Rostrum of Asclepius Vol 11, No. 1 (2012): January - March 2012

"Iron Chelation Therapy" is a term used to describe the procedure of removing excess iron from the body, which is applied after a total of approximately 20 blood transfusions or when serum ferritin levels rise above 1000 ng/ml. Aim: The purpose of the present paper is a retrospective search in bibliography, concerning the methods of iron chelation treatment for patients with hemochromatosis owing to their undergoing multiple blood transfusions. Method: The methology followed, included the search for review and research studies, in electronic databases as well as scientific haematology journals, mostly regarding recent entries in greek and international bibliography. Results: According to the bibliography, chelation therapy compounds have significantly changed the patients' clinical features and have substantially improved their quality of life, along with their outcome over time. However, the level of patient compliance to treatment still remains the basic problem of iron chelation therapy. Conclusions: Even though the discovery of orally administered chelating agents can qualify as an auspicious accomplishment, research fields should cover a much wider spectrum, in order to improve the effectiveness of iron chelation treatment.

Keywords: Hemochromatosis, iron chelation therapy, chelating agents, thalassemia

The creation of an achieved nursing department model is essential for the improvement of the quality of care and patients' satisfaction. Aim: To investigate the criteria for the creation of an achieved model of nursing department. Methodology: Literature review was based on studies and reviews derived from international (Medline, PubMed, Cinahl, Scopus) and Greek (Iatrotek) data bases concerning planning, application and management of health services in nursing departments. Results: The creation of an achieved model of nursing department is essential because it will contribute to patients' satisfaction and to renewal of scientific knowledge of health professionals. Conclusions: For the creation of the above model, there is a necessity for collaboration between the members of multidisciplinary health care team, prevention of conflicts in the working place, continuous control and evaluation of health professionals, standards of quality assurance, continuous education of health professionals, and conduct of research studies in order to improve clinical practice.

Keywords: Nursing department, multidisciplinary health care team, prevention of conflicts, quality assurance

Cancer is one of the modern health problems of people living in developed countries. Furthermore, therapeutic approaches to cancer patients is constantly updated with new data. Aim: The aim of the present study was to review the international literature referred to the application of music therapy in the treatment for pediatric and adult patients with cancer. Method and materials: The method of this study included bibliography research from both the review and the research literature on MEDLINE (2000-2010) database and using as key words music, music therapy, alternative-complementary therapy, cancer, children. Results: Music therapy, the last few years, seems to be one of the forms of alternative-complementary therapy for patients treated for cancer. Music therapy is applied as part of complementary therapy in pediatric and adult patients with cancer. Complementary-alternative methods are non-invasive, non-toxic, cheap, safe and can be easily used by the patients themselves. Primarily, the music therapy aimed to the reduction of the emotional trauma and the feeling of the pain during the process of the treatment (radiotherapy, chemotherapy, other painful procedures) but also in the whole patients life. Conclusions: Scientific bibliographic databases research concerning the music therapy in patients with cancer seem encouraging, especially in children. Nevertheless, the further study of the role of the music during hospitalization in the outcome of the treatment is essential.

Keywords: Music, music therapy, alternative-complementary therapy, cancer, children

Child discipline is one of the most important elements of successful parenting. As discipline is defined the process that help children to learn appropriate behaviors and make good choices. Aim: The aim of the present study was to review the literature about the discipline methods. The method οf this study included bibliography research from both the review and the research literature, mainly in the pubmed data base which referred to the discipline methods. Results: In the literature it is cited that discipline is not the same as punishment because is more related to teaching. The ultimate goal of effective punishment is to help the child in exercising self-control, accountability and respect. Children raised without proper discipline, are at risk for a variety of behavioral and emotional problems. Over the last decades, many child discipline techniques have been suggested that vary according to the age of the child, the parenting style and the severity of the behavior. The most effective methods are giving rewards and guidance to make good choices, explaining negative consequences for disobedience without issuing threats, teaching of moral behaviors by displaying parents' good and moral behaviors. Another commonly accepted discipline method is "the consequences' which permits children to have the dignity of dealing with results of their behavior. Conclusions: Discipline consists a tool for parents for the reason that it trains children to think their improper behavior and the following consequences as well as the possible solutions to each problem.

