Rostrum of Asclepius Vol 12, No. 3 (2013): July - September 2013

The Delphi technique is a research method with a multitude of literature regarding its application, yet there is limited guidance on methods of analysis and the presentation of results. Aim: To describe and critically analyze the main methods of the qualitative and quantitative data analysis in studies using the Delphi Technique. Materials and methods: The literature search included research and review articles of nursing interest within the following databases: IATROTEK, Medline, Cinahl and Scopus, from 2001 to 2011. Key-words were used Delphi technique, nursing and research methodology, in English and Greek language. Results: The literature search revealed 285 articles of nursing interest (266 reserch articles and 19 reviews). Data analysis in formal methodology surveys using the Delphi technique initially involves a qualitative analysis of the experts' views which are gathered during the first round. Subsequently, various statistical analyses methods are employed in order to estimate the final level of consensus on the coming rounds (iterations). Prescribing the desired degree of consensus is usually based on subjective assumptions, while the final identification is done with mainly via descriptive and inductive statistical measures. In the presentation of results, simple tables are mainly used which are based on descriptive data, statistical criteria or scatter charts in order to illustrate the experts' opinions. Conclusions: The Delphi Technique has infiltrated nursing research with great variability in data analysis methodology and presentation of results depending on each study's aims and characteristics.

Keywords: Delphi technique, nursing research, research methodology, data analysis.

The resistance exercise is an important part of all rehabilitation programs in patients with chronic heart failure. Among several kinds of resistance exercises, the one mainly applied is isotonic exercise, whereas, in the contrary, isometric is not heavily used although it affects the daily lives of patients who, trying to look after themselves (moving, walking, lifting objects), twitch in an isometric way their peripheral muscles due to reduced cardiovascular endurance. Purpose: The purpose of the present review was to present the data available so far for isometric exercise in cardiovascular patients and to examine the importance of applying this kind of exercise in rehabilitation programs in the context of, firstly, evaluation, and secondly therapeutic intervention. Material - Methods: The methodology followed included searching inquiries and reviews from international databases (Pubmed, Medline, Scopus) on the effects of isometric exercise in patients with chronic heart failure. The progress and development of the studies are of particular importance to this work and, to this end, the literature refers to the entire range of time in the last three decades, from 1985 to 2012 according the key words noted. Results: In rehabilitation programs for patients with chronic heart failure, resistance exercise if applied in an isotonic way helps improve hemodynamic and functional parameters. In contrast, resistance exercise applied in an isometric way requires further investigation because most findings are related to hemodynamic disturbances. The data which is encouraging for isometric exercise programs are few and, therefore, it cannot be directly recommended as a proper way to exercise. Conclusions: Isometric exercise has an important place in the evaluation of patients with chronic heart failure, and limits should be "placed" in its application as a therapeutic tool to prevent complications.

Keywords: Chronic heart failure, resistance exercise, aerobic exercise, isometric exercise

Clinical studies have shown that patients with cancer experience multiple and simultaneously occurring symptoms, both during the illness and the therapeutic interventions. Aim: The aim of the present systematic review study was to investigate the symptom complex (cluster symptoms) occurring in patients suffering from cancer and their effect on the outcome of the disease. Methods: Data collection was based on electronic databases «MEDLINE / PubMed», «CINAHL», «PsycINFO», «Science Direct», «Springerling» and «Cochrane Database», using keywords like: «cluster symptoms», «multiple symptoms», «concurrent symptoms», «constellation of symptoms». Limitations on articles' research were the year of publishing from 1971-2011 and the English language. Identified 96 completed articles and 75 were used.Results: Presented the prevailing scientific view on the definitions, theoretical frameworks, metrics, and results of operations in clusters of symptoms. However, researchers have different opinions about the number and relationships between symptoms in a cluster. The functional status and the patients' quality of life showed a negative correlation with the severity of the symptom complex. Conclusions: The technique of symptom clusters' recognition remains a research tool with potential great clinical importance. Understanding the complex experience of symptoms in cancer patients could provide a scientific basis and provide new directions for the clinical assessment of symptoms and appropriate interventions that would reduce the impact of clusters on patients' quality of life.

