Baqiyatallah University of Medical Sciences Hospital Practices and Research 2476-390X 2 4 2017 12 01 Is Aspirin Still the Cornerstone of Antiplatelet Therapy in Patients With Coronary Artery Disease? An Historical and Practical Narrative Review 94 101 49556 10.15171/hpr.2017.24 EN Carol Gravinese Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy Matteo Bianco Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy 0000-0002-6751-6437 Enrico Cerrato Interventional Cardiology Unit, Infermi Hospital, Rivoli and San Luigi Gonzaga University Hospital, Orbassano, Italy 0000-0002-1260-7534 Paola Destefanis Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy 0000-0001-5060-9568 Alessia Luciano Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy Alessandro Bernardi Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy 0000-0002-0235-1336 Simone Bellucca Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy Ferdinando Varbella Interventional Cardiology Unit, Infermi Hospital, Rivoli and San Luigi Gonzaga University Hospital, Orbassano, Italy Fiorenzo Gaita Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy 0000-0003-3178-6205 Roberto Pozzi Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy Journal Article 2017 05 25 Aspirin is an irreversible and non-selective inhibitor of cyclo-oxygenase. It represents the cornerstone of antiplatelet therapy and is used in secondary prevention of cardiovascular disease. Disagreement over the optimal maintenance dosage still exists; in America and Europe the most used doses of aspirin are 81 mg and 100 mg daily, respectively. There is also debate on the formulation and route of administration of the loading dose. The latest studies advise chewable and non-enteric coated aspirin; intravenous administration represents an alternative for unconscious or shocked patients. Aspirin hypersensitivity is characterized by the onset of respiratory, mucocutaneous, and systemic symptoms. It is marginally considered, but its prevalence is significant. International cardiologic guidelines only report the possibility of desensitizing intolerant patients or, alternatively, administering one single antiplatelet agent. Desensitization can induce a temporary tolerance to the drug and consists of the administration of sequential and incremental doses of aspirin. Rapid desensitization protocols have proven to be safe and effective in the vast majority of cases, and they should be included in the management of these patients. New studies are being carried out comparing aspirin with other antiplatelet agents, and the results will be available shortly.

https://www.jhpr.ir/article_49556_55055df57e5c23d67dd957d1a4bd8b91.pdf

Baqiyatallah University of Medical Sciences Hospital Practices and Research 2476-390X 2 4 2017 12 01 Factors That Influence Nurses’ Work-Family Conflict, Job Satisfaction, and Intention to Leave in a Private Hospital in Turkey 102 108 49633 10.15171/hpr.2017.25 EN Dilek Ekici Nursing Department, Health Science Faculty, Gazi University, Ankara, Turkey 0000-0002-8401-4172 Kamuran Cerit Nursing Department, Health Science Faculty, Süleyman Demirel University, Isparta, Turkey 0000-0002-1234-4025 Tugba Mert TOBB ETU Hospital, Ankara, Turkey Journal Article 2017 04 28 Introduction: Nurses who have difficulty balancing their family role and responsibilities because of intense work pressure tend to leave their current jobs to work in organizations which offer better working conditions, lower workloads, and more managerial support. Objective: This study aimed to determine nurses’ work-family conflict (WFC), job satisfaction, and intention to leave the job in a private hospital. Methods: This descriptive study is based on a methodological and causal research design. The population of the study included 98 nurses working in a private hospital. The research model is tested with structural equation modelling (SEM). Results: Nurses working changing shifts reported statistically higher levels of work-to-family conflict and workload than those consistently working daytime shifts. Managerial support and workload explained 48% of WFC. Work structure alone explained 44% of job satisfaction. Job satisfaction and WFC explained 17% of the variance in intention to leave. Conclusion: Nurses who have difficulty balancing their family roles and responsibilities because of intense work pressure tend to leave their current jobs to work in organizations which offer better working conditions, lower workload, and more managerial support. The work structure of nurses should be reorganized in order to enhance nurses’ job satisfaction.

