Rostrum of Asclepius Vol 10, No. 4 (2011): October - December 2011

Acute chest pain is one of the most common causes of patient attendance in the emergency departments (EDs). Traditionally, the diagnosis of acute coronary syndromes (ACS) relies on the combination of typical chest pain, electrocardiographic (ECG) changes and serum markers elevation, such as Troponin-I and CK-MB isoenzyme. However, a large number of patients with myocardial ischemia remain undiagnosed. Ischemia-modified albumin (IMA) increases within minutes after the onset of ischemia and remains elevated for 6 to 12h. Aim: The aim of the present study was to review the literature, Greek and international, regarding the efficacy of IMA in the early diagnosis of myocardial ischemia. Methods: The methodology followed, included bibliography research from both review and research literature, through databases PubMed, Medline, Scopus and Embase, with the use of keywords, such as ischemia-modified albumin, myocardial ischemia, acute coronary syndromes, albumin cobalt-binding test. Complementary bibliography was found through other electronic search engines (Medscape, MedExplorer), and by reviewing references of already found articles. Data were collected between October 2008-January 2009 and the research was repeated from September to December 2010. Results: Research findings indicate that IMA can detect ischemia whether or not necrosis is present. Given the fact that IMA levels return to normal within 24h, the aforementioned marker may contribute decisively in risk stratification of acute chest pain patients. Due to its high negative predictive value (NPV) and its high sensitivity in detecting ACS may help in screening patients with chest pain. Unfortunately, IMA's high sensitivity comes at the expense of a lower specificity for the myocardial cell, since its increase may be due to ischemia of other tissues. This may increase the number of patients admitted, that do not have ischemia. Conclusion: A better understanding of IMA mechanism of action in the early stages of myocardial ischemia in patients with ACS is considered of great importance and further research in this direction is already ongoing (international multicentre IMAGINE trial).

As the main interest of health professionals is for the well-being of patients/clients, ethical decision making is one of the prominent elements of his/her professionalism. Aim: The present study aims to illustrate the role of ethical judgment and the so-called "moral imagination" in health professions. Method and material: Review of theoretical and research literature, including both classic and recent sources about ethical dilemmas that health professionals may anticipate, as well as the suggested ways to manage these dilemmas. Results: Health professionals often have to act in complicated situations. Review of relevant literature indicates that the professionals' ethical decisions are structured not only through the codes of ethics, but also through other collective practices, such as organizational culture and cultural schemas about the role of health professional. Resorting to schematic thinking may temporarily release the professional from his/her concerns, but in the long run, it may devoid him/her of the sense of satisfaction from work and of the ability to offer clients the optimal care. The development of the so-called "moral imagination" permits the professional to advance from the typical application of the rules to actual ethical judgment. Conclusions: Ethical decision making presupposes not only a thorough knowledge of ethical guidelines, but also the development of the ability to openly reflect upon the ethical dimensions of an issue (moral imagination) that allows health professionals to overcome schematic thinking and investigate comprehensive solutions to ethical dilemmas.

Keywords: Moral ability, ethics, ethical dilemmas, schematic thinking, moral imagination

The aim of the present study was to review the literature about religiousness within hospitals. The method οf this study included bibliography research from both the review and the research literature, in the "pubmed data base" which referred to the religiousness within hospitals. Results : According to the literature research an administrative institution, such as hospital does not include only one culture but on the contrary many different cultures that interact since health professionals have their own background. Hospital as a place of special care, that has its' own culture, is expected to fulfill patients' needs (family, social, occupational), health and disease. Faith is encouraged in hospitals where the icons and Christian churches are prevalent, while faith individuals express their deeper need for pray. The tendency of religious individuals to ask for an upper support mainly in difficult circumstances such as for recovery in the clinical environment is deeply rooted in its' soul and consists an element of its' nature. Conclusions: In contemporary Greek reality, medical science has always had at the practice a great charity: religion.

Keywords: Hospital, culture, religiousness

As the main interest of health professionals is for the well-being of patients/clients, ethical decision making is one of the prominent elements of his/her professionalism. Aim: The present study aims to illustrate the role of ethical judgment and the so-called "moral imagination" in health professions. Method and material: Review of theoretical and research literature, including both classic and recent sources about ethical dilemmas that health professionals may anticipate, as well as the suggested ways to manage these dilemmas. Results: Health professionals often have to act in complicated situations. Review of relevant literature indicates that the professionals' ethical decisions are structured not only through the codes of ethics, but also through other collective practices, such as organizational culture and cultural schemas about the role of health professional. Resorting to schematic thinking may temporarily release the professional from his/her concerns, but in the long run, it may devoid him/her of the sense of satisfaction from work and of the ability to offer clients the optimal care. The development of the so-called "moral imagination" permits the professional to advance from the typical application of the rules to actual ethical judgment. Conclusions: Ethical decision making presupposes not only a thorough knowledge of ethical guidelines, but also the development of the ability to openly reflect upon the ethical dimensions of an issue (moral imagination) that allows health professionals to overcome schematic thinking and investigate comprehensive solutions to ethical dilemmas.

