Quarterly scientific journal

Rostrum of Asclepius Vol 20, No. 3 (2021): July - September 2021

Vima AsklipiouRostrum of Asclepius Vol 20, No. 3 (2021): July - September 2021


Provision of patient centered care | 255-257

Olga Kadda

Hot Topic

The role and skills of the modern manager in the Greek public hospital | 258-272

Athanasios Makrakis



The proper and optimized operation of the Greek public hospital at the present time requires the existence of a manager who, through his / her substantive and formal qualifications, will be able to coordinate the multifaceted staff and harmonize the complex working environment. Compliance with the minimum criteria of the existing legislation [article 2 (4) of Law 4052/2012] with a modernization and an increase in the legislative specifications for the occupation of the manager position is considered to be imperative and major, in order the hospital to be in constant communication and harmonization with its needs as a result of the changes of the internal and external hospital environment.

Hospital administration requires knowledge, skills, abilities and a variety of administrative tools which must be adapted to the needs of the constantly changing environment of the public hospital. Changes should focus primarily on organizational behaviour and be achieved through staff training by acquiring principles and methods of professionalism through scientific documentation. A positive impact of the changes for the hospital is expected to be the efficiency and effectiveness in human and material resources management in order to achieve the goals of the organization.

The success of an organization, thus of a public hospital, lies to a great extent on its management. This is the position of the hospital manager who has to be transformed into a charismatic leader with inspiration and vision in order to entangle his subordinates, turning them into participants of his vision of the hospital. Acquisition of the voluntary participation of subordinates and the adoption of the proposed changes will contribute to the achievement of innovative results.

Keywords: Hospital management, manager skills, management tools, leadership, internal enviroment, external enviroment

Special Article

The evolution of Greek primary healthcare from the implementation of the national healthcare system until today-The declaration of Astana and current challenges in primary healthcare | 273-289

Vasiliki Tsigkou , Ioannis Apostolakis , Pavlos Sarafis



The declaration of Alma Ata in 1978 aimed at “Health for All by 2000” through the development of primary healthcare for the prevention, treatment and rehabilitation from the disease and the abolition of social inequities. Nevertheless, primary healthcare in Greece has never been able to reach this goal.

Greek primary healthcare has continuously been fragmented, without proper management and control, with poor management of human resources, lack of infrastructure, poor quality, high cost of services and focus on treatment than prevention. Several strategies have aimed at the reform of primary healthcare from the establishment of national healthcare system until 2009. However, a pilot test of the family doctor and referral system is under evaluation since 2017.

The declaration of Astana in 2018 pointed again the need for primary healthcare reform globally towards sustainable development. Greece has made some progress after several decades of unsuccessful reforms of primary healthcare; nevertheless, the whole strategy is yet under evaluation.

Keywords: Primary healthcare, declaration of Alma Ata, declaration of Astana, healthcare services

Abortion after rape: moral perspective and debate | 290-304

Dimitrios Theofanidis



The purpose of this paper is to examine the ethical dilemmas presented in the decision for abortion after rape.  In the case of rape, the woman is forced to suffer further psychological harm by carrying the ‘product’ of violence rather than consent. However, in the event of rape, any subsequent abortion essentially punishes the unborn child who has committed no crime. Instead, the perpetrator should be punished, not the foetus.

In the case of incest, the woman who becomes pregnant by her relative is very likely to deliver a monstrous fetus, which will suffer throughout its life. Abortion is therefore suggested as a 'therapeutic solution'. Yet, there is a risk (to a lesser extent) of genetic abnormalities even for consensual pregnancies. So by the same token, should all fetuses with genetic abnormalities be killed?

In conclusion, in the case of rape, the fetus or the child, it is not the symbol of an act of love, but the aftermath of a violent act, a living reminder of the inhumane event and a hindrance to the victim's mental redemption. The option of abortion seems to be the way that the victim can continue with her life. But from an ethical point of view, abortion after rape is not justified because the innocent victim is actually 'punished' and not the perpetrator.

