Rostrum of Asclepius Vol 13, No. 1 (2014): January - March 2014

The health sector is characterized by diversity due to its singularity but also the many professions associated with it (e.g. doctors, nurses, nursing attendants, managers, suppliers etc.). This kind of diversity has resulted in a dramatic increase of health costs leading hospitals into using business techniques to reduce costs. Purpose: The purpose of the present review was to explore the possibility of operating a hospital standards of operational policy. Material and Method: The methodology followed is based on searching and reviewing research studies and scientific articles abstracted from an international database (Scopus) and from the Greek and international literature between the years 1996 to 2012, using keywords such as: hospital, business, health expenditure, supplies, total quality management. Results: The review of literature shows that hospitals suffered from mismanagement, excessive expenses and insufficient health care services. The application of Lean Six Sigma methodologies and TQM helped to reduce costs, the continuous control problems encountered in raising the level of benefits. Conclusions: The hospital cannot be associated with a business, because the hospital is meant to care for the public in general as opposed to businesses that aim at increasing their profits. However, adopting techniques of the business field, the hospitals have the ability to control operating costs and curb costs, therefore, the modern hospital can function as an ‘idiosyncratic’ form of business.

Keywords: Hospital, business, health costs, commissions, total quality management, Lean Six Sigma

Over half a century after the discovery of chlorpromazine and haloperidol, antipsychotic drugs showed a true evolutionary revolution. The knowledge of their adverse effects is of outmost importance as it may contribute to the prevention of unwanted sequelae, to the decrease of the duration and cost of hospitalization, it may improve the quality of life of patients, minimize the problems and maximize the therapeutic gain. Aim: The aim of this review was the presentation of the hematologic side-effects of antipsychotic drugs, and most particularly their frequency and association with the different classes of these drugs, their clinical picture and their pathophysiologic mechanisms. Material-method: This paper is a review of the literature (mainly articles from journals, PubMed, as well as books and monographs) of the period 1978-2012. Key-words used included antipsychotics, hematologic adverse effects, drug-induced adverse effects. Results: Antipsychotic-drug induced hematologic side-effects are not particularly highly prevalent, while many of them are found in case reports. For this reason they have not drawn much of attention. These hematologic dyscrasias may concern all the blood cell series as well as the coagulation mechanism. Excluded from this rule is the case of clozapine-induced agranulocytosis, which demands increased clinical vigilance. In fact, agranulocytosis was the reason why the drug was drawn away from circulation approximately 35 years ago. Conclusions: In any case the appearance of a hematologic disorder in a patient receiving antipsychotic medications should prompt careful evaluation.

Keywords: Hematologic adverse effects, antipsychotic drugs, drug-induced side effects, drug-induced hematologic disorders

Chronic physical illness burdens children and their families with organic and functional problems, repeated medical visits, complicated tests, frequent hospitalizations, uncertainty about the future and complex secondary psychological, social and educational problems. Purpose: The purpose of the present study was the presentation and the critical approach to the adjustment difficulties of a child with chronic disease (7-11 years) and of its family as recorded in Greece and internationally. Material and Methods: In this review, the methodology followed included specialized electronic search of articles in PubMed, in international and Greek biomedical journals that explore the process of adaptation of children to chronic diseases such as asthma, diabetes, thalassemia, cardiovascular diseases and neoplasms using special keywords e.g. chronic physical illness, chronic disease and family, child and chronic disease. There were 29 foreign articles and 16 greek ones during the last fifteen years. Results: Children with chronic physical diseases face psycho-emotional difficulties (depression, increased anxiety), behavioural disorders (hyperactivity, social isolation) and learning difficulties. Their families are equally affected by chronic disease on multiple levels as their cohesion is disrupted as well as the emotional relationships between them, the roles they should adopt towards the new situation (difficulties between the couple and the siblings). This situation in Greece highlights major problems and failures that require immediate attention (on grants and donations to associations, insurance providers, staffing and operation of hospital units, public awareness, etc.) Conclusions: The comprehensive treatment of the effects of chronic physical illness, both medical and psychosocial in level, requires the provision of comprehensive care through coordinated medical, psychological, educational and social services.

Keywords: Child and chronic physical illness, adjustment difficulties, family illness and Greece, hospitalization and Greece

Systematic approach of anxiety in non-psychiatric patients contributes significantly to the effective treatment. At first, is essential to explore the biological causes and afterwards the possibility that anxiety is a manifestation of a psychiatric disorder. Furthermore, when anxiety is diagnosed as patient's response to the disease, it is crucial to explore the psychological mechanisms that the patient mobilizes in order to defend it, the psycho-social problems of the patient, the supportive network, personality and the personal meaning that the patient gives to the disease. The most effective treatment of anxiety is the combination of medication therapy (benzodiazepines, antidepressants) with psychological therapies such as cognitive- behavioral psychotherapy that aim to change patterns of thought, behavior and belief.

