Rostrum of Asclepius Vol 20, No. 4 (2021): October - December 2021

Keywords:

ABSTRACT

Achieving the well-being of the population is largely achieved through the existence of a welfare state and the adoption of a social policy commensurate with the socio-economic, political, and cultural form of each country. A bibliographic review of relevant articles was made in the Medline / Pubmed and Google Scholar Electronic Databases as well as in books, scientific journals and websites with the help of keywords. Sources from print media were also sought. The keywords used were welfare state, long-term care, demographic aging, informal caregivers, challenges. The typologies of welfare states by Titmuss, Espring-Andersen and Ferrera are important tools for comparing different welfare states in terms of state, market, and family contribution. However, they do not cope with modern reality, as they do not consider demographic aging, the crisis of the institution of the family, low birth rate, migration, and the economic crisis. The existence of Long-Term health Care (LTC) due to the strong demographic aging is an indication of the action of a welfare state that aims at the well-being of the population. Formal and especially informal caregivers play an important role in providing MFY. In addition, it is provided in both public and private structures. In Greece, the long-term health care sector is underdeveloped compared to the rest of Europe, with limited government intervention supporting the family's contribution. The existence of a welfare state in Greece is necessary to address potential emerging risks, such as demographic aging and can be achieved by meeting emerging challenges such as meeting the needs of long-term care services, improving quality, their organization and governance.

ABSTRACT

The significant rise in resistant antimicrobial strains to chemical drugs being recorded is increasingly an issue of concern as it means that once again bacterial infections are one of the biggest public health challenges.

Resistance to antibiotics as a natural evolutionary step of microorganisms is due to the irrational use of the former and translates into both clinical and economic and social parameters. International, European and national agencies have developed Action Plans to tackle this phenomenon.

A Health Promotion proposal, in order to be called complete, should include all three pillars, namely Health Education both within the Health Service and in the public in general, Health Protection by using measures and policies designed to promote the same ends and lastly Disease Prevention by increasing the readiness of the Health System and their ability to respond rapidly to any and all problems.

Likewise, a full proposal for evaluation of actions will range in the short term, as a direct response to the educational process, in the medium term, in a second year as a comparative evaluation of the present period with the analogous period before the implementation of the actions, and in the long term; as a decrease in the number of indicators that testify to an increasing trend in antimicrobial resistance.

Fighting the problem requires interdisciplinary and cross-sectoral cooperation today, as the situation is now so critical it leaves no room for delays.

Keywords: Antimicrobial resistance, health promotion, evaluation, combat actions

ABSTRACT

The need to provide high quality health services with the available material and human resources, combined with simultaneous patient safety, is a major concern of countries worldwide, culminating in the Tokyo Declaration of Patient Safety in 2018.

In Greece, an effort is being made to establish a National Agency for Quality Assurance of Health Services, which will be staffed by a team of scientists of various specialties and will take action in all areas of clinical governance through the implementation of clinical control, continuing education and development, the establishment of national quality assessment indicators, the implementation of clinical protocols and guidelines, the certification of health care providers, through implementation of total quality management in these areas.

However, a primary indicator of the quality of health services provided is patient safety, which is a major asset. It depends on various factors and is ensured by actions related to many areas including staffing, infrastructure and equipment, continuous certified staff training, implementation of procedures for recording and documenting ongoing processes, the existence and implementation of both treatment protocols and patient safety, internal audits, user evaluation.

Keywords: Patient safety, quality, outcome indicators, National Quality Agency, assurance, Tokyo Declaration

ABSTRACT

Introduction: Stroke is a clinical syndrome characterized by a neurological deficit attributable to an acute, focal lesion of the central nervous system (CNS), of a vascular origin such as cerebral infarction and intracerebral hemorrhage.

Aim: The aim of the present thesis was to record the outcome of patients with ischemic stroke treated in the pathological unit of a public hospital, while the secondary objectives aimed to record the treatment and correlate the patients’ outcome with their demographic and clinical characteristics.

Material and Method: The research conducted was descriptive and retrospective. The data were collected from patient files of public hospital, who were hospitalized from 2012 until December 2018.