Keywords: Moral ability, ethics, ethical dilemmas, schematic thinking, moral imagination

The motivation of human resources and in particular of the nursing staff is a crucial issue that influences their job satisfaction, as well as patients' satisfaction from the health services offered. Aim: The presentation of selected motivation theories through literature review and the development of a framework of realistic motives applied to the nursing staff of a public hospital. Material-Method: The Greek and international bibliography has been reviewed, and in particular papers on the motivation theories of human resources in hospitals (the hierarchy of human needs theory, the two-factor theory of motivation, the achievement theory of motivation, and the expectancy theory) published during the last ten years via PubMed and Science Direct. Results: A series of motives could be developed that by themselves are not the solution to the problem of employee performance and effectiveness, and their application could be a combination of different models or examined case by case, depending on the functional department of the public hospital. The economic motives and the negative motives cannot, by and large, be applied by management, thus, motives having to do with training, organization and coordination of human resources, communication and fair treatment are the most realistic and applicable ones, for this particular workplace. Conclusions: The motives presented in the current paper are not the panacea for the work performance and effectiveness and they are not a complete record of all potential motives. The application of motives could be combinational or could be contingently examined for the department of the public hospital applied, as well as the nursing staff employed, i.e., specificities related to knowledge, experience, abilities. Furthermore, the duties performed by the nursing staff and the policy implemented by management towards the human resources affect the offered motives.

Keywords: Motivation, nursing staff, public hospital, the hierarchy of human needs theory, the two-factor theory of motivation, the achievement theory of motivation, and the expectancy theory

Different therapeutic options (surgery, radiation) may have some impact on certain dimensions of their quality of life. Aim: The aim of this paper was to investigate the impact of treatment options on the quality of life of patients with laryngeal cancer, comparing two groups of patients after total laryngectomy or other treatment. . Material-Methods: The population of this study included 128 previously hospitalized patients in large public urban hospitals of Athens and Thessaloniki. Sixty five patients (50,8%) had total laryngectomy (group A) and 63 patients (49,2%) partial laryngectomy, or other treatment (radiation, chemotherapy) maintaining voice capacity. Data was collected using a demographic and clinical traits questionnaire and the Quality Of Life Questionnaire (EORTC, QLQ-C30). Statistical analysis used SPSS 15.0 for chi-square test and Mann-Whitney U test. Results: Group comparison revealed that patients from group A scored significantly higher in all scales of a) functionality (p<0,05), b) symptoms (p<0,05) and c) financial difficulties (p<0,05) compared to group B. Moreover, patients from group B reported better overall quality of life compared to group A (p=0,001). Conclusions: Different treatment options and their effect on specific dimensions of life, such as alterations of body image and voice loss, have a deep impact on self reported quality of life for laryngeal cancer patients. Improving their quality of life is a great challenge for health professionals.

Keywords: Quality of life, laryngeal cancer, laryngectomy

Depression is one of the most common psychiatric illnesses nowadays and according to the World Health Organization (WHO) it affects millions of people worldwide. It is an illness that has multiple causes, and it is the result of the interaction of genetic, biological and psychosocial factors. Aim: The aim of this project is the study of the elements and the characteristics of stress and depression in mental health professionals and the degree at which they are affected by factors such as the age, the marital status, the job and the level of education. Material – Method: The sample of the study includes 62 mental health professionals (25 men and 37 women), at an average age of 39,4±8,4, nurses (n=35), doctors (n=12) and other jobs in the health section (n=15). An anonymous closed questionnaire DSSI/sAD by Bedford & Foulds was used. The data analysis was realized with multivariate analysis (MANOVA) and SPSS 16.0. Results: Patients who visited a special doctor for their symptoms demonstrated higher degrees of anxiety and depression [t(60)=2,876, p=0,006] and by those who received special medical treatment [t(60)=3,571, p=0,001]. During the data analysis the effect of age seemed statistically important [F(16,41)=2,83 p=0,004] and the marital status [F(16,41)=2,55 p=0,008] on depression and stress scales respectively. Married patients appeared statistically important anxiety (p=0,001), higher tension (p=0,002) and insomnia (p=0,001). The singles show statistically significant lower score in stress scale (p=0.014) although they tend to resign more often (p=0.001) and working people aged 35-49 experience more intense sorrow than the other age groups (p=0,003), more intense feelings of panic (p=0,018) and tension (p=0,049) and bad mood (p=0,018). Conclusions: The marital status was the most important independent factor which seems to be related in our sample with anxiety and depression, while in a high degree the effect of age at these symptoms was influenced by the marital status. This data is discussed in relation to the potential effect it may have on work and the psychic health of the people.

Keywords: Stress, depression, mental health, mental health professionals