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Journal Cover Hospital Practices and Research
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  This is an Open Access Journal Open Access journal
   ISSN (Print) 2476-390X - ISSN (Online) 2476-3918
   Published by Baqiyatallah University of Medical Sciences Homepage  [7 journals]
  • Prevalence of Dissociative Experiences in Those Referred to Emergency
           Psychiatric Centers After ...

    • Abstract: Background: Dissociation is a symptom that can be related to traumatic childhood events. Dissociation in some cases is categorized in a distinct subgroup from other psychiatric disorders. Objective: The purpose of this study was to investigate the prevalence of dissociative experiences in patients who have attempted suicide and who have referred to an emergency psychiatric center. Methods: This was a cross-sectional epidemiological study in which dissociative experiences were evaluated in 98 patients who referred to Ibn Sina and Hafez hospitals after attempting suicide. In addition to determining the prevalence of these experiences, the relation between the symptoms and variables such as sex, age, marital status, education and suicide risk was determined. Results: There was a significant difference in the level of disappointment between married and single patients (P = 0.047). The mean disappointment score for the overall population was 11.92, which is in the normal range. There was no significant relationship between the dissociation score and level of disappointment (P = 0.933). The prevalence of dissociative experiences was found to decrease as the age of the patients increased (P = 0.006). There was no significant difference between the rate of suicide as reflected in the measurement of disappointment and dissociative symptoms. There was no significant relationship between DES score and other variables. Conclusion: One cause of psychological pressure in deciding to attempt suicide is family conflict. Many individuals who attempt suicide did not have a thought-out desire to take their lives, but attempted it impulsively in response to a periodic stressor.
      PubDate: Fri, 09 Feb 2018 20:30:00 +010
  • Medical Errors Disclosure: Is It Good or Bad'

    • Abstract: Background: In the treatment and health process, there are a lot of dangers to patients, and the increased number of medical errors is one of the most important circumstances of this process. Objective: The present research purposed to decrease medical errors through disclosure of them in hospitals of Tehran University of Medical Sciences. Methods: This qualitative-quantitative study included a population of 232 individuals, selected through targeted non-random selection, who were somehow connected with medical errors made in hospitals affiliated with Tehran University of Medical Sciences. The triangulation technique was utilized to collect data. Data was analyzed using the factor analysis technique. After the effective factors were determined, their internal correlation was determined through regression correlation. Results: Disclosure is made up of organizational culture, the factors related to the patient, the factors related to the presenter, the factors involved in the error, structural factors, and disclosure situation indexes, and is an effective factor in managing the medical errors in hospitals of Tehran University of Medical Sciences. Disclosure increases the immunity of patients. Conclusion: Disclosure is an effective factor in managing the medical errors that occur at hospitals affiliated with Tehran University of Medical Sciences. It is essential that managers identify the effective factors in disclosure and take steps to apply a suitable disclosure system to decrease errors.
      PubDate: Sat, 03 Feb 2018 20:30:00 +010
  • Knowledge, Attitude, and Contraceptive Preferences Among Postpartum Women
           in Izzi, Ezza South, ...

    • Abstract: Background: The fertility rate is high and the contraceptive prevalence rate is very low in Nigeria. Thus, women in Nigeria are exposed to the dangers of unwanted and unplanned pregnancies. Objective: The current study aimed to determine the levels of knowledge, attitudes, and contraceptive preferences among couples in selected health facilities in Ebonyi State so as to recommend a package of intervention to increase contraception uptake. Methods: This cross-sectional descriptive quantitative study used questionnaires administered by the researchers themselves among 128 postpartum women who were current users of contraceptive methods in Izzi, Ezza South, and Ikwo local government areas of Ebonyi State, Nigeria from January 1, 2016 to June 30, 2017. Informed consent was obtained from participants. Data was analyzed using SPSS version 20. Simple percentages were used to report categorical variables. Results: The study results showed that most of the respondents (49%) had a secondary education, were aged above 20 years, and were mainly employed as civil servants with an average monthly income of $47.20. About 69% had less than 5 living children. Most respondents knew about contraception as a means of delaying pregnancy or limiting the number of children (37%) and recommended its use for family/society (46%). The most commonly used contraceptive methods were implants and injectable ones, while the IUD was the least preferred. Both implants and injectable contraceptives were recommended by friends and believed to be highly effective. Conclusion: The current study showed that knowledge and positive attitude of participants towards family planning was high, comparable to studies in other parts of the world. Further research on determinants of postpartum use of family planning methods among this population is recommended.
      PubDate: Wed, 31 Jan 2018 20:30:00 +010
  • Audit of Minimally Invasive Hysterectomy Rates: A Canadian Retrospective
           Cross-Sectional ...

