.28±529 and 529.72±113 g, respectively. The prevalences of low and high placental weights were 2% and 2.8%, respectively. There were statistically significant relationships between placental weight and birth weight, fetal distress, Apgar score, maternal diabetes, pre-eclampsia and approaches of deliveries (a=0.05). Our findings indicate that placental weight can be associated with important variables influencing some maternal and neonatal outcomes and placental weight lower than 330 g can be a warning sign. Careful attention to placenta growth during pregnancy, for example by ultrasonography, can guide physicians to assess neonatal Health.

Background: Decision making for timing motherhood is one of the vital aspects of reproductive Health. Separating sexual relationship from having a child has led to a different and unprecedented lifestyle in human history.Objectives: The objective of this study was to determine the socioeconomic and emotional factors predicting decision making for timing motherhood among Iranian women using the statistical softwares of IBM SPSS 21 and LISREL 8.8.Patients and Methods: This cross-sectional study enrolled 820 primiparous women from different hospitals across the country using multistage random sampling method in 2013. The tools of the study were enrich marital satisfaction, socioeconomic status, perceived social support, hopefulness, and life regard index. The data was analyzed using SPSS 20 and LISREL 8.8.Results: The results revealed that among direct pathways, marital age (b=0.62) was the most effective predictor of timing motherhood. The hopefulness had an inverse association with timing motherhood through inverse effect of marital satisfaction. Moreover, marital satisfaction (b=-0.09), perceived social support (b=-0.09), and life regard index (b=0.01) had an inverse effect on timing motherhood. Marital satisfaction had a non-causal effect of 0.024.Conclusions: Marital age, and socioeconomic status had a direct association, and hopefulness and marital satisfaction had an indirect one with Iranian women's decision for timing motherhood. Therefore, this is the responsibility of policy-makers and Healthcare providers to advise women by providing appropriate interventions and facilities.