https://www.jhpr.ir/article_49633_73e4a23ae4137875047fc4ba71ea8d29.pdf

Baqiyatallah University of Medical Sciences Hospital Practices and Research 2476-390X 2 4 2017 12 01 Effects of Different Doses of Fentanyl on the Sedation of Infants Under Mechanical Ventilation; A Randomized Clinical Trial 109 112 51974 10.15171/hpr.2017.26 EN Bita Najafian Department of Pediatrics, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran 0000-0002-4029-1979 Hamed Eyvazloo Department of Clinical Pharmacy, Faculty of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University (IAUPS), Tehran, Iran Mohammad Hossein Khosravi Student Research Committee (SRC), Baqiyatallah University of Medical Sciences, Tehran, Iran International Otorhinolaryngology Research Association (IORA), Universal Scientific Education and Research Network (USERN), Tehran, Iran 0000-0003-0426-5092 Journal Article 2017 08 01 Background: Respiratory distress syndrome (RDS) is a medical emergency in infants resulting from a lack of or deficiency in surfactant, and leads to pulmonary failure. Surfactant and mechanical ventilation are among the primary treatments for helping infants with respiration. Some sedative drugs, such as benzodiazepines and opioids, are used to reduce stress and restlessness in infants under mechanical ventilation. Objective: This study aimed to evaluate the effect of 2 different dosages of Fentanyl on sedation of infants under mechanical ventilation. Methods: In this randomized clinical trial, infants with RDS were assessed, and restless infants under mechanical ventilation were included in the trial. Infants were randomly allocated into 2 groups. Infants in group A underwent treatment with 0.5 μg/kg fentanyl, and those in group B received 1 μg/kg of fentanyl. Demographic information as well as data on the duration of mechanical ventilation, length of hospital stay, and need for re-intubation were recorded on a pre-designed checklist. Results: Ultimately, 60 infants (46 male and 14 female) with a mean gestational age of 36.7±1.48 weeks in group A and 36.2±1.42 weeks in group B underwent analysis (P=0.087). Patients in group A were hospitalized for 10.36±3.59 days, and those in group B were hospitalized for 10±3.95 days (P=0.642). Mean duration of mechanical ventilation was 3.96±2.02 days in group A and 3.51±1.5 days in group B infants (P=0.459). Conclusion: The findings of the present study suggest that both doses of fentanyl (0.5 μg/kg and 1 μg/kg) reduced all parameters of respiratory distress, such as heart rate and respiratory rate, with no significant difference between the 2 doses.

https://www.jhpr.ir/article_51974_e2e102b4cdb5e9f688eb7833e0a3c322.pdf

Baqiyatallah University of Medical Sciences Hospital Practices and Research 2476-390X 2 4 2017 12 01 Epidemiology of Hereditary Coagulation Bleeding Disorders: A 15-Year Experience From Southern Iran 113 117 51384 10.15171/hpr.2017.27 EN Azadeh Farjami Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Sezaneh Haghpanah Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 0000-0002-8666-2106 Peyman Arasteh Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran Department of MPH, Shiraz University of Medical Sciences, Shiraz, Iran 0000-0001-6499-9093 Rezvan Ardeshiri Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Hakimeh Tavoosi Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 0000-0002-6867-0495 Zohre Zahedi Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Shirin Parand Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 0000-0002-5881-9807 Mehran Karimi Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 0000-0001-8555-1001 Journal Article 2017 09 26 Background: Data on the frequency of hereditary bleeding disorders (HBDs) and associated mortality and morbidities during a long-term follow-up from Iran are scarce. Objective: This study evaluated the epidemiologic features among patients with HBD in one of the largest referral centers in southern Iran. Methods: In this cross-sectional study, 619 patients with HBD were evaluated during the period 1996 to 2011. Aside from baseline characteristics and type of factor deficiency, associated morbidities including viral infections, neurological disorders, asthma, thalassemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency, diabetes, hypertension, cardiac and renal diseases were evaluated. Furthermore, among patients who died, the underlying disease and etiology of death were also evaluated. Results: Patients’ mean age was 24.4 ± 13.5 years. Factor VIII deficiency was the most prevalent type (50.4%) of HBD, and combined Von–Willebrand and factor XIII deficiency (2.3%) was the most prevalent type of combined factor deficiency. A total of 0.5% had hepatitis B and 11.5% had hepatitis C. Cardiac disease was seen in 1.5%, hypertension in 0.2%, renal disease in 0.2%, and diabetes in 1.3% of patients. Overall, 5.2% had intracranial hemorrhage, 2.1% had epilepsy, and 0.8% had mental retardation. During the 15-year follow-up, 22 patients died; car accident was the leading cause of death in this population. Conclusion: Associated morbidities were seen in 24.3% of patients with HBD. Most prevalent morbidities were HCV infections (11.5%) and neurological disease (7.3%). The mortality rate among patients with HBD was 3.4%, and the most common cause of death was accident, which is similar to that of normal Iranian populations.

