Rostrum of Asclepius Vol 22, No. 1 (2023): January - March 2023

Η άνευ προηγουμένου ζήτηση για υπηρεσίες υγείας, λόγω της γήρανσης και της αύξησης του πληθυσμού, έχει οδηγήσει την επιστημονική κοινότητα στην ανάπτυξη καινοτόμων τεχνολογικών λύσεων στον τομέα της υγειονομικής περίθαλψης. Ο κύριος στόχος είναι η προσφορά προϊόντων και υπηρεσιών ικανών να συμβάλουν στη διαχείριση των ασθενών, παρόλη την αποδεδειγμένη ένδεια σε επαγγελματίες υγείας παγκοσμίως. Τα πληροφοριακά συστήματα που εφαρμόζονται στον τομέα της υγείας, θεωρούνται ως ο μοναδικός και σε μεγάλο βαθμό, σημαντικότερος παράγοντας για τη βελτίωση της ποιότητας παροχής υπηρεσιών περίθαλψης, ενώ παράλληλα στοχεύουν στη μείωση του συνεχούς αυξανόμενου κόστους σε αυτόν τον τομέα. Σύμφωνα με τη μελέτη RAND's Health Insurance Experiment (HIE), οι Ηνωμένες Πολιτείες της Αμερικής θα μπορούσαν να εξοικονομήσουν περίπου 80 εκατομμύρια δολάρια το έτος, αν χρησιμοποιούσαν καθολικά ένα σύστημα Ηλεκτρονικού Φακέλου Υγείας (ΗΦΥ). Με αυτό το σκεπτικό, κυβερνήσεις πολλών χωρών ώθησαν τον τεχνολογικό κλάδο στη δημιουργία όλο και πιο εξελιγμένων συστημάτων και έδωσαν κίνητρα στους οργανισμούς παροχής υγειονομικής περίθαλψης να τα υιοθετήσουν. Ένα σύστημα ΗΦΥ, θεωρείται πλέον αναγκαίο για την ποιοτική και ουσιαστική παροχή υπηρεσιών ενός οργανισμού υγείας αφού συλλέγει και αποθηκεύει ευαίσθητες πληροφορίες όπως δημογραφικά στοιχεία, ιατρικό και νοσηλευτικό ιστορικό, διαγνώσεις, φαρμακευτική αγωγή, θεραπευτικό και νοσηλευτικό σχεδιασμό, πληροφορίες ασφαλιστικού φορέα, αλλεργίες, εργαστηριακά αποτελέσματα ή και καταγραφές από ιατρικά μηχανήματα όπως καρδιογράφο, υπηροχοτομογράφο κλπ.

Keywords: Electronic Health Record, EHR, privacy

Background: Cardiovascular diseases remain the leading cause of death worldwide. Within this context, the need for a greater focus on their prevention makes, among others, increasing physical activity levels an effective strategy.

Aim: To examine the effect of type (aerobic, resistance, mixed) and intensity of physical activity on cardiovascular risk and to highlight the gaps in the scientific literature regarding physical activity and cardiovascular morbidity.

Material-Methods: A detailed research of high-quality scientific studies aimed at the effect of exercise type and intensity level on cardiovascular disease endpoints such as cardiovascular mortality, myocardial infarction, stroke and heart failure, was conducted. Data were searched and collected through the PubMed online database.

Results: A total of 51 recent studies were selected for the synthesis of the results. Regarding exercise type, the cardioprotective effect of aerobic exercise was highlighted in both <65 and >65 years old adults, whereas resistance exercise or combination of both types of exercise seemed to lack an adequate focus. Regarding exercise intensity, the data are clearer and support the effect of moderate and high intensity exercise on the 11-52% and 27-58% reduction in cardiovascular morbidity and mortality, respectively, compared with low intensity exercise. In addition, several studies reveal a dose-response relationship between exercise intensity and cardiovascular risk reduction.

Conclusions: The current findings highlight the benefit of moderate-to-high-intensity aerobic, with or without resistance, exercise in reducing the risk of major cardiovascular disease endpoints. At the same time, awareness is raised in the scientific community so as the sub specific characteristics of exercise to be further investigated, as well as in the public health systems in order for recommendations on physical activity in the population to be implemented.

Keywords: physical activity, intensity, type, cardiovascular risk

Background: The last decades, the incidence of inflammatory bowel diseases (IBD) in childhood has increased significantly. The long-term complications of IBD pose the need for an immediate and valid treatment as soon as possible.

