Rostrum of Asclepius Vol 21, No. 4 (2022): October - December 2022

Pulmonary embolism (PE) is one of the two forms of venous thromboembolic disease. PE is the most dangerous and fatal form of the disease because if it stays undiagnosed and untreatable, can lead to death. Its appearance is about 120 cases in 100.000 persons. Its presence is associated with hereditary and acquired risk factors. The therapy is the anticoagulants. The primary prevention of pulmonary embolism is based on the recognition of risk factors that, in combination with the estimated thromboembolic risk, results in the early initiation of prophylaxis, which is either pharmaceutical or mechanical, or both. This review analyses current trials in medical patients and especially in critically ill patients. The main patients’ categories that the primary prevention is needed are patients with stroke, hospitalized in intensive care units and those with infections and reduced mobility (including COVID-19 patients). The results demonstrate superiority in the use of heparin (unfractionated and low molecular weight), while the use of direct oral anticoagulants (DOACs) is indicated only in patients that can take oral medicine and mainly in the long- term prevention after discharge. The mechanical prophylactic means are used in combination with the pharmacological means or alone, as monotherapy (favours intermittent pneumatic compression), only in cases of restricted contraindication of pharmacological measures.

Keywords: Pulmonary embolism, primary prevention, COVID-19, stroke, intensive care unit

Hematology histograms constitute the graphical representation of data related to the number, morphology, and composition of blood cells, and are readily available during the full blood count analysis from the modern hematology analyzers. Blood histogram curves accompanying the numerical findings of full blood count often provide evidence of underlying pathology in a direct and visualized manner and guide the differential diagnosis and further investigation in patients with acute and chronic diseases. This study presents the basic principles of hematology analyzers and the interpretation of histograms and focuses on their connection with pathological conditions encountered in clinical practice and routine of hematology laboratory. For this purpose, a series of common clinical cases with typical qualitative and quantitative changes in blood figures are presented. The full blood count analysis was performed in our laboratory with the Beckman Coulter Unicel DXH 800 hematology analyzer. The morphology, the base width, and the displacement of the histogram curves were used to check the validity of instrument flags, to rule out pre-analytical or analytical errors and for the initial diagnostic approach of hematology diseases, infections and disorders with secondary hematological manifestations. The above data combined with the clinical history and the microscopic examination of the peripheral blood smear contributed to the correct and timely diagnosis and treatment decisions.

Keywords: hematology analyzer, hematology histogram, Beckman Coulter Unicel DXH 800 analyzer

It is well established that patient-physician communication is considered as determinant factor in both their relationship and the quality of medical care provided. Several models have been proposed about the description of the types of relationship and communication between physicians and patients, as well as the analysis of shared decision making in clinical practice, focusing mainly on oncology patients. In particular, Roter et al., interpreted five communication patterns (narrowly biomedical, expanded biomedical, biopsychosocial, psychosocial and consumerist) parallel the ideal forms of patients-physician relationships described in literature for primary health care physicians. According to this model, the type of relationship affects the patient’s participation in shared decision making and are recommended two conceptual models of Stiggelbout et al., and Kane et al., for facilitating shared decision making in oncology practice. Namely, medical language has negative consequences for both patients and patient-physician relationship with the physicians during the diagnosis of some forms of breast cancer, such as ductal carcinoma in situ. Additionally, it is imperative the proposal of a guide to strengthen the recall of information during the medical visit to young specialists, which considers the active patient as the key player. Keywords: patient-physician communication, shared decision making, breast cancer, recall of information.

Keywords: patient-physician communication, shared decision making, breast cancer, recall of information

The Hirschsprung's disease (HSCR) is a congenital intestinal motility disorder. Its main pathogenetic cause consists of an absence of enteric ganglion cells from the distal intestine, due to a defect in the neural crest cells migration between the 5th and the 7th week. As a result, knowledge of the embryonic development of the intestine and its nervous system is important for understanding the pathology of the malformation. Various genetic mutations have been associated with HSCR. The incidence of HSCR is estimated at 1:5000 live births, with a male to female ratio of 4:1. The symptoms are typical of functional bowel obstruction. Current technology provides several diagnostic options, but the histological one is considered the most reliable. Surgical repair is the treatment of choice and involves resection of the abnormally innervated (aganglionic) bowel.