https://www.jhpr.ir/article_51384_72ab967f8559ce300b06bf5d54789c00.pdf

Baqiyatallah University of Medical Sciences Hospital Practices and Research 2476-390X 2 4 2017 12 01 Effects of Different Times of Glutaraldehyde 2% on Bacillus subtilis Spores (In Vitro) 118 121 53461 10.15171/hpr.2017.28 EN Eshagh Lasemi Craniomaxillofacial Research Center, Tehran Dental Branch, Islamic Azad University, Tehran, Iran 0000-0001-8927-8719 Mohammad Hossain Kalantar Motamedi Craniomaxillofacial Research Center, Tehran Dental Branch, Islamic Azad University, Tehran, Iran Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran Fina Navi Craniomaxillofacial Research Center, Tehran Dental Branch, Islamic Azad University, Tehran, Iran 0000-0002-7342-8193 Maryam Rezae Department of Microbiology, Dental Branch, Islamic Azad University, Tehran, Iran Niousha Homay Nikfar Private Practice Zahra Danial Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran Faculty of Psychology & Educational Sciences, Allameh Tabataba’i University, Tehran, Iran 0000-0002-1409-8972 Roojan Azizpour Craniomaxillofacial Research Center, Tehran Dental Branch, Islamic Azad University, Tehran, Iran 0000-0002-7588-2234 Journal Article 2017 02 20 Background: Due to the importance of disinfectant and sterilization of dental instruments, in total, 14%–28% of dentists, 13% of assistants, and 17% of healthcare workers (HCWs) have been subjected to the hepatitis B virus (HBV), and more than 200 healthcare providers (HCPs) pass away annually in the United States from HBV infection catched from their work place. Objective: This study examined the effects of glutaraldehyde 2% on Bacillus subtilis spores in the Surgery and Microbiology Department of the Dental Branch of Islamic Azad University. Methods: This experimental research evaluated a total of 58 samples, one called first evidence (pure glutaraldehyde not exposed to spore suspension), one called second evidence (spore suspension not exposed to glutaraldehyde), and 40 samples including a suspension with a normal turbidity of 1×108 CFU/mL according to 0.5 McFarland with exposure to glutaraldehyde 2%. Experiments were done in time intervals of 10, 15, 20, 25, 30, 40, and 60 minutes with 8 repeats. In all times, a B. subtilis spore suspension was used as evidence and also as a case. Results: This research was done on 58 samples. The results showed that in the 10th minute there were 102 colonies, 18.6 ± 3.4 in the 15th minute, 6.2 ± 1.4 in the 20th minute, 2.1 ± 0.8 in the 25th minute, and no colonies after 30 minutes. In an overall observation, it was seen that there were more colonies in the first 10 minutes, and from 15 to 20 minutes, this amount significantly decreased; after 30 minutes in each 8 repeats, the growth of colonies had stopped completely, while in the evidence samples, B. subtilis spores grew. Conclusion: It seems that the density of 2% glutaraldehyde in 30 minutes time was enough to destroy the spores of B. subtilis.