Keywords: Cluster symptoms, multiple symptoms, concurrent symptoms, constellation of symptoms

Whilst the use of restraint and seclusion has been common place in psychiatric practice for decades to control patients' uncontrolled, violent behaviour it raises ethical and legal concerns. The aim of this review was to identify through the literature the issues arising from the use of restraint and seclusion in a psychiatric ward. Material and Methods: A literature search was performed in Medline, Cinahl, BNI, PsycINFO, and Scopus databases with keywords relevant to the subject of this review. Results: Restraint and seclusion as therapeutic interventions are used in a psychiatric ward to provide physical protection for the patient, for other patients and for the staff, at the same time maintaining the ward's therapeutic milieu. Restraint aims at restricting patients' body mobility and the use of seclusion aims to decrease sensory stimuli that increase patients' agitation. Guidelines have been developed for the use of restraint and seclusion to ensure the implementation of a therapeutic plan. Current practice advocates minimal use of either intervention with the aim of ultimately abolishing both practices. However, the existing current trends regarding the use of restrictive measures are to minimize until abolish them. Conclusions: The therapeutic use of seclusion and restraint is acceptable when practitioners follow the appropriate instructions and guidelines. However, the main goal of health professionals, especially nurses, who are directly involved in the implementation of those restrictive measures, is to minimize their use. This could be achieved through training and adequate staffing levels.

Keywords: Physical restraint, seclusion, psychiatric patients, aggressive behaviour, nurses

Aim: The aim of the present article was the presentation of the most basic historical steps of human sexuality from ancient times to our days, also reflecting the various cultural tendencies that have influenced it. Materials and methods: The bibliographic sources of the most important investigators of sexuality were used. Results: From the findings of this present review, it evolves that human sexuality is a biomedical entity especially affected by the cultural and religious aspects of any society. Conclusions: In conclusion, despite the difficulties in the access of accuracy of the historical sources, the knowledge of conceptions and religious beliefs of anytime society, as well as practice and law changes helps the contemporary understanding of the expression of sexuality.

Keywords: Human sexuality, historical evolution, ancient times, Ellis, Freud, Jonson

Thalassanemia is one of the most common monogenic disorders in Mediterranean countries, S.Asia and Africa. The main clinical manifestations include severe anemia which requires blood transfusion, liver and spleen swelling bone diseases and skeletal complications, iron chelation and retardation of physical development. The annual incidence is 5-10 while in Greece 3000 persons suffer from thalassanemia. Αim:The aim of the present study was to investigate the knowledge of patients with thalassemia in major issues of their illness Methods-Material: The research was carried out (October 2007- May 2008) with the use of anonymous questionnaires addressed to thalassanemic patients (n=330) over 18 years of age who are being transfused in various hospitals in the Athens region. Results: 87% of the respondents declare that they suffer from β-thalassanemia, 54% are women and 50% are between 30-39 years of age, 88% of the respondents states that they are adequately informed regarding transfusion procedures, 81% reply the same regarding the nature of their disease and 76% also seem satisfied with information on the need to examine other members of the family. Percentages of satisfaction regarding the information provided are lower as far as the following issues are concerned: implications (67%), genetics of the disease (65%), side effects from medication (56%) and patients' rights (49%). As far as information on even more specific issues is concerned, the replies which consider this information as inadequate range from 32-40%. Conclusions: According to the findings information is considered to be sufficient as far as practical and procedural matters are concerned, but it lacks behind as far as patients' rights, information regarding new therapeutic methods and possibility of participation in research protocols are concerned. The respondents' wish for better and broader information on all investigated issues is more than obvious.

Keywords: Thalassanemia, information, consent, preimplantation genetic diagnosis

Neurological impairment is common in survivors after cardiac arrest. Mild therapeutic hypothermia (32-34°C) has been suggested to be useful in improving both survival rates and neurological outcome of these patients. Aim: The aim of the present study was to explore the relation between the method of mild therapeutic hypothermia, in ICU, with the traditional method (normothermia), for the treatment of out-of-hospital cardiac arrest survivals, after restoring spontaneous circulation. Material and method: As for the design, it was a retrospective study. The studied population consisted of 25 patients who suffered cardiac arrest, with initial cardiac rhythm ventricular fibrillation (VF) or ventricular tachycardia (VT),who were successfully resuscitated and hospitalized after restoration of spontaneous circulation. During a 2-year period (2009-2011) these patients were treated with hypothermia (32-34°C) with ice packs or an endovascular cooling device. Results: he systematic cooling of survivals, between 32-34°C for a 24-hour period, increased the probability of survival (p=0.17) and improved neurological outcomes (p= 0.06), compared to normothermia. Complications, such as arrhythmias, bleeding and infections were treated by rewarming. Conclusions: Although there is a number of complications associated with hypothermia such as arrhythmias, bleeding disorders and infection, none seems to relate to adverse patient outcomes.

Keywords: Spontaneous circulation, neuro-protection, cooling, mild therapeutic hypothermia, ICU