Objective: The study of the therapeutic approach of IBD in childhood aiming at achieving and maintaining the remission and the prevention of long-term complications caused by each disease.

Material and Method: The PubMed, Scopus and Google Scholar databases were searched using the keywords: inflammatory bowel disease, crohn’s disease, ulcerative colitis, childhood, treatment.

Results: The aim of the treatment is the achievement of the best possible clinical and laboratory control of each disease with the least possible side effects, while allowing the best possible quality of life for patients. Treatment includes a range of medications and surgical techniques to achieve and maintain remission. Over time, treatment has changed to reflect the development of new biological agents that target specific pathogenetic mechanisms of each disease.

Conclusions: A better understanding of the pathophysiological mechanisms of IBD has led to more effective and targeted therapies, which, however, have not led to a cure, but have significantly improved the quality of life of young patients. Although the treatment of IBD is demanding and complex, it can turn a seriously ill child to a well-thriving child.

Keywords: Inflammatory Bowel Diseases, childhood, crohns disease, ulcerative colitis,  treatment

Introduction: Early recognition of an in-hospital cardiopulmonary arrest, as well as prompt support, are critical prognostic indicators, according to the European Resuscitation Council. Clinical nurses are the health professionals, who on the one hand are closely linked to the caring of patients, as they are present 24 hours per day near the patient, but on the other hand, they are the ones who will first recognize signs and symptoms of clinical deterioration, as well as confirmation of cardiopulmonary arrest. As first responders, they have a multi-dimensional role by which they mobilize life-saving interventions for the final outcome. Purpose: To describe the role of nurses when recognizing a worsening clinical condition, as well as during a cardiopulmonary arrest. Material and Method: Review of the international literature in the international electronic databases PubMed, Science Direct, Springer Link and Google Scholar was performed on the subject. Results: The early recognition of a clinical burden, as well as the immediate confirmation of a cardiopulmonary arrest, are crucial factors for the positive outcome of each incident. It is research-documented and non-negotiable that staff training, the ability to monitor vital functions, the recognition of dangerous situations, and the use of standardized structured communication and incident delivery tools are crucial factors. Conclusions: Nurses who have the knowledge and experience to recognize the early warning signs of a clinical deterioration usually catch a cardiopulmonary arrest. However, if the patient suffers an arrest, the same nurses recognize it in time, inform the corresponding team (according to the protocol of the nursing institution) and undertake to resuscitate the patient themselves, performing skills and using appropriate equipment.

Keywords: nurses., inhospital cardiac arrest, first responder

ABSTRACT

Background: Maternity is one of the biggest chapters in a woman's life. As beautiful as it might be, it comes with many responsibilities and obligations. Most mothers in order to respond to this new role in their life, start searching information on how to take care of their babies.

Purpose: The purpose of this study is to assess the potential of asynchronous education (moodle) of first-time mothers regarding the care of their newborn.

Material - Method: This research was done in a public maternity clinic, using 53 first-time mother participants who were educated about baby care material via tablet. The age of the participants was between 18 to 47 years old coming from different nationalities, background and religions. Part of the e-learning lesson included multiple quizzes which helped the study be more accurate. The collected data compared the awareness of the mothers before and after they were introduced to the e-learning material. In addition, 47 similar knowledge quizzes were collected from first-time mothers online.

Results: The research showed a significant difference between the correct answers regarding the knowledge that the mothers had before studying the asynchronous lessons and after studying them. The median value of the correct answers before reading the lessons was determined at 51% while after reading the lessons it was equal to 90%. As a way of obtaining information about the arrival of their newborns, the participants declared the internet (46.25%) while the second place was occupied by information from books (31.25%). The most correct answers were gathered by the question about the proper bath of the baby (88%) and the fewest were the manipulations in case of drowning of the baby (3%).

Conclusions: The data analysis showed that all participants had almost doubled up the awareness they had before introduced to the asynchronous education. The moodle platform can be used both outside of formal education and for a very diverse audience.

Keywords: Asynchronous education, baby care, first time mothers, breastfeeding, maternity, moodle

ABSTRACT

Introduction: Diabetes mellitus is one of the most common non-communicable diseases and the implementation of management strategies is important for patients, in order to achieve a stable blood glucose level.

