Predicting needlestick and sharps injuries and determining preventive strategies using a Bayesian network approach in Tehran, Iran

Hamed Akbari,Fakhradin Ghasemi 한국역학회 2018 Epidemiology and Health Vol.40 No.-

OBJECTIVES: Recent studies have shown that the rate of needlestick and sharps injuries (NSIs) is unacceptably high in Iranian hospitals. The aim of the present study was to use a systematic approach to predict and reduce these injuries. METHODS: This cross-sectional study was conducted in 5 hospitals in Tehran, Iran. Eleven variables thought to affect NSIs were categorized based on the Human Factors Analysis and Classification System (HFACS) framework and modeled using a Bayesian network. A self-administered validated questionnaire was used to collect the required data. In total, 343 cases were used to train the model and 50 cases were used to test the model. Model performance was assessed using various indices. Finally, using predictive reasoning, several intervention strategies for reducing NSIs were recommended. RESULTS: The Bayesian network HFACS model was able to predict 86% of new cases correctly. The analyses showed that safety motivation and fatigue were the most important contributors to NSIs. Supervisors’ attitude toward safety and working hours per week were the most important factors in the unsafe supervision category. Management commitment and staffing were the most important organizational-level factors affecting NSIs. Finally, promising intervention strategies for reducing NSIs were identified and discussed. CONCLUSIONS: To reduce NSIs, both management commitment and sufficient staffing are necessary. Supervisors should encourage nurses to engage in safe behavior. Excessive working hours result in fatigue and increase the risk of NSIs.

Million Visual Analogue Scale Questionnaire: Validation of the Persian Version

Hesam Akbari,Mohammad Ghasemi,Taha Yegani,Mohammad Gholami- Fesharaki, PhD,Maryam Saraei,Yalda Barsam,Hamed Akbari 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.2

Study Design: Descriptive cross-sectional study. Purpose: To validate the Persian version of the Million Visual Analogue Scale Questionnaire (MVAS), a self-administered low back pain (LBP) questionnaire. Overview of Literature: The majority of LBP questionnaires translated into Persian evaluate the impact of LBP on daily living. The MVAS is one of the most commonly used self-administered LBP questionnaires, and was developed to assess a different direction and effect of activities of daily living on LBP intensity. Methods: The questionnaire was translated into Persian with the forward-backward method and was administered to 150 patients randomly sampled from an occupational medicine clinic in Tehran in 2017. Results: Cronbach’s alpha for all subscales ranged between 0.670 and 0.799. Confirmatory factor analysis showed adequate construct validity of the Persian version of the MVAS, with root mean square error of approximation 0.046, goodness of fit index 0.902, and comparative fit index 0.969. Other indexes were satisfactory. Conclusions: The Persian MVAS is a valid and reliable instrument that can assess the effect of various daily activities on the intensity of LBP.

Effects of Smoking on Cost of Hospitalization and Length of Stay among Patients with Lung Cancer in Iran: a Hospital-Based Study

Sari, Ali Akbari,Rezaei, Satar,Arab, Mohammad,Majdzadeh, Reza,Matin, Behzad Karami,Zandian, Hamed Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.9

Background: Smoking is recognized as a main leading preventable cause of mortality and morbidity worldwide. It is responsible for a considerable financial burden both on the health system and in society. This study aimed to examine the effect of smoking on cost of hospitalization and length of stay (LoS) among patients with lung cancer in Iran in 2014. Materials and Methods: A total of 415 patients were included in the study. Data on age, sex, insurance status, type of hospitals, type of insurance, geographic local, length of stay and cost of hospitalization was extracted by medical records and smoking status was obtained from a telephone survey. To compare cost of hospitalization and LoS for different smoking groups, current smokers, former smokers, and never smokers, a gamma regression model and zero-truncated poisson regression were used, respectively. Results: Compared with never smokers, current and former smokers showed a 48% and 35% increase in hospitalization costs, respectively. Also, hospital LoS for current and former smokers was 72% and 31% higher than for never smokers, respectively. Conclusions: Our study indicated that cigarette smoking imposes a significant financial burden on hospitals in Iran. It is, however, recommended that more research should be done to implement and evaluate hospital based smoking cessation interventions to better increase cessation rates in these settings.

Clinicopathologic Characteristics of Male Breast Cancer: A Report of 21 Cases in Radiotherapy Center of Hamedan, Iran

Sedighi, Abdolazim,Hamed, Ehsan Akbari,Mohammadian, Kamal,Behnood, Sepideh,Kalaghchi, Bita Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.12

Background: Male breast cancer accounts for less than 1% of all cancer in men and only around 1% of all diagnosed breast cancer. Despite a significant raise in the last 25 years, it still remains a rare disease. Materials and Methods: We conducted a retrospective study from 2004-2011 with 21 male breast cancer patients. We aimed to analyze the epidemiologic data (age, personal and family history), tumor characteristics (size, histological type, location, TNM stage, receptors), surgery, adjuvant chemotherapy and radiation therapy, hormonal therapy and survival (relapse, follow up, death) who reffered to our center with breast cancer. Results: The median age was $49.2{\pm}14.2$ years (range 30-83 years). A family history of breast cancer was noted in four cases. The main clinical complaint was a retroareolar mass in 85.7%of patients (n=18). Histologically, 85.7% (n=18)were invasive ductal carcinoma and 4.7% (n=1) had ductal carcinoma in situ and 9.4% (n=2) had mixed histology including invasive medullary and ductal carcinoma. Hormonal therapy was delivered to 16 cases (76.1%) due to ER or PR positivity. During median follow up of 30 months (3-84 month), distant metastases were evident in 4 cases (19%). During the follow-up period, only one patient died due to metastatic disease. The mean time to recurrence detection was 30 months. Conclusions: The percentage of cases of male breast cancer is very low compared to breast cancer in females, explaining why very few investigations have been conducted in Iran. Limited coverage in the literature make gender-specific findings difficult so future research of this entity involving multi-institutional cooperation and longer follow up is essential to provide new insights about the biological and clinical factors of this rare cancer.

