Quarterly scientific journal

Rostrum of Asclepius Vol 11, No. 3 (2012): July - September 2012

Vima AsklipiouRostrum of Asclepius Vol 11, No. 3 (2012): July - September 2012

Editorial

The concept of dignity: A constant but forgotten value in nursing | 315-318

Evridiki Papastavrou

Review

Identification of pediatric patient | 319-329

Ioannis Koutelekos , Maria Polikandrioti

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Identification of pediatric patient consists a dynamic alternative complex procedure that includes many and various dimensions which may define up to some extent the life of each individual and even the outcome of the disease. Aim: The aim of the present study was to review the literature about the identification of pediatric patient. The method of this study included bibliographic research of the literature from reviews and researches, mainly in the PubMed data base, which referred to the identification of pediatric patient. Results: According to the literature, many factors influence the identification of pediatric patient, of which the main are the body image and the age that the patients experience this change. Another factor that affects significantly the configuration of the identification of pediatric patient is the extent to which society influences the daily life of the patient, the perceptions and attitudes of health professionals as well as the religiosity in the way it is expressed in the clinical environment. Conclusions: Design of protocols of care based on the identification of pediatric patient including spirituality will contribute to the most effective satisfaction of patients' needs.

Keywords: Identification of pediatric patient, spirituality, attitudes of health professionals

Prevalence of tuberculosis among immigrants and impact on indigenous populations of Europe | 330-346

Victoria Alikari

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From the mid-'80s, the phenomenon of increasing cases of tuberculosis (TB), due to immigration, in developed low prevalence of disease countries, is illustrated by many studies. The particular characteristics of the disease makes the treatment from National Health Systems as a matter of highest interest and the in-depth study of the phenomenon at the level of prevention, diagnosis, treatment and control as urgent. The aim of the study was to review the literature about the prevalence of TB due to immigration to European countries. The methodology of work included search of epidemiologic studies in the electronic data base Pub Med that was reported in the increase of tuberculosis cases because immigration in European countries. The search covers the period 1980-2008 and the words used were: "epidemiology", "resurgence", "tuberculosis", "immigrants", "Europe". Results: In all studies was observed increase of frequency of TB in migrants compared with local populations and independent rate of disease transmission. Higher rates of disease were immigrants from Africa, Asia and Eastern Europe. The low socioeconomic level of migrants, drug and alcohol abuse, increased incidence of AIDS, increasing antimicrobial resistance and multi-management, delay in diagnosis and social problems such as unemployment, are some of the aggravating factors in this population. The conformity of migrants in terms of treatment and prevention of transmission was low in most countries. Conclusions: We reassess the sorting process (screening) of immigrants in entering the country, continuous upgrading of the guidelines, knowledge on the disease, especially among young people. Axes control prevention is: the Mantoux test, the radiograph of thorax, the chimeioprofylaxis

Keywords: Epidemiology, resurgence, tuberculosis, immigrants, Europe

Bioethical – Theological and Legal approach in genetic testing of adult persons | 347-357

George Katsimigas , Georgia Vasilopoulou

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Thorough genetic testing gives possibility's diagnosis of genetic diseases or identity individuals, who genetic predisposed for disease outbreak Aims: To present/identify the ethical and religious issues, which arise from the application of genetic testing in humans. Furthermore, the principles from the European and Greek legislation regarding genetic testing will be discussed. Materials & Methods: A literature review based on both review and research literature, conducted during the period of (1993-2010), derived from MEDLINE, SCOPUS and ΙΑΤΡΟΤΕΚ databases using as key words: Bioethics, genetic testing, bioethics, access, genetic information, orthodox ethics, Legislation. Results: Genetic testing for disease prevention is of primary importance. The main ethical concerns however, are related to the dissemination/ disclosure and use of this information from insurance companies, healthcare authorities, scientists, forensic departments/services and employers. Similarly, the orthodox religion accepts the use of genetic testing for the prevention and treatment of diseases as long as there is no break of confidentiality. Finally, considering the legal issues, it is apparent that genetic information is regarded as personal information and as such it is protected from the national (Greek) and international law. Conclusions: It is necessary to ensure that the public authorities protect the rights of their citizens regarding genetic testing and all insurance companies, employers, schools etc. should not be allowed to have access to genetic information. Such an approach will ensure that social discrimination, obstructions or other inequalities between people on the basis of genetic information is avoided.