Keywords: Discipline, effective methods of discipline, compliance

Aim: The presentation of moral questions derived from the application of prenatal and preimplantation genetic control on human embryos. Material and Method: A literature review based on both review and research literature, conducted during the period of 1984-2007, derived from MEDLINE, SCOPUS and ΙΑΤΡΟΤΕΚ databases using as key words Prenatal diagnosis, Bioethics, preimplantation genetic diagnosis. Results: The literature review revealed that the moral reflection in regard to the prenatal diagnosis and the preimplantation control focused on the following major points a) the rejection of the non healthy fetus and b) the choice of sex. The genetic control in the children raises numerous moral questions that concern mainly two sectors: a) the preventive test on ostensibly healthy children, for disorders that will be appeared in an advanced age and for which the early treatment or the follow-up for complications would not help and b) the examination in healthy children, in order to be diagnosed for hereditary disorders.. Conclusions: The genetic advisory is considered to be one of the most advisable ways of confronting the moral questions arised by the application of prenatal control.

Keywords: Prenatal diagnosis, preimplantation genetic control, bioethics

Humor is defined as a state of good spirit, exhibited with a smile or laughter, as a response to external stimuli. It constitutes a special form of human communication as well as a form of social conduct. The word «humor» appears for the first time in Hippocrates' writings. Psychology considers humor as one of the most powerful weapons against depression and disappointment. In psychiatric therapeutics humor serves many purposes, thereby acting as a supplement, not a substitute to treatment received. Purpose: of this article is to highlight the positive effects of humor in humans, health professionals and patient. Material and method: An extensive literature search databases such as Medline, Pub Med, Wikipedia, Cinahl, Medscape, with key words: humor, psychiatric patient, care, humor scales Results: Humor is an interpersonal process which facilitates and promotes expression and exchange of views; however it requires prudence, cautiousness and respect to patients' personality and sensitive issues. Humor is not innate, it is acquired and it can be learning and taught. Conclusion: The correct use of humor in therapeutic practice, contributes to the development of a therapeutic relationship between patient and healthcare professional as well as a sense of trust between them.

Keywords: Humor, psychiatric patient, care, humor scales

Students' incentives when choosing what studies to follow relate to the prospects that a degree course may offer. Aim of this study was to investigate the goals and expectations of nursing students from entering the nursing profession. Method: This synchronic study is quantitative and qualitative in design. The sample consisted of 146 students from 1st and the 7th semester of the Nursing Department, TEI of Athens. Data collection was conducted via a questionnaire that was based on the theoretical framework of Ford's Taxonomy of Human Goals. These goals identity internal or cognitive goals and include experiences, social behavior, self-efficacy and task goals. Results: 45,5% and 58,75% of students from 1st semester and 7th respectively chose to study nursing because they believed that it would offer them a secured employment in the future. The largest percentage of students from both semesters (1st=33%, 7th=27,5%) was affected in their choice by social environment. Their responses at an open question indicated that 57,14% of the 1st semester chose nursing as their profession because they wished to "offer help", and 80% of the 7th semester indicated that "they liked looking after other people". They found the content of their studies curriculum very interesting (1st=80,30%, 7th=53,75%). The provision of care to patients was found to be responsible for feelings of satisfaction of both semesters (1st=95,35%, 7th=98,75%). Conclusions: Nursing students seem to choose the profession of nursing because they want to offer. Their participation in patient care creates feelings of satisfaction in the majority of the students. Nurse educators should emphasize on all areas of nursing work, as well as a more realistic view of nursing.

Keywords: Nursing students, expectations, career goals, nursing profession

The last two decades a huge progress has taken place in the field of the primary prevention of infections and many new vaccines have been introduced in the compulsory vaccination program. There is evidence, however, that immunization coverage against some infectious diseases is not adequate. Aim: It was to investigate the level of immunization coverage of Greek and Immigrants' children aged 4-12 years old in the prefecture of Evritania regarding vaccines against pertussis-diphtheria-tetanus (DTaP), poliomyelitis (IPV) and measles–mumps–rubella (MMR). Material and methods: The sample of the study consisted of the pupils of all nursing and elementary schools of the prefecture of Evritania , aged 4-12 years old. Children's personal Health Cards were used to evaluate the adequacy of vaccine doses. X2 was usedfor comparisons. Statistics was processed with SPPS 17.0. Results: The boys of the sample were 469 (51.9%) and the girls 434 (48.1%). Full vaccination coverage with DTaP, MMR and IPV was 87.3%, 79.9%, and 97.6% respectively. No statistically significant differences were observed between Greek and Immigrants' children. Conclusion: Vaccination coverage against measles, mumps and rubella was inadequate. Immigrants' and Greek children are equally covered. Vaccination coverage with MMR is troublesome.