https://www.jhpr.ir/article_53461_4b084ae4ac122a74d6c6b960b9f32c14.pdf

Baqiyatallah University of Medical Sciences Hospital Practices and Research 2476-390X 2 4 2017 12 01 Creating a Better Patient Safety Culture in Taiwan: The Viewpoints of Physicians and Registered Nurses 122 124 51214 10.15171/hpr.2017.29 EN Chih-Hsuan Huang School of Business Administration, Hubei University of Economics, Wuhan, China Institute for Development of Cross-Strait Small and Medium Enterprise, Hubei University of Economics, Wuhan, China 0000-0002-0955-6000 Hsin-Hung Wu Department of Business Administration, National Changhua University of Education, Changhua, Taiwan Department of M-Commerce and Multimedia Applications, Asia University, Taichung, Taiwan 0000-0002-3702-276X Yii-Ching Lee Department of Health Business Administration, Hung Kuang University, Taichung, Taiwan Quality Management Center, Shanghai Changtai Medical Technology Co. Ltd., Shanghai, China The School of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan Li Li School of Management, Wuhan Institute of Bioengineering, Wuhan, China Cheng-Feng Wu Institute for Development of Cross-Strait Small and Medium Enterprise, Hubei University of Economics, Wuhan, China School of Logistics and Engineering Management, Hubei University of Economics, Wuhan, China 0000-0002-0222-6674 Journal Article 2017 08 27 Background: Patient safety culture in healthcare organizations has become an important issue globally for improving medical services. In 2016, Taiwan’s National Health Insurance (NHI) system covered 99.6% of Taiwan’s population. With the enhancement of medical quality, patients expect medical service providers to care more about safety and medical service. Understanding physicians and registered nurses’ attitudes toward patient safety is a critical issue for healthcare organizations wanting to improve the quality of the medical care they provide. Objective: The purpose of this study was to discern physicians and registered nurses’ attitudes toward patient safety using Sexton and colleagues’ Safety Attitudes Questionnaire (SAQ) in order to develop strategies for improving the quality of medical services. Methods: Pearson correlation analyses were conducted to demonstrate the relationships among six patient safety culture dimensions. Physicians and registered nurses were asked to complete the questionnaire in a case hospital in Taiwan in 2016. Results: The results of Pearson correlation analyses demonstrated a strong and positive relationship between perceptions of management and working conditions. Additionally, teamwork climate was highly correlated to safety climate. The results also illustrated that teamwork climate and job satisfaction were significantly related. Conclusion: The assessment of patient safety culture can provide a basis for hospital managers to monitor the quality of the medical care provided at their organizations. Hospital managers should put more efforts into the essentially important elements of patient safety culture, such as teamwork climate, safety climate, perceptions of management, and working conditions, so as to continuously improve the quality of medical care.

https://www.jhpr.ir/article_51214_1dcc1e8fab24558892deb9d5030ee495.pdf

Baqiyatallah University of Medical Sciences Hospital Practices and Research 2476-390X 2 4 2017 12 01 Bilateral Facial Paralysis and Otitis Media as the First Presentations of Wegener’s Granulomatosis: A Case Report 125 127 50892 10.15171/hpr.2017.30 EN Seyed Mohammad Javad Hosseini Biological-Molecular Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran 0000-0001-9143-4565 Jaleh Yousefi Department of Otorhinolaryngology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran 0000-0002-7410-0886 Habib Yaribeygi Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran 0000-0002-1706-6212 Gholam Hossein Alishiri Department of Rheumatology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran 0000-0002-0545-8462 Journal Article 2017 09 04 Introduction: Cranial nerve palsy in Wegener’s granulomatosis is a curious incident, particularly if it occurs without kidney or lung involvement. In a review of medical articles, only 1 case of Wegener’s granulomatosis with bilateral facial nerve palsy was found. Case Presentation: The patient was a 16-year-old female who presented with pain and hearing loss in both ears and reduced muscle tone in the right side of her face. After myringotomy and ventilation tube embedding in both ears, she gradually developed infectious otorrhea in both ears. Despite antibiotic and antifungal therapy for 2 weeks after surgery, the patient developed paresis in the left facial nerve and gag reflex disorder. Both magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) tests were normal, but the C-anti-neutrophil cytoplasmic antibody (CANCA) test result was about forty times higher than normal, and a sinus biopsy also verified Wegener’s granulomatosis. The patient was then treated with pulse corticosteroid and cyclophosphamide therapy. Her gag reflex healed and the ear secretions stopped, but the facial nerve palsy continued. Conclusion: Although cranial nerve involvement in Wegener’s granulomatosis is an unusual incidence, it may occur in some cases. In the current case, otitis media and cranial nerve paresis without kidney or lung disorders were the only signs of disease onset; of course, computerized tomography (CT) scan revealed a right mandibular sinus disorder without any clinical signs. Another important point in this case is that other identified Wegener’s patients were in their fourth or fifth decade of life; thus, Wegener’s was the last choice for a diagnosis in the current case.

https://www.jhpr.ir/article_50892_66c62b60b79f881c67d1ea2b38d3a23c.pdf