    • Abstract: Background: Minimally invasive hysterectomy is generally preferable to abdominal hysterectomy. The technicity index (TI) is the proportion of hysterectomies performed by minimally invasive surgery. Many centers globally have started to audit local TI as a quality indicator, but only a handful have published their results to help define international standards of care. Objective: In this study, TI was examined in Winnipeg and Canada to determine consistency between local and national patterns of practice, audit expected changes, and contribute to the growing body of literature defining international standards of care. Methods: A retrospective cross-sectional database review of hysterectomies performed in the Winnipeg Regional Health Authority (WRHA) from 2008 to 2015 was conducted. Mixed effects linear regression models were generated primarily to analyze TI and account for surgeon and hospital characteristics. The Canadian Institute for Health Information (CIHI) database was accessed to estimate the average national TI from 2009 to 2014. One-sample t tests compared annual WRHA and CIHI TI. Results: In Winnipeg, 1363±32 hysterectomies were performed annually for all indications with an average TI of 34% independent of time (P=0.09). The CIHI database recorded approximately 27 000 hysterectomies annually with increasing TI (41%-52%, 3.5±1.8%/year, P=0.025). WRHA TI differed from national TI every year (P<2.2x10-16). Conclusion: Over the study period, WRHA TI was below the Canadian average and static despite national increases. The importance of local audits to identify underperformance and stimulate initiatives for quality improvement is highlighted in this study.
      PubDate: Sat, 27 Jan 2018 20:30:00 +010
  • Sickness absenteeism of Healthcare Workers in a Teaching Hospital

    • Abstract: Background: Absence from work for health reasons is known as “sickness absenteeism”. Frequent sick leave is a major concern to any organization, especially hospitals. Objective: This study analyzed the extent and causes of sickness absenteeism in a teaching hospital and evaluated its corelation with demographic and occupational factors. Methods: In a cross-sectional study, data was extracted from computerized records regarding sickness absenteeism of healthcare workers (HCWs) in the Occupational Health Department of a teaching hospital in Tehran. Studied variables included demographic characteristics, occupational factors, and causes of sickness absenteeism. The sickness absence rate (SAR) and absence frequency rate (AFR) in the study period were calculated. Chi-square and Mann-Whitney tests were used for the comparison of categorical and quantitative variables, respectively. Results: In the current study, SAR and AFR were 0.011 and 0.68, respectively. Job type was the only factor that had a significant correlation with sickness absenteeism. The major disease-causing sicknesses were flu (21%) and musculoskeletal disorders (18.9%). Conclusion: A significant relationship was found between the nursing group and sickness absence episodes. Flu, musculoskeletal disorders, and infectious diseases were the most frequent causes of sickness absence. Based on these findings, it can be concluded that factors such as availability of the flu vaccine and providing principles of personal protection and infection control can reduce sickness absence due to infectious disease.
      PubDate: Sat, 27 Jan 2018 20:30:00 +010
  • Preventing Traumatic Urinary Catheter Insertion Through a Computerized
           Ordering System: ...