Keywords: Hirschsprung disease, congenital intestinal malformation, paediatric surgery

Introduction: Refugees, Migrants and Roma, have complex and various medical and social needs, where it results that the health professionals have to deal with many challenges in progress of providing health care. Purpose: The purpose of this project is the research of the health professionals’ points of views, towards the particularities of the provision of care to the refugees, migrants and Roma. Material and Method: For the research was used the method of sampling none probabilities since the population is not known while the sampling is also defined as convenience methodology. The questionnaire was posted on the internet and was sent in different e-mails and web pages in order to collect the answers. The form of the questionnaire was digital because of its nature, due to the creation of the questionnaire was carried out using Google Docs. Results: Women, the older ones with children and bigger previous service believe that Greek nurses respect the peculiarities of foreigners/Romany patients (17% - 41%) and only the ones with higher education believe that they are sensitized at the ΔΥ (35%). Women, the older ones with children and bigger previous service believe that the Greek services provide a high feeling of safety to immigrants/foreigners/Romany patients (17%-41%) while they believe that they do not have to adjust their behavior (15%-19%) since they think that nurses do not treat them like a problem (17%-30%). Conclusions: The health professionals have the necessary knowledge so they can approach effectively their patients of different cultural teams and they are adjusting at different juncture and requirements. That’s why education must be continuous in order to sensitize and inform the health professionals about the peculiarities of the people who are coming from different cultures, with further purpose the improvement of the provision of Intercultural Health Care in the context of a multicultural society.

Keywords: intercultural health care

Introduction: The complexity of health care, contribute to conflicts, while emotional intelligence is a skill that can contribute to the resolve of these conflicts Purpose: The purpose of this study is to investigate the management of conflicts between health professionals and the role of Emotional Intelligence in them. Material-Method: A survey was conducted with the use of a self-report questionnaire on health professionals of the Nursing Unit. The final sample of the survey was 153 people out of 220, with a response rate of 70%. The statistical analysis was performed with the statistical program S.P.S.S. 25. Results: Health professionals regardless of specialty believe that communication problems lead to moderate conflicts. No difference was found between the views of the specialties of the sample and the causes of conflicts related to job expectations, nor between the occupations of the health professionals in terms of conflict management strategies, with the exception of compromise. It is also not selected by the majority of the sample the claim of victory or the accepting the other's wish, while 40% of administrators choose to compromise, compared to the lower percentages of other occupational groups (p = 0.049). The analysis of the correlation between the Emotional Intelligence of health professionals and the causes of conflict showed that as the Emotional Intelligence of physicians and administrators increases, their belief that orders from more than one person cause conflicts decreases (r = -0.049, p and r = -0.561, p = 0.010). Also, as the Emotional Intelligence of doctors increases, so does the belief that the unfair distribution of resources leads to conflicts (r = 0.386, p = 0.035). Conclusions: Conflicts in the hospital environment are a condition that cannot be easily eliminated due to the specificity and burden of the environment.

