Hospital Practices and Research
Volume:2 Issue: 4, Autumn 2017

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.

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.
This study aimed to determine nurses’ work-family conflict (WFC), job satisfaction, and intention to leave the job in a private hospital.
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).
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.
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.

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.
This study aimed to evaluate the effect of 2 different dosages of Fentanyl on sedation of infants under mechanical ventilation.
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.
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).
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.

Data on the frequency of hereditary bleeding disorders (HBDs) and associated mortality and morbidities during a long-term follow-up from Iran are scarce.
This study evaluated the epidemiologic features among patients with HBD in one of the largest referral centers in southern Iran.
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.
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.
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.

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.
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.
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.
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.
It seems that the density of 2% glutaraldehyde in 30 minutes time was enough to destroy the spores of B. subtilis.

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.
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.
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.
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.
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.

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.
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.
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.

By evidence, we mean systematic and extensive studies conducted to enhance knowledge and evidence-based policymaking (EBP), or evidence-based decision-making, an approach that helps individuals make decisions with more information and use the best evidence to establish, implement, and develop policies.1 Evidence-based policymaking is a complex of methods giving information to the process of policymaking rather than directly affecting the policies’ probable goals. It is based on the idea that, in decision making, the existing information evidence should be exploited; moreover, the information used should have logical analysis.2 Hospital centers are the pillars of the health system in each country, and reforming the health sector without addressing such community centers and improving their performance would not be possible.3
One policy of the Ministry of Health for providing better performance and improving services in hospitals both qualitatively and quantitatively is to set up hospital committees. The hospital manager needs to establish hospital committees to plan, organize, guide, and control hospital activities.4 Groups and committees are usually set up to coordinate activities or accomplish a certain goal. Committees play a significant role in following up on the procedure of improving hospital services and the regular and continuous assessment of hospital activities; they are established to strengthen functions and solve all existing problems and hardships.5 Since hospital committees are regarded by hospital managers and owners as think tanks and as the advisory and decision-making arms of hospitals, obviously, optimal decisions made by such a committeecan be effective in achieving the goals of the hospital and correcting its problems. Therefore, it is suggested that evidence from other countries on the issue of decision-making should initially be assessed with regard to the economic, social, and political conditions of the country. Furthermore, the conditions dominating in a hospital must be considered in making the final decision.