Keywords: Anxiety, diagnosis and treatment of anxiety, chronic disease

Volunteering is an activity that develops in a personal, spontaneous, free, without personal benefits. This is offered by individual citizens, individually or through organizations. Aim: The aim of the present study was to investigate the features of personality for health professionals to volunteering. Methodology: The data collection was done by completing a written questionnaire in time and place of participants’ choice. The tools used were: (a) Questionnaire of socio-demographic characteristics, (b) the Altruism Scale, (c) the Narcissistic Personality Inventory and (d) the Eysenck Personality Questionnaire. The statistical analysis was performed using the SPSS (18) statistical package. Results: In this study involved 110 doctors and nurses of Sparta General Hospital (overall study sample), 64.2% of the sample were male, 57.3% were married, 37.7% were tertiary education graduates, while 99.1% had the Greek ethnicity. Results showed that the mean value of the Narcissistic Personality Inventory in women was (7.8) while in men was (11.4). At this point Independent Sample t-test showed statistically significant difference to the mean value of the NPI between women and men t = 2.470 p =0.017. Regarding to volunteering, the mean values of Narcissistic Personality Inventory showed statistically significant difference between those who had participate in a voluntary effort and those you hadn’t (t-test = 2.2927 & p-value = 0.004). Independent Sample t-test showed statistically significant difference to the mean value of the NPI between the marital status groups but in significance level of 10% (t-test = 1.927 & p-value = 0.071). Conclusions: The results of this study highlight the relationship between specific personality traits with volunteering. According to the results, there appear to be some evidence that individuals, who have participated in a voluntary effort, are people with a high sense of altruism, present low score in the scale of narcissistic personality and a high score in the scale of personality. Moreover, there is evidence that gender, marital status, educational level and job play a role in shaping the three personality scales. Note, however, that the results are statistically significant.

Keywords: Altruism, happiness, narcissism, voluntary work, healthcare professionals

Smoking is the leading preventable cause of morbidity and mortality worldwide. Health care professionals can contribute to controlling the epidemic of smoking by applying brief counseling for smoking cessation in clinical practice. Purpose: The program B.O.A.T was implemented to increase knowledge and enhance health professionals’ attitudes on the brief counseling for smoking cessation. The purpose of the intervention was to enforce participants' intention to implement counseling. Material and Method: The research project was a pretest-posttest equivalent groups design. The sample consisted of 33 health professionals of various specialties. The intervention consisted of a two-hour training course and distribution of printed material. Attitudes, subjective norm, perceived control and intention of health professionals were measured, regarding the counseling in smoking cessation. Results: Statistical analysis showed an increase of perceived control in the experimental group (p = 0.031) and increase of its intention to implement smoking cessation counseling compared to the comparison group (p = 0.003). There was no difference between and within groups before and after the intervention for the variables of attitudes and subjective norm. The evaluation also showed an increase of knowledge in the experimental group. Conclusion: This study reinforces the current literature which supports that training health professionals on smoking cessation counseling can be effective. The theoretical background turns out to be important. In the future more time and resources should be invested to increase effectiveness and efficiency of such programs.

Keywords: Smoking, counseling, health professionals, theory of Planned Behavior

Pressure ulcers are a challenge for health systems worldwide. Reducing the frequency criterion of prevention and treatment of each country can be more effective. Aim: The purpose of the present study was to explore the level of knowledge of nurses in the ICU on the prevention and treatment of pressure ulcers. Material – Method: The studied sample consisted of 148 nurses working in ICU of 2 Hospital in Athens, of which one was public and one private. The collection of data was completed through a questionnaire, which included demographic and business information as well as questions relating to preventive measures for pressure ulcers and their treatment. Statistical analysis was performed using the statistical package SPSS ver.19. Results: 73.7% (n = 110) of the studied sample were women. The mean age was 32 years, with a standard deviation of ±3.81. According to the proportion of nurses - patients, policy of 1/2 presented in 76.4% of the studied population and policy of 1/3 in 23%. 64.2% (n = 95) reported having attended an educational seminar for prevention and treatment of pressure ulcers. There was statistically significant difference between whether they have attended a seminar or not with the views of nursing staff. Another factor that seemed to affect the responses of nurses was the ratio of nurse-patient policy in the ICU. Conclusions: There is a lack of knowledge about the prevention of pressure ulcers and implementation of guidelines. It is concluded that continuous training of nurses through seminars is crucial both to enrich the knowledge and the proper treatment of pressure ulcers.

Keywords: Pressure ulcers, Intensive Care Unit, nursing staff, preventing pressure ulcers