Evaluation of Dentists' Attitudes Towards Principles of Professional Ethics.

OBJECTIVE: The aim of this research was to investigate attitudes towards principles of professional ethics (PPE) amongst Iranian dentists working in Isfahan, Iran. METHODS: This pilot cross-sectional study was conducted amongst 273 dentists in Isfahan, Iran. A validated, comprehensive questionnaire including principles of respect for patient autonomy, nonmaleficence, beneficence, and justice was used to evaluate dentistry professional ethics aspects. Age, gender, marital status, type of graduate university, level of education, specialised field of study, work experience, workplace, and participation in ethics workshops and courses were registered from participants. Total and domains scores of used questionnaires were calculated and compared across categories of study participants' characteristics. RESULTS: Mean ± SD age of participants was 35.4 ± 10.7 years, and 57% were female; about 73% graduated from Isfahan University of Medical Sciences, and 65% were general dentists. The attitude total score of dentists towards PPE was 133.02 ± 13.16. Mean total score of the questionnaire and its domains was different significantly (P < .05) across categories of level of education, marital status, and passing the ethical courses. CONCLUSIONS: The attitude of dentists towards PPE was rated at a good level. However, improvement in attitudes of some specific subgroups such as general dentists and newly graduated ones is needed. Conducting specific workshops about professional ethics and incorporating these principles into university curricula can be beneficial.

Nurses' experiences of the ethical values of home care nursing: A qualitative study.

Objective: Considering the importance of out-of-hospital services, the emergence of home care nursing, and the need for an ethical framework in nursing practice, the present study aimed to explore the nurses' experience of ethical values of home care nursing. Methods: The data of the study was collected using face-to-face individual interviews. Through purposive sampling, 20 nurses who worked in the home care centers in four cities of Iran in 2020 were interviewed. They shared their experiences of the ethical values of home care nursing. Then, the interviews were analyzed based on the content analysis approach and using Graneheim and Lundman method. Results: In the present study, 416 codes were extracted. Merging these codes based on the similarity, seven main themes, and 16 sub-themes were extracted. The themes included perception of the professional identity, respect for the client's autonomy, respecting privacy, establishing human interaction, maintaining mutual safety, observance of justice, and cultural-religious competence. The sub-themes included responsibility, development of professional and inter-professional interactions, maintaining the professional status at home, providing the holistic artistic care, patient's privacy, nurse's privacy, and maintaining the confidentiality of information, respect for the client's choice, honestly informing, empathetic interaction, adjusting the power positions, client's safety, nurse's safety, establishing justice, respect for the religious beliefs at home and cultural sensitivity. Conclusion: The participants stated that due to entering the patient's privacy in the home care cases, the ethical values such as perception of the professional identity, privacy, family interactions' management, mutual security, and cultural-religious competence became doubly important compared to the hospital caring.

Practical anatomical landmark for optimal positioning of left-sided long-term central venous catheter (a pilot study).

BACKGROUND: Long-term central venous catheter (CVC) insertion in dialysis patients is an accepted method of hemodialysis. The appropriate CVC tip placement may reduce both early and late complications related to catheter and increase patency rate. This study aimed to evaluate a new, simple, and feasible method based on surface anatomy for the proper placement of tunneled CVC in the left internal jugular vein for hemodialysis or chemotherapy. MATERIALS AND METHODS: The study was carried out as a quasi-experimental model at Saint Al-Zahra Education Hospital in 2016. A total of forty patients with an indication of left-sided (upper) long-term CVC insertion were enrolled. The length of catheter to be inserted in the left internal jugular vein was considered as the sum of distance from the insertion point of the needle up to sternal notch plus the total distance between the left and right sternoclavicular joint and half-length of the sternum. The right atrium (RA) or superior vena cava-RA junction was the correct region for inserting the catheter tip. The collected data were analyzed using Fisher's exact test and t-test using SPSS (version 22). RESULTS: The patients were 63.75 ± 17.96 years of age, weighed 67.33 ± 13.20 kg, and height of 166.92 ± 8.99 cm. Catheters were inserted successfully in 95% of patients (n = 38). No significant relationship was found between the success of new method and age, gender, height, weight, body mass index, and sternum half-length plus the distance between the right and left sternoclavicular joint. CONCLUSION: "The mid - sternal length plus sternoclavicular joints spacing" as a new formula (based on anatomical landmarks) was found practical and safe and could easily be used among adult patients who undergo tunneled CVC in the left internal jugular vein.