Keywords: Genetic testing, bioethics, access, genetic information, Orthodox ethics, legislation

Investigating doctors and nurses views about the decision of Do-Not-Resuscitate (DNR) in patients of ICU. A systematic review | 358-372

Olga Kadda , Georgios Argyriou

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In the Intensive Care Unit (ICU) hospitalized patients with major decisions taken with regard to their treatment. The cardiopulmonary resuscitation (CPR) process is critical for patients with potentially reversible diseases. In Medicine "do not resuscitate" (DNR) is a legal order which concerns patient's desire not to accept CPR if the heart cease to operate or stop breathing. Aim: The aim of this review was to investigate doctors' and nurses' views on DNR decision making concerning ICU patients. Material-Method: The methodology used was the review of Greek and foreign literature in databases (Iatrotek, Pubmed, Cinahl, Scopus,). The keywords used were "do not resuscitate decision," "intensive care unit", "ethical issues", "doctor" "nurse", "end-stage patient." Results: 15 published articles were found. Nurses having greater self-confidence discuss more easily DNR decisions with patients and their relatives. Moreover they would like to participate more often in such decision. With regard to doctors, it seems that their experience in ICU affect their decision making. Most of the doctors are not aware of the legal side of DNR decision. Moreover, they appear more willing to discuss such decision for patients with poor prognosis. Conclusions: The decision-making such as DNR is a point of reflection on the legal framework and ethical rules governing the implementation of CPR. Different views of doctors and nurses in deciding DNR cause a lot of worry and it is necessary to carry out further studies to draw firm conclusions.

Keywords: Do-not-resuscitate order, intensive care unit, ethical issues, nurse, doctor, end-stage patient

Effect of anxiety and depression in the onset and progression of heart failure | 373-387

Zoi Agelopoulou , Nikolaos Fotos , Hero Brokalaki

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Introduction: Clinical experience suggests that depression and anxiety are connected with the onset and progress of heart failure (HF). Aim: The aim of the present study was to investigate the effect of stress and depression in the onset and progress of HF. Material and method: A literature review was conducted in order to identify articles relevant to the stress and depression in patients with HF, published in the English language, during the last decade (1-1-2002 to 31-5-2011), using different databases such as PubMed, CINAHL και Cochrane. The key words were: "heart failure", "anxiety", "depression", "quality of life", "psychiatric symptoms", "psychological support". Results: The literature review showed that psychosocial factors, such as stress and depression, both have a significant role in the onset of diseases that cause HF and in the progression of HF. Also, it is shown that early and effective treatment of psychosocial factors can lead to a reduction in the frequency and severity of HF. In this effort nurses could help by applying new methods and techniques. Conclusions: The correlation of anxiety and depression with the onset and progress of HF could trigger nurses to adopt new therapeutic interventions, which will help them treat patients with HF in a better and more holistic way.

Keywords: Anxiety, heart failure, depression, quality of life, psychosocial factors

Special Article

Merging of hospitals. The case of Argolida prefecture | 388-404

Ilias Giannakoulis

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Based on the institutional framework (Government's Newspaper Issue: 1681/B'/28-7-2011), we have developed a proposition of merging/consolidation between the General Hospitals of Argos and Nafplion as our interest is the best provision of health services to the citizens at the lowest possible cost. Purpose: Our case study is the rational management of the resources and facilities of the two hospitals in the form of a Corporate Body under Public Law with a single statute and budget and a merging of departments. Material- Methodology: The material used was the data from the two hospitals regarding human and financial resources and facilities. The methodology involved the use of ratings in order to find the best possible combination of the above resources for a more effective use of all the productive factors. Results: According to the hospital's capacity in 2010, the necessary beds for the General Hospital in Argos were 109 and for the General Hospital in Nafplion were 38. The new hospital, with a 10% superaddition, will need 166 beds. The personnel ratings are 0,84 doctors/ bed and 1,34 nurses/ bed. The development of unified outsourcing cleaning, security and cooking services would bring in a financial profit of 250.000€. Unified services of laundry-ironing-sawing, a catering service, provisions etc are within the framework of restructuring the two hospitals. As far as the operational expenses are concerned, a merging of the hospitals can bring in a reduction of expenses by 50%. Moreover, the expansion of the facilities in the General Hospital in Argos and providing for all the patients in the prefecture with kidney disease are a feasible target. Conclusions: With the creation of a Corporate Body under Public Law based in Argos we expect to have: an enhancement in the quality of health services, an improvement in their distribution in terms of space and a reduction of expenses, an immediate performance of the new merged services and a positive impact on tourism. The opportunity cost is such that we are not allowed to ignore the fact that financial and human resources can be used more effectively creating scale economies.

Keywords: Μerging / consolidation, capacity, personnel ratings

Original Paper

The medical device sector in Greece: An economic evaluation of the Magnetic Resonance Imaging (MRI) market | 405-421

Athanassios Vozikis , Antonia Kaskarelis

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The medical devices equipment and more specifically the Magnetic Resonance Imaging (MRI) units, open new horizons in the realization of diagnostic examinations, offering additionally an exceptionally reliable information in the process of the clinical decision-making. Aim: Aim of the present study is the general review of the medical devices sector globally but also in Greece and the economic analysis of the MRI market in Greece. Material and Methods: This study was realized using data concerning the number, the characteristics and the use of the MRI units for the year 2009. For the analysis of those data, simple methods of descriptive statistical analysis were applied. Results: The present research points out that the proportion of the MRI units per million of population ranks Greece in the third place globally after USA and Japan. Moreover, it was unveiled that only 13% of total MRI's units are installed in public hospitals, while their unequal distribution and their absence in the countryside are obvious. Conclusions: The findings confirmed the conclusion that the imperative need of strategic planning of supply, fair distribution and rational use of MRI units in Greece.