Keywords: Vaccination, children, school, immigrants

The aim of the present study was to explore nurses' knowledge regarding hypertension. Method and material: The sample –studied consisted of individuals from all levels of nursing personnel. Data were collected by the use the completion of a specially designed questionnaire which apart from demographic variables, it included items concerning knowledge about hypertension. Results: From the 360 participants, 88% were women, while the mean age of the sample-studied was 36,1 years old. In terms of the knowledge of participants, 11,2% reported that knew some appropriate organization which publishes guidelines about hypertension. 39,3% of the sample-studied reported correctly the limits of blood pressure while only 3 to 10 nurses knew that hypertension in adults is mainly idiopathic. 95,2% and 85,9% of the participants knew that hypertension has disastrous effects on heart and brain, respectively. 65,7% assessed wrongly as patient of higher risk that with blood pressure within 160/95 mmHg and two cardiac risk factors. 78,1% knew that care of hypertension initially demands dietary treatment and afterwards medicine treatment. 96,3% knew that is demanded cessation of smoking and the 59,9% knew that is demanded constraint of sweet and fatty food. Regarding medicine regimen, 52,0% knew that the majority of individuals with hypertension is satisfactory regulated by the administration of more that one hypertensive medicines. 43,1% knew that in patients with diabetes mellitus or chronic renal disease, blood pressure should be maintained within <130/80 mmHg. 69,4% knew that a satisfactory regulated hypertensive patient should pay a visit to the doctor every 3-6 months. Conclusion: Findings of the present study showed that nursing staff knew the resulting damages owing to hypertension and the basic treatment dietary or physical lines of hypertensive individuals, however it was shown deficiency of knowledge regarding etiology and diagnostic boundaries of hypertension, the assessment of cardiac risk and the medicine treatment of hypertension. Finally, high percentage of the sample ignored existence of guidelines about hypertension. For the improvement of nurses' knowledge, emphasis should be given on the lifelong learning.

Keywords: Hypertension, risk factors, treatment, prevention, guidelines

Delirium is a common complication in hospitalised patients, however it is often misdiagnosed by health care professionals. Failure to achieve a timely diagnosis results in poor outcomes, prolongation of patient hospitalization, increased costs of hospitalization, increased morbidity and mortality. Aim: To investigate the level of knowledge of nurses with regard to delirium and the care of hospitalized patients with delirium. Material - Method: A cross-sectional questionnaire survey was carried out with a sample of 108 (N=108) nurses working in medical and surgical wards in two general hospitals of Athens and in three provincial hospitals. For the data collection, a 28 item questionnaire was developed, based on a preexisting research tool as well as on the relevant literature. The questionnaire additionally demonstrated high reliability (Cronbach's a=0,860) as well as face and content validity. Respondents also answered open questions on knowledge regarding the nursing care of patients with delirium. Descriptive and inferential statistics was used for the data analysis. Content analysis was used in analyzing data gathered from the use of open questions and results were presented in percentages. Results: The majority of nurses answered incorrectly or declared that they did not know, in 17 of the 28 questions in relation to delirium. Of the respondents 63,8% were unable to answer with clarity in open questions on the care of patients with delirium. 82,4% reported that caring for patients with delirium was based solely on the instructions of doctors. 44,4% answered that patients' care include the administration of anxiolytics, tranquilisers, and the stay of a familiar person next to the patient as well as 80,5% answered the use of patients' restraint. 67,5% of respondents pointed out that they had not been taught in their undergraduate studies regarding delirium. Multiple regression analysis revealed that specialization in nursing and postgraduate studies affect positively at statistically significant level (p<0.05) nurses' knowledge about delirium. Conclusions: Is necessary to incorporate delirium in nurses' curriculum at the undergraduate level. In addition, continuing education courses have to be held in order to provide knowledge on nurses working in hospital settings to help the early detection of the symptoms of delirium and provide effective nursing care.

Keywords: Delirium, nurses, knowledge, nursing assessment, nursing care