Keywords: conflicts, emotional intelligence, satisfaction, health professionals

Introduction: Radiation dermatitis in children covers a wider range of symptoms and manifestations of skin toxicity after radiation therapy (RT). The rapid development of radiology in recent years has led to a significant improvement in the effectiveness of cancer treatment. Aim: The aim of this systematic review was to investigate the incidence of radiodermatitis in children, adolescents and young adults with cancer undergoing radiotherapy. Method and Material: A systematic review of the literature was conducted from 01/01/2002 to 15-02-2022, using the keywords: “radiotherapy, radiology, toxicity, dermatitis, radiodermatitis, actinodermatitis, dermatologic complications, pediatric patients, children, cancer”, for articles written in English language, in the following databases: MEDLINE (via PubMed), The Cochrane Library, CINAHL, Web of Science Collection, and Scopus. The PICOTS process (Population, Intervention, Comparator, Outcome, Timing, Setting) was used as an evaluation criterion for the induction of articles in the study. After the articles’ evaluation 16 articles emerged. Results: The results of 16 studies in 2,818 children, adolescents and young adults showed that dermal toxicity after radiotherapy varies not only in the frequency of occurrence but also with the severity and its extent, independently of the radiotherapy method. Skin effects of radiodermatitis vary considerably in severity, course and prognosis and the most obvious relation of its occurrence was the higher dose RT and the extent of skin therapy. Moreover, there is limited evidence indicating higher rates of radiodermatitis in smaller children in comparison to adolescents or young adults. Conclusions: The incidence of radiodermatitis in children undergoing radiotherapy appears to occur quite frequently. Further research is needed to substantiate strong evidence for the assessment and management of radiodermatitis.

Keywords: radiation oncology, children, hospitalized, radiodermatitis

Introduction: The prevention of Central Line-Associated Bloodstream Infections (CLABSIs) can be achieved through systematic surveillance and intervention through the implementation of care bundles. An integral component of the care bundles is the central line insertion and maintenance checklists. Aim: The aim of this literature review was to investigate the compliance rate of the nursing staff with the central line insertion and maintenance care checklists as well as the factors affecting it. Material and Methods: Search was performed on PubMed (April 05, 2021) with the keywords: “nurse*”, “nursing staff”, “compliance”, “central line insertion checklist” and “central line maintenance checklist”, without time limit for the publication of scientific papers. Keywords were searched in the title and abstract of the studies. Studies were excluded if they were not published in the English language, were conducted on animals, and were case studies, editorials, and letters to the editor. Results: Of the scientific papers retrieved, 5 were included in the systematic review. The compliance rate of nursing staff with central line insertion and maintenance checklists ranged from 8.4% to 74.3% and from 11.4% to 77.3%, respectively. Regarding the factors affecting the compliance of nursing staff with both types of checklists, these were the nurse-to-patient ratio and the number of beds of nursing wards. Conclusions: Compliance rates with the central line insertion and maintenance checklists are moderate and low. Interventions are required that will increase compliance rates leading to lower CLABSI rates.

Keywords: Nursing staff, compliance, central line-associated bloodstream infection

Occupational therapy treatment in certain medical and health conditions has been consistently found to reduce health care costs and improving the quality of life of the patients. A rising strand of the literature underlines the need for socioeconomic evaluations in occupational therapy interventions. The present study uses as a case study, the occupational therapy department of a Greek General Hospital, the one of Syros island. The paper has a two-fold research goal: to examine the economic costs and revenues of the occupational therapy department and to evaluate the health-related quality of life of the patients of the department, before and after the first lockdown in Greece due to COVID-19, that lead to a three-month shutdown of all occupational therapy sessions. Regarding the economic evaluation part, there seems to be a downward trend in the department’s expenditure, mainly due to the nationwide decrease in wages. However, there is noted a large discrepancy between costs and revenues of the department, due to the insufficient public reimbursement and the low pricing imposed on occupational therapy sessions. On the other hand, health-related quality of life scores of the patients treated, just before the lockdown (in February 2020), differentiate between age groups. For adult patients, there does not seem to be any significant differences in their health-related quality of life due to the disruption of their treatment. Still, for children-patients, a significant number of them seems to have lower health-related quality of life scores after the three-month disruption in their sessions. The results should be viewed with caution due to the limitations in the sample size and information. Still, due to the scarcity of studies in this area, we hope the study can provide some initial research insights on the research topics addressed.

Keywords: Occupational therapy, economic evaluation, health-related quality of life, COVID-19, Greece