Results: The sample consisted of 55 patients with an average age of 81.2 years, 52.7% were women, and the rate of patients with ischemic stroke was 98.1%. Based on the findings, patients who expired and those who developed complications had established ischemic stroke, while they had statistically significant lower scores on the Glasgow scale. Moreover, patients who expired (p <0.047) or had complications (p <0.001) had a longer duration of hospitalization. The complications rate was significantly higher in patients with fever (p <0.001) and in those with impaired speech (p <0.049).

Conclusions: The outcome of patients with ischemic stroke treated in the pathological clinic of a public hospital is good, as the vast majority of patients are discharged. Apparently the international guidelines concerning the evaluation and management of patients with stroke are not followed. Moreover, the development of specific complications underlines the importance of providing more intensive nursing care of patients with ischemic stroke. In any case, at a national level compliance with the international guidelines is recommended. As stroke is associated with increased disability and deterioration in patient’s quality of life, further investigation of the determinants of patient outcome is considered to be necessary.

Keywords: Stroke, ischemic stroke, outcome, complications, morbidity, mortality

ABSTRACT

Background: Diabetes Mellitus (DM) is a serious chronic disease. Healthcare professionals’ knowledge and attitudes regarding DM can affect health outcomes of diabetic patients.

Aim:  Healthcare professionals’ knowledge, attitudes and behavior regarding DM and malignancies.

Material and method: The present study was conducted among healthcare professionals of Anti-Cancer Hospital in Thessaloniki. DSDS and DAS-3 scales were used to assess the attitudes of health professionals regarding SD.

Results: 168 health professionals participated in the study, with a mean age of 44.08 years (SD ± 9.17) and an average working experience of 19.3 years (SD ± 8.99). Regarding participants' feelings about DM, the highest scores were found in "support from the family in managing diabetes" (4.36 ± 1.06) and in "exercise and diabetes mellitus" (4,35 ± 1,04). Participants agreed with the view that there is a need for special training regarding DM care, of healthcare professionals (mean 1.78 ± 0.48), while the sample had a neutral view on disease severity (mean 3.08 ± 0.57).

Conclusions: Training of healthcare personnel in DM is considered necessary. Organized interventions can facilitate diabetic patients’ attitudes regarding DM management, contributing to higher levels with treatment adherence.

Keywords: Diabetes mellitus, healthcare professionals, attitudes, perceptions.

Keywords: Diabetes mellitus, healthcare professionals, attitudes, perceptions

ABSTRACT

Background: The Phlebotomy Department of the General Hospital of Serres GR provides the proceeding external health service users with blood sampling facilities, therefore a satisfaction degree survey regarding the received services was considered critical to be conducted, while highlighting the importance of measuring the satisfaction of their expectations in relation to the quality of health services offered.

Objective: The purpose of this study was to explore the degree of users satisfaction with the services provided by a  blood collection department of a General Public Hospital.

Material-Method: A cross sectional study of a 23-query questionnaire, whilst implementing convenience sampling of users proceeding for blood tests, was undertaken during December 2018 and January 2019, applied to 208 individuals and replied to by 200 of them. It was statistically analyzed via SPSS 21, while Pearson chi-squared distribution was used to test for independence, Cramer’s V and Contigency coefficient were used to test correlations, and Cronbach Alpha was used to measure internal consistency reliability, with the statistical significance level set at 0.05.

Results: High rates of “very” satisfied users were yielded in the main correlations between gender and (a) staff experience – competence in performing blood sampling, at 90,5% (men) and 78,6% (women), (b) reliability – speed of results export at 68,9% (men) and 65,1% (women) (c) agreement with the new GDPR procedures at 85,1% (men) and 73,8% (women) (d) satisfaction with service – wait time–courtesy of staff at 83,8% (men) and 71,4% (women) (e) equal treatment of un insured individuals, at 63,5% (men), and 72,2% (women). In the 3 sections of key questions considering the procedures of the Phlebotomy Department we received satisfaction rates of 85,8%, 80,1% and 95% (in totals of aggregated positive responses of «very» and «quite» satisfied).

Conclusions: Positive satisfaction rates of over 80% in the main procedures being followed, showed high levels of satisfied health service users.