Evaluation of Diagnostic Values of Clinical Assessment in Determining the Maturation of Arteriovenous Fistulas for Satisfactory Hemodialysis.

BACKGROUND: Fistulas are the preferred permanent hemodialysis vascular access, but a significant obstacle to increasing their prevalence is the fistula's high "failure to mature" (FTM) rate. This study aimed to identify postoperative clinical characteristics that are predictive of fistula FTM. MATERIALS AND METHODS: This descriptive cross-sectional study was performed on 80 end-stage renal disease patients who referred to Al Zahra Hospital, Isfahan, for brachiocephalic fistula placement. After 4 weeks, the clinical criteria (trill, firmness, vein length, and venous engorgement) examined and the fistulas situation divided to favorable or unfavorable by each criterion, and the results comprised with dialysis possibility. Data were analyzed with SPSS version 21. Diagnostic index for CLINICAL examination was calculated. RESULTS: Among the 80 cases, 25 (31.2%) female and 55 (68.8%) male were studied with the mean age of 51.9 (standard deviation = 17) year ranged between 18 and 86 years old. Sixty-two (77.5%) cases had successful hemodialysis. All four clinical assessments were significantly more acceptable in patients with successful dialysis (P < 0.001). According to the results of our study, the accuracy of all physical assessments was above 70% and except vein length other criteria had a sensitivity and negative predictive value of 100%. In this study, firmness of vein has highest specificity and positive predictive value (83.9% and 64.3%, respectively). CONCLUSION: Results of our study showed that high sensitivity and relatively low specificity of the clinical criterion. It means that unfavorable results of each clinical criterion predict unfavorable dialysis. Clinical evaluation of a newly created fistula 4-6 weeks after surgery should be considered mandatory.

Evaluation of routine postoperative chest roentgenogram for determination of the correct position of permanent central venous catheters tip.

BACKGROUND: Proper placement of central venous catheter (CVC) tip could reduce early and late catheter-related complications. Although the live fluoroscopy is standard of care for placement of the catheter, it is not available in many centers. Therefore, the present study evaluated the sensitivity and specificity of bedside chest X-ray (CXR) for proper positioning of the catheter tip. MATERIALS AND METHODS: A total of 82 adult patients undergoing elective placement of tunneled CVC were enrolled in this study during 2010-2012. The catheter tip position was evaluated by postoperative bedside chest radiographs as well as trans-thoracic echocardiogram as definite diagnostic tool. The catheter position was considered correct if the tip was positioned in the right atrium both in CXR or echocardiography. Finally, CXRs interpreted by expert radiologist. Thus findings were compared by echocardiography. Sensitivity, specificity, accuracy, positive, and negative predictive values were calculated. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL), and P < 0.05 considered as significant. RESULTS: The patients were 57.37 ± 18.91 years of age, weighed 65.79 ± 15.58 kg and were 166.36 ± 9.91 cm tall. Sensitivity and specificity of CXR for proper catheter tip position were 74.3% and 58.3%, respectively. Positive and negative predictive values were 91.2% and 28%. In addition accuracy, positive likelihood ratio, and negative likelihood ratio were 71.9%, 1.78, and 2.27 respectively. CONCLUSION: Bedside CXR alone does not reliably predict malpositioning after CVC placement.

