Quarterly scientific journal

Rostrum of Asclepius Vol 15, No. 1 (2016): January - March 2016

Vima AsklipiouRostrum of Asclepius Vol 15, No. 1 (2016): January - March 2016

Editorial

Instead of editorial | 1

Christina Marvaki

Special Article

The use of reflective diaries in education of health and social welfare students: an approach under the rules of professional ethics and values | 2-16

Eleni Papouli

AbstractMore

In recent years, the usage of reflective diary has been increasingly recognized as an essential tool in the learning, assessment and development of health and social welfare professionals (e.g. doctors, nurses, midwives, social workers, etc.) in modern western societies. The reflective diary utilizes the concept of reflection and thus the reflective practice through various reflective models with the ultimate aim to improve learning and behavior change towards entrenched educational or professional beliefs and practices. This article seeks to highlight the necessity of using the reflective diary in the training of students in health and social welfare sciences at the higher education in Greece. Due to lack of sufficient Greek literature on the topic, the article hopes to provide a basis on which to form the theoretical and conceptual background for further study, research and development of the subject under study

Keywords: Reflective diaries, reflective journals, reflection, models of reflective practice, health and social welfare sciences

Lean Thinking in health care: cost containment, better outcomes | 17-26

Ioannis Mastrogiannis

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The concept of “lean thinking” or “lean management” is usually associated with Japanese manufacturing, particularly the Toyota Production System. In the last few years it has increasingly applied to health services in order to eliminate waste and create value. Lean thinking is a management system, a philosophy with a positive impact on health services. Today, health care organizations are facing the challenge of improving the quality of services with limited resources. By defining the value-added steps and eliminating the non-value-added steps through lean thinking, hospital quality levels can be significantly improved, but also to achieve large cost savings

Keywords: Lean thinking, quality of health services, cost savings, waste, value

Clinical Guidelines as the fundamental criterion for the establishment of “Fault” in Medical Liability: Advantages, issues and proposals | 27-59

Athanasios Panagiotou

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In most jurisdictions, fault is the fundamental criterion of imputation of medical liability. The evaluation of physician conduct for the assertion or the rejection of fault is based on the required standard of care established by legislation. Due to the vagueness and case-specific character of the notion of fault, the courts face difficulties to resolve the relevant cases and physicians do not know what the law expects of them. This has led to discussion of the need to clarify the concept of fault and to adopt more specific standards. In fact, some claim that the law should take advantage of clinical guidelines by adopting them as the legal standard of care. Despite the superficial advantages of a guideline-informed standard of care, the problems arising from this approach are significant and certainly hinder its current application. The article closes with some proposals, which show that there is still a long road ahead before guidelines become the fundamental criterion to establish “fault”

Keywords: Medical, liability, fault, errors, mistakes, clinical, guidelines

Original Papers

Investigating the factors that affect the attitude of patients and doctors about substituting original drugs with generic | 60-82

Sofia Sotiria Xanthopoulou , Korina Katsaliaki

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Substituting original drugs with generic constitutes a highly controversial issue and is often met with suspicion both by patients and health care professionals. Objective: The aim of the study was to determine the factors that affect patients’ and doctors’ attitudes about substituting original drugs with generic. Method: In this study, which was conducted with the use of questionnaires from February to April 2015 and its data were statistically analyzed with SPSS, participated 242 patients and 85 doctors of different specialties. Results: Only 43% of the patients, who took part in the research, believed that generic drugs are as safe and effective as the original and the main factor that affected them positively about the substitution of their anticancer drug was the recommendation of their doctor. 54,5% of the respondents agreed with the view that some doctors are opposed to generic prescribing due to clientelistic relationships with the pharmaceutical companies. Statistically significant correlations were observed between patients’ demographic characteristics (gender, age, level of education and annual income) and their attitudes about generic substitution (p≤0,05). From the side of the doctors, who took part in the research, 68,2% of the respondents agreed that generic drugs are bioequivalent with the original and 67,8% of them believed that are safe and effective. Statistically significant correlations were also observed between doctors’ demographic characteristics (gender, age, years of profession, annual income, internship and sector of specialty) and their attitudes about generic substitution (p≤0,05). Conclusions: The Greek government has to support the promotion policies of generic drugs in order to remove patients’ and doctors’ reservations about the issues of bioequivalence and implementation of substitution in clinical practice. This will increase their prescriptions and will provide important economic benefits for the country, especially during this period of ongoing financial crisis

Keywords: Generic drugs, substitution, patients’ attitudes, doctors’ attitudes, anticancer hospital

Emergency endoscopies in patients with gastrointestinal bleeding | 83-95

Eleni Keimali , Olga Kadda , Georgios Vasilopoulos , Georgia Chasioti , Edison Jahaj , Aikaterini Marvaki , Nikolaos Raptis

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Emergency endoscopy is the epitome of the advanced treatment of acute gastrointestinal haemorrhage. Aim: The aim of the present study was to estimate and record the laboratory values and endoscopic findings in patients with acute gastrointestinal haemorrhage, who treated with emergency endoscopy, and their outcome. Material and Method: The studied sample consisted of 302 patients. For data collection especial form was used which was model on the needs of the study. Statistical analysis was performed by using the statistical package SPSS ver.20. Results: 60.6% (n=183) of the studied sample were men with mean age 62.6±15 years. Upper gastrointestinal disease was found in 69.9% (n=211) of the sample, while 30.1% (n=91) involved in the lower gastrointestinal. Moreover, it was revealed that 7.6% (n=23) of the total sample had no evidence of bleeding. The mean length of stay in hospital was 4.3 ± 4 days. Through multiple linear regression analysis, it was explored the effect of various factors, including: gender, laser treatment, polyp resection, embolization, the use of coffee, tobacco and alcohol, hematocrit and hemoglobin levels in patient outcomes (hospital discharge-death). It appears that patients to whom laser therapy was applied had higher survival rate (OR: 1.69 p = 0.010). Conclusions: The conclusion from this study was that the application of emergency endoscopy reduces the length of stay in hospital, the percentage of cases that led to operation room and improveς patients’ outcome

Keywords: Emergency endoscopy, gastrointestinal haemorrhage, outcome, treatment

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