Keywords: Research, needs satisfaction, health service users, quality of services provided

ABSTRACT

Background: Healthcare workers tend to get addicted with work and to ignore their personal needs. The job satisfaction is defined as the positive response derived from implementing tasks at workPurpose: The purpose of the current study is to investigate the relationship between the workaholism and the job satisfaction for the healthcare workers in the Cyclades Islands, Greece.

Methodology: The participants in this study which took place between January 2020 and April 2020, were in total 172. The selected sample of the healthcare workers are from medical centres and hospitals in the Cyclades islands. The sample consists of resident doctors, consultant doctors, nurses, nurse assistants, administration and technical employees. Data were collected through electronic self-completion surveys and analysed through the SPSS software, version 24. The survey consists of three parts. The first part includes the demographic questions with regards to the location, family and employment. The second part presents questions about the workaholism. The third part includes questions for the job satisfaction.

Results: The overall results show that the employees’ level of job satisfaction is low. This result holds for all the 8 types of job satisfaction. Also, more than the half of the participants expressed low levels of workaholism.

Discussion: Relevant actions include to provide more attractive packages as motivation for work (e.g. benefits) and more promotions evaluations. It is suggested that hospital and medical centers introduce initiatives to educate the healthcare workers, to improve the employee relation management, and to decrease the workload overload. The suggested initiatives aim to increase the overall job satisfaction.  It is suggested the psychology support of healthcare workers.

Keywords: Workaholism, job satisfaction, Cyclades Islands

ABSTRACT

Introduction: Stabilizing the condition of a multi-injured patient is a challenge for nurses and doctors. Successful management of multiple injured patient includes securing the airway by immobilizing the cervical spine, restoring respiration and circulation to the tissues, adequately assessing the patient's neurological condition, and managing the external environment for the benefit of the patient. Airway management and intubation is a particularly important skill.

Purpose: The purpose of this study is to evaluate the laryngoscopy device Airtraq in the management of the airway in multiple injured patients in the emergency department.

Methodology: Systematic review of the literature by searching for relevant articles published in the Pubmed, Cochrane, Scopus and Google Scholar databases, from 2011-2020.

Results: Compared to other laryngoscopy devices, Airtraq appears to be more effective, offering higher rates of successful intubation in multiple injured patients. In addition, Airtraq requires fewer corrective intubation movements, shorter intubation time, and faster stabilization of patients' vital signs.

Conclusions: As unsuccessful endotracheal intubation increases the morbidity and mortality of multiple injured patients, the use of Airtraq compared to similar devices has a number of advantages.

Keywords: Airtraq device, airway management, multi-injured patient

ABSTRACT

Introduction: Cardiac arrest is one of the leading causes of death. The incidence of in-hospital cardiac arrest is 1-5 per 1.000 patients with the survival to discharge reaching 15%-20%. Adrenaline is being used traditionally in cardiac arrest in an effort to systematic circulation maintenance and cerebral function.

Aim: The aim of this systematic review was to investigate the effectiveness of adrenaline in cardiopulmonary resuscitation, both for the rapid return of spontaneous circulation and for the optimal neurological outcome of patients with cardiac arrest.

Materials and Methods: We searched the relevant Greek and international bibliography from 2014 to 2019 in online international databases: Pubmed, ScienceDirect, Scopus, Cochrane, in Grey Literature, in journals of scientific interest and in postgraduate and doctoral programs in the departments of Medicine and Nursing. The key-words we used were: adrenaline, epinephrine, cardiac arrest, cardiopulmonary resuscitation.

Results: Out of the 497 articles found, 16 articles were finally selected to cover the topic under study. After the systematic review, the results showed that fewer doses of adrenaline, administered as quickly as possible, had better results in both rapid return of spontaneous circulation and survival with favorable neurological outcome, in patients with cardiac arrest. Multiple drugs and doses of adrenaline are associated with lower survival rates. There may be a need of individualized resuscitation, as patients with body weight >82.5kg seem to not receive adequate amounts of adrenaline.

Conclusions:  Fewer doses of adrenaline and other drugs that are used in cardiopulmonary resuscitation, administered as quickly as possible, have better effects on both rapid recovery of systematic circulation and favorable neurological outcome in patients with in-and out-of-hospital cardiac arrest.

Keywords: Adrenaline, epinephrine, cardiac arrest, cardiopulmonary resuscitation