Aim: To investigate the level of compliance of patients with type 2 diabetes mellitus to management strategies. We also investigated determinants of compliance.

Material and Methods: A cross-sectional study was conducted and the study population included 150 diabetic patients who visited a General Hospital of prefecture Attiki. Mean age of patients with diabetes was 70,8 years. 68% of study population were men and 32% were women. Average duration of diabetes was 12,7 years. Data collection was performed during March to April 2021. We used the “Diabetes Self-Care Activities Questionnaire” for compliance measurement. Data analysis was performed with SPSS v.21.

Results: Diet level, blood sugar control and medication adherence were mediocre. Exercise level and foot care level were low. Women found to have better food care(p<0,001), better nutrition (p<0,001) and better medication adherence(p=0,031) compared to men. Higher level of education was associated to better blood glucose control(p=0,015)  and better nutrition(p=0,043). The existence of other diseases was related to diet and physical activity(p<0,05). Finally, the patients who lived with other person had better food care compared to patients who live alone (p=0,001).

Conclusion: The implementation of management strategies for effective management of diabetes is important. Diabetes education and mental empowerment are necessary for patients in complying with diabetes management strategies in order to have better quality of life.

Keywords: type 2 diabetes, compliance, management strategies, determinants, Cross-sectional study

ABSTRACT

Background: Osteoporosis is a systemic skeletal disease that affects over 200 million people worldwide, most of them women, during or after menopause.

Aim: The present study investigates the quality-of-life levels of patients with osteopenia and osteoporosis.

Material and method: A systematic search of the literature was performed in the PubMed and Scopus databases from October 18 to November 1, 2019.

Results: After the application of exclusion and admission criteria, 21 studies remained, in which a total of 18,525 people were evaluated. The majority of research has been done on postmenopausal women. The quality of life of women with osteoporosis and fractures was found to be lower, compared to the quality of life of women with osteoporosis and without fractures, but also compared to the quality of life of healthy women. No definite conclusions can be drawn about the extent to which osteoporosis and osteopenia affect patients' quality of life, with an absence of fractures, as systematic review studies have yielded conflicting findings. The areas of quality of life that seemed to be most affected in osteoporotic and osteopenic patients were mainly pain followed by social function, physical function and mental function.

Conclusions: Osteoporosis in the presence of fractures helps to reduce the quality of life of women suffering from the condition, but, in the absence of fractures, the effect of the condition remains unclear. More studies are needed to investigate the relationship between bone density and quality of life, but also to investigate the quality-of-life levels of men with osteoporosis. It is important for women with osteoporosis to be evaluated early for the risk of fracture, and to receive appropriate interventions.

Keywords: Osteoporosis, osteopenia, quality of life, life of people with osteoporosis, levels of quality of life

Background: Pediatric nurses are very vulnerable to occupational stress due to their constant and intense contact with children that are suffering from diseases threatening to their lives and are experiencing pain psychologically and/or physically.

Aim. The purpose of this systematic review was to investigate the quality of professional life of pediatric nurses and factors that influence and contribute to higher occupational stress.

Material-methods. Systematic review that was conducted by searching articles in international bibliographic databases (Medline, PubMed, Scopus) for the period January-May 2021. Selection criteria set were the studies to be primary, published in English after 2015, to concern pediatric nurses as a whole or a large part of the sample, to be published and their subject matter to be completely relevant to the aim of the review. There were 313 articles that were identified and after evaluation only 13 met the criteria for inclusion in the systematic review.

Results. Pediatric nurses have moderate percentage of compassion fatigue and burnout, 20-50%, and high percentage of compassion satisfaction. Have found a positive correlation between female compassion satisfaction and age <40 years and a negative correlation between secondary traumatic stress and education level. Pediatric nurses with many years of experience have developed coping mechanisms to manage symptoms of stress and have acquired resilience as a personality trait. Moreover, occupational stress as well as current stress was associated with compassion fatigue and secondary traumatic stress. No differences were found between nurses and doctors, between different levels of education, while between different pediatric departments the results were contradictory. Social and organizational support was found to be effective in reducing stress parameters and increase satisfaction.    

Conclusions. It is imperative that nursing organizations and administrations take steps to enhance the satisfaction and quality of professional life of pediatric nurses by implementing training programs, work support groups and individual self-care programs to help nurses cope with stressful situations at work.

Keywords: compassion fatigue, compassion satisfaction, secondary traumatic stress, burnout, pediatric nurse