The mid-sternal length, a practical anatomical landmark for optimal positioning of long-term central venous catheters.

BACKGROUND: Long-term tunneled catheters are used for the hemodialysis or chemotherapy in many patients. Proper placement of the catheter tip could reduce early and late catheter related complications. Aim of the present study was to evaluate a new formula for proper placement of tunneled hemodialysis or infusion port device by using an external anatomic landmark. MATERIALS AND METHODS: A total of 64 adult patients undergoing elective placement of tunneled Central Venous Catheter (CVC) requiring hemodialysis or chemotherapy were enrolled in this prospective study during 2011-2012 in the university hospital. The catheter length to be inserted in the right internal jugular vein (IJV) was calculated by adding two measurements (the shortest straight length between the insertion point of the needle and the suprasternal notch plus and half of sternal length). The catheter position was considered correct if the tip was positioned in the right atrium (RA) or Superior vena cava (SVC)-RA junction. RESULTS: The patients were 55.28 ± 19.85 years of age, weighed 5.78 ± 16.62 kg and were 166.07 ± 10.27 cm tall. Catheters were inserted successfully in 88% of patients (n = 56). Catheter tip positions in the failures were SVC (n = 5), tricuspid valve (n = 2), and right ventricle (n = 1) in our patients. CONCLUSION: Long-term hemodialysis or port CVC could easily insert in the right IJV by using half of the sternal length as an external land marks among adult patients.

Assessment of effects of upper extremity exercise with arm tourniquet on maturity of arteriovenous fistula in hemodialysis patients.

OBJECTIVE: This study was designed to investigate the effects of hand exercise using a tourniquet on arteriovenous fistula (AVF) maturity in patients with end stage renal disease.
 METHODS: Fifty patients were randomly allocated to 2 groups with 25 patients. After creating an AVF, in the control group, patients were asked to start doing simple hand exercise- opening and closing the fingers. In the second groups, patients underwent a structured isometric exercise program. The pre exercise and post exercise ultrasound examination were performed in the first 24 hours and 2 weeks after the operation respectively. Patients were also clinically evaluated at the end of the study.
 RESULTS: Post exercise ultrasound showed significant difference in the draining vein diameter, vein wall thickness, vein area and blood flow rate (BFR) (p-value: 0.009, 0.04, 0.02 and 0.02 respectively). The number of patients who had clinically mature AVFs in the case group was significantly more than the control group (13 vs. 5; p-value: 0.008).
 CONCLUSION: We conclude that hand exercise using arm tourniquet affects most sonographic parameters which are associated with AVF maturity, and could be beneficial for acceleration of AVF clinical maturation.

Inferior vena cava reconstruction with a flap of parietal peritoneum: an animal study.

BACKGROUND: The development of reconstructive venous surgery has been hampered by the lack of suitable grafts. Patency rates with grafts in the venous system are commonly less satisfactory than in arterial system, mainly due to nonpulsatile flow velocity and the low pressure in veins. Grafting of the inferior vena cava may be necessary in cases of trauma and major tumor surgery involving the vein. Several types of grafts have been evaluated. Reconstruction of the vena cava with autologous vein is so time-consuming and requires extra incisions. Prosthetic material is associated with a higher risk of infection and thrombosis. We, therefore, created an animal model of inferior vena cava reconstruction using a flap of parietal peritoneum. METHODS: A tube, 5 cm in length and 1 cm in diameter, was constructed from the parietal peritoneum of the anterior abdominal wall of ten dogs. It was anastomosed end-to-end as an interposition graft to the inferior vena cava. The observation period was two months. RESULTS: Eight of ten grafts were macroscopically and venographically patent, while the other two were occluded. Eight out of ten specimens (for pathologic examination) which revealed patent lumens were completely endothelialized.No infection or other problems were noted. CONCLUSION: The peritoneum is an accessible and safe substitute for reconstruction of the inferior vena cava.