Concurrent Chemoradiation with Weekly Gemcitabine and Cisplatin for Locally Advanced Cervical Cancer

Hashemi, Farnaz Amouzegar,Akbari, Ehsan Hamed,Kalaghchi, Bita,Esmati, Ebrahim Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.9

Background: For more than 80 years, the standard treatment of locally advanced cervical cancer was radiotherapy. However, based on several phase III randomized clinical trials in the past decade, concurrent cisplatin-based chemoradiotherapy is the current standard for this disease. Gemcitabine has potent radiosensitizing properties in preclinical and clinical trials, so it can be utilized simultanously with radiation. Materials and Methods: Thirty women with untreated invasive squamous cell carcinoma of the cervix of stage IIB to stage IVA were enrolled in the study in the Radiation Oncology Department of Imam Khomeini Hospital in Tehran from September 2009 to September 2010. Sixty $mg/m^2$ gemcitabine followed by $35mg/m^2$ cisplatin were concurrently administered with radiotherapy to the whole pelvic region on day one of each treatment week for five weeks. One and three months after treatment, patients underwent a complete physical examination and MRI to determine the response to treatment. Results: The mean age of patients was $58.1{\pm}11.8$ (29-78) years. After 3 months of treatment, 73.3%had complete and 26.7% demonstrated partial response to treatment. Grade 3 anemia was seen in 10%, grade 3 thrombocytopenia in 3.3% and grade 3 leukopenia in 10% of the patients. Conclusions: According to the positive results of this study in stage IIB, further phase II and III clinical trials are suggested to evaluate the role of chemoradiation using Gemcitabine for advanced cervical cancers.

Efficacy of High Dose Radiotherapy in Post-operative Treatment of Glioblastoma Multiform - A Single Institution Report

Pashaki, Abdolazim Sedighi,Hamed, Ehsan Akbari,Mohamadian, Kamal,Abassi, Mohammad,Safaei, Afsane Maddah,Torkaman, Tayebe Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.6

Background: Glioblastoma multiform (GBM) is a highly aggressive tumor with median survival of approximately 14 months. Management consists of maximal surgical resection followed by post-operative chemoradiation with concurrent then adjuvant temozolamide. The standard radiotherapy dose is 60Gy in 2-Gy fractions recommended by the radiation therapy oncology group (RTOG). With the vast majority of tumor recurrences occurring within the previous irradiation field and the poor outcome associated with standard therapy, regimens designed to deliver higher radiation doses to improve local control and enhance survival are needed. In this study, we report a single institutional experience in treatment of 68 consecutive patients with GBM, treated with resection, and given post-operative radiotherapy followed by concurrent and/or adjuvant chemotherapy. Results: Of the 80 patients who entered this study, 68 completed the treatment course; 45 (66.2%) males and 23 (33.8%) females with a mean age at diagnosis of $49.0{\pm}12.9$ (21-75) years. At a median follow up of 19 months, 39 (57.3%) patients had evidence of tumor progression and 36 (52.9%) had died. The median over all survival for all patients was 16 months and progression free survival for all patients was 6.02 months. All potential prognostic factors were analyzed to evaluate their effects on overall survival. Age ${\leq}50$ year, concurrent and adjuvant chemotherapy and extent of surgery had significant p values. We found lower progression rate among patients who received higher doses of radiotherapy (>60Gy). Higher radiation doses improved progression free survival (p=0.03). Despite increasing overall survival, this elevation was not significant. Conclusions: This study emphasize that higher radiation doses of (>60Gy) can improve local control and potentially survival, so we strongly advise prospective multi centric studies to evaluate the role of higher doses of radiotherapy on GBM patient outcome.

Production, assessment, and impregnation of hyaluronic acid with silver nanoparticles that were produced by Streptococcus pyogenes for tissue engineering applications

Behrooz Yahyaei,Niloofar Peyvandi,Hamed Akbari,Sepideh Arabzadeh,Sima Afsharnezhad,Hatef Ajoudanifar,Parastoo Pourali 한국응용생명화학회 2016 Applied Biological Chemistry (Appl Biol Chem) Vol.59 No.2

Hyaluronic acid (HA) is a mucopolysaccharide with different applications in the medicinal field. Since HA does not have antibacterial property, in this research a bacterium with both abilities of HA and silver nanoparticles (SNPs) production was used; HA containing SNPs (HA/SNPs) was obtained and the toxic effect of HA/SNPs was achieved using Limulus Amebocyte Lysate (LAL) and 3-(4,5 dimethyl thiazol-2yl)-2,5 diphenyl tetrazolium bromide (MTT) assays. HA and SNPs were produced separately by Streptococcus pyogenes. Then HA was analyzed using fourier transform infrared (FTIR) spectroscopy and transmission electron microscope (TEM), and SNPs were analyzed using TEM and X-ray diffraction analysis (XRD). In order to produce HA/SNPs complex, SNPs were added to the supernatant containing HA and the complex was precipitated using isopropyl alcohol. HA, SNPs, and HA/ SNPs were used for the antibacterial assay. Results proved the formation of HA and SNPs in the bacterial culture medium. SNPs sizes were around 5–30 nm and entered in the structure of HA. Antibacterial test showed that unlike the pure HA, SNPs and HA/SNPs had antibacterial activity. LAL and MTT assays results showed that HA/SNPs had low and dose-dependent toxic effects. In future, the use of HA/SNPs scaffold in tissue engineering field is expected.