Keywords: Medical device equipment, MRI units, cost of diagnostic examinations, distribution of resources

The influence of single parenthood on the social needs of the single parent | 422-437

Dionysia Antonopoulou

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The changes occurring in the socio-economic situation in our country shape the environment that single - parent families experience. The treatment of single- parent families as a factor of economic and social development is a key objective in a state with a social character. AIM: The aim of this study was to research the phenomenon of single- parent families in Greece, and the effect of single parenthood on the social needs of the single parent. MATERIAL-METHOD: A specially designed, anonymous questionnaire was used for this research, which was given to a random sample of single-parent families with dependent children both in the urban centers and in the province. The study sample consisted of 206 single parents with dependent children. The statistical analysis was carried out with the use of the statistical package SPSS, 16.00 (SPSS Inc, Chicago, IL). RESULTS: Of the 206 participants in the study, 181 were women and 25 were men. The average age of the heads of single parent families was 44 years, while 41.7% had one child and 41.3% had 2 children. Regarding the educational level of the participants, 39.3% were high school graduates. In relation to social needs, 66.1% of single parents expresed a need for psychological support. 27.2% reported the state for psychological support. 20.9% resorted to church and the 18.0% had applied to organizations. The 32.5% of single parents expressed a need for work. CONCLUSIONS: In Greek single-parent families there is an increased need for psychological support and employment. The psychological situation, as seen in the demand for psychological support of single parents with dependent children and the lack of employment, seem to relate to the form of single parenthood, marital status, educational level and residence of the single parent family.

Keywords: Single-parent family, social needs, psychological need, form of single parenthood

Exploring the experiences patients who undergo 24hour Video- electroencephalography | 438-452

Antigoni Fountouki , Dimitrios Theofanidis , Paraskeuas Perifanos , Eleni Marineli

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Epilepsy is a frequent neurological disorder well-known by ancient times. The most accurate and valid diagnostic tool for epilepsy, is electroencephalography which provides details on the brain's function by recording brain cells' waves. Aim of the study was the exploration of the patients' total experience at a psychological and emotional level during a 24hour EEG. Materials and Methods: The sample included 40 subjects aged 18-40 years with a history or suspicion of epileptic symptoms. Due to the study's explorative/explicative nature, a qualitative research design was used. Data collection was performed through semi-structured interviews, direct observations and field notes. Following patients' permission, the interviews were recorded and the verbatim data was analyzed via thematic content analysis. Results: The verbatim text was the raw material where key words or phrases with autonomous meaning, relevant to the study's aims where subsequently organized in 4 major themes and 20 sub-categories, namely: Emotional-Psychological state (Positive: Joy, Optimism, Positive Thinking, Self-Confidence. Negative: Sadness, Anxiety, Fear, Panic, Pessimism). Behavior of patients (Calmness, Comfort, Nervousness, Aggravation). Options for patient involvement (TV, Reading, Music, Sleep, Lack of internet). Interpersonal relationships (family, friendly). Conclusions: During achieving the study's aims, many methodological and practical obstacles have been encountered as it proved to be particularly challenging to encompass patients' emotions and accurately cite their experiences during the EEG. However, results that have been revealed are adequate in formulating a holistic picture about the psychological state and the emotions that patients experience during the procedure.

Keywords: Epilepsy, patients experiences, electroencephalography, psychological changes, thematic content analysis

Coronary artery disease prevalence in diabetics type 2 without anginal symptoms | 453-467

Eirini Kotsalou , Athanasios Kotsalos , Aikaterini Anastasaki , Nikolaos Dimakopoulos , Nikolaos Zakopoulos

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The prevalence of coronary artery disease (CAD) in diabetics is extremely high. AIM: We studied the role of myocardial perfusion scintigraphy (MPS) and the incidence of CAD in asymptomatic diabetics comparing them to symptomatic ones, thus aiming to their best stratification into high and low risk category of CAD. Material and method: 78 diabetics type 2, mean age 62 years, which proceeded Cardiothoracic Department of NIMTS. Inclusion criteria were appropriate control of diabetes, of hypertention, no damage in organ-targets and absence of coronary intervention. We reported the risk factors for CAD, hereditary history, possible acute coronary syndrome referrals, or angina symptoms and medication and all diabetics were subjected in myocardial perfusion study. Results: Our study revealed the high prevalence (73%) of CAD in asymptomatic diabetics included and statistically higher prevalence of CAD in male than in women ( p<0,01). Statistical correlation was reported between severity of ischemia findings and typical angina symptoms (p <0,05), duration of diabetes mellitus (DM) (p=0,003), while type of therapy (p=0,37) and number of risk factors of CAD (p =0,23) were independent. Conclusions: MPS aids the detection of silent ischemia and diabetic autonomic neuropathy in DM patients, especially the asymptomatic ones, though DM is currently thought as a CAD equivalent independently of the presence of hypertension. Thus, MPS can help to early application of appropriate medication according to the recommendations of American Society of Diabetes.

Keywords: Diabetes mellitus (DM), Coronary Artery Disease (CAD), Myocardial Perfusion Scintigraphy (MPS)

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