    • Abstract: Background: Iatrogenic urethral injury is a well-known risk of urinary catheter insertion. Associated morbidities include stricture formation, catheter associated infection, risk for instrumentation, and extended length of stay. Yet, insufficient attention is paid to its prevention. Objective: This study aimed to assess the effectiveness of a computerized ordering system in reducing iatrogenic urethral injuries in men at high risk for iatrogenic urethral injury from traumatic catheterization. Methods: A pre-post study was performed to assess the impact of a computerized ordering system that recommended a 16 Fr Coudé-tip catheter be used instead of the standard 16 Fr Foley catheter for men at high risk for difficult catheter insertion. The intervention was implemented in October 2012. The rates of traumatic and non-traumatic insertion consults were compared between the pre-intervention (10/1/2010-09/30/2011) and post-intervention (10/1/2012-9/30/2013) time periods. Results: The results showed that 78.5% of patients with iatrogenic urethral injury possessed at least one identified risk factor for difficult catheterization. There was no significant difference in frequency of traumatic or non-traumatic insertion consults between the pre- and post-intervention cohorts. Conclusion: The current study highlights the possibility of preventing traumatic insertions by targeting men at high risk for iatrogenic injury. Without a simultaneous plan for improving catheter placement awareness and training, any change in the ordering process is unlikely to succeed on its own.
      PubDate: Sat, 27 Jan 2018 20:30:00 +010
  • Steroid Cell Tumor of Ovary Diagnosed After Delivery; Case Report

    • Abstract: Introduction: Steroid cell tumors (SCTs) constitute less than 0.1% of all ovarian tumors. They are divided into 3 categories according to cell of origin: Stromal Luteoma arising from stromal cells of the ovary, Leydig cell tumor arising from Leydig cells, and SCT not otherwise specified (NOS) when the origin of the tumor is not defined.Case Presentation: Herein is presented a case of SCT diagnosed one month after a caesarian section delivery of a female fetus with ambiguous genitalia. The patient was admitted to the emergency department with the findings of acute abdomen, and surgery was performed under emergency conditions. The patient had virilization and hoarsening of the voice before surgery. Intraoperatively, a 21-cm ovarian mass was detected and resected with unilateral salpingo-oophorectomy.Conclusion: A histopathological examination of the tumor showed a tumor with cystic degeneration, necrosis, hemorrhage, and tumoral embolism. The pathological examination revealed ovarian SCT. Virilization was resolved immediately after the surgery. In women with virilization who give birth to a fetus with ambiguous genitalia, SCTs should be kept in mind.
      PubDate: Fri, 26 Jan 2018 20:30:00 +010
  • Effects of Different Times of Glutaraldehyde 2% on Bacillus subtilis
           Spores (In Vitro)

    • Abstract: 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.
      PubDate: Tue, 28 Nov 2017 20:30:00 +010
  • Effects of Different Doses of Fentanyl on the Sedation of Infants Under
           Mechanical Ventilation; ...

    • Abstract: 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.
      PubDate: Sun, 12 Nov 2017 20:30:00 +010
  • Epidemiology of Hereditary Coagulation Bleeding Disorders: A 15-Year
           Experience From Southern Iran

    • Abstract: 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.
      PubDate: Fri, 27 Oct 2017 20:30:00 +010
  • Creating a Better Patient Safety Culture in Taiwan: The Viewpoints of
           Physicians and Registered ...

    • Abstract: 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.
      PubDate: Mon, 23 Oct 2017 20:30:00 +010
  • Bilateral Facial Paralysis and Otitis Media as the First Presentations of
           Wegener’s ...

    • Abstract: 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.
      PubDate: Fri, 13 Oct 2017 20:30:00 +010
  • Factors That Influence Nurses’ Work-Family Conflict, Job Satisfaction,
           and Intention to Leave ...

    • Abstract: 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.
      PubDate: Fri, 25 Aug 2017 19:30:00 +010
  • Is Aspirin Still the Cornerstone of Antiplatelet Therapy in Patients With
           Coronary Artery ...

    • Abstract: 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.
      PubDate: Mon, 21 Aug 2017 19:30:00 +010
  • The Use of Evidence by Decision-Making Committees

    • PubDate: Tue, 04 Jul 2017 19:30:00 +010
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