Keywords: Abortion, rape, ethical dilemmas

Original Paper

The impact of the rotating shift work scheme on the health of the nursing staff | 305-317

Lamprini Cherouveim , Alexandra Skitsou , George Charalambous



Introduction: Rotating shifts as well as night work are responsible for the deregulation of the circadian rhythm that causes changes of the hormonal system manifested with symptoms associated with cardiovascular and the gastrointestinal system, as well as sleep disturbances, intense fatigue, emotional distress and stress.

Aim: To investigate the overall physical and mental health of the nursing staff that works rotating shifts and the factors that burden them.

Materials and Method: The cross-sectional study used scales of The Standard Shiftwork Index Questionaire that were completed by 100 nurses of the General Hospital of Kavala that work rotating shifts. The data analysis was done using the 21st version of the SPSS Program.

Results : Data results showed increased cognitive and physical stress of the nursins staff that worked rotating shifts, which were manifested by cardiovascular and gastrointestinal symptoms (p<0.001). The shift work triggers habits such as smoking (mean difference=10.69, p=0.01), bad nutrition (mean difference=0.933, p<0.001), obesity (40.48 % were overweight and 17.86 % were obese), increased consumption of alcohol and caffeine (mean difference= 0.933, p<0.001). Nurses over 40 years old and with more than 15 years of work experience were more burdened.

Conclusion : Shift work increases the nursing staff's stress resulting in burdened physical and mental health. Arithmetic abundance of nurses to patients would mean better work programs, health protection and more efficient and effective health systems.

Keywords: Circadian rhythm, nurses, shifts, health impact

Postoperative meningitis in patients hospitalized in the Intensive Care Unit: a retrospective study | 318-333

Panagiota Triantafyllaki , Georgios Vasilopoulos , Vasiliki Romanou , Dimitrios Papageorgiou



Introduction: Postoperative meningitis is a rare neurosurgical complication considered to be associated with loss of meningeal integrity due to neurosurgery with or without CSF drainage catheters. Despite its low incidence, serious complications occur.

Aim: Investigation and analysis of cases of postoperative meningitis admitted to the ICU (predisposing factors, microbial causes, treatment and outcome)

Material and Methods: A retrospective study was performed in 2016 at «Georgios Gennimatas» Genaral Hospital of Athens. The study population included 23 patients over 18 years of age who had undergone neurosurgery. Special recording forms were used for data collection and the data were taken from patients' files. The statistical analysis of the data was performed with the program Statistical Package for the Social Sciences ver.25. Values p <0.05 were considered statistically significant.

Results: Of the 23 patients studied, 9 experienced post-surgery meningitis (39.1%). Comparing the 9 meningitis patients with the 14 who didn’t develop the complication there was a statistically significant difference concerning the urgency of the surgical procedure and the involvement of external CSF catheters. In addition, patients with post neuro-surgery meningitis had a statistically significant increase in the length of stay in ICU when compared with those post-neurosurgery patients who did not develop central nervous system infection.

Conclusions: Meningitis in the post-neurosurgery patients hospitalized in ICU constitutes a serious complication related to the presence of cerebrospinal fluid (CSF) external catheters. Postoperative meningitis increases ICU length of stay.

Keywords: postoperative menigitis, nosocomial meningitis, nosocomial infection

Knowledge of nurses in airway management | 334-353

Eleni Moschona , Antigoni Skoura , Hra Antoniadou , Dimitrios Kosmidis , Dimitrios Theofanidis


Introduction: Airway management in critical care units, such as ICUs, A&Es and Anesthesiology Departments, includes nursing procedures that require expert knowledge and skills. These two key elements remain a controversial clinical area as they have not been studied in Greece. Aim: To evaluate the level of knowledge in airway management of nurses working in ICU, A&E and Anesthesiology Departments. Material and Methods: A cross-sectional study was conducted using a self-administered questionnaire which was distributed to a sample of 211 nurses working in 24 departments (ICU, A&E and Anesthesiology) in 8 hospitals of Northern Greece. The knowledge test tool consisted of 25 closed-ended knowledge questions. The mean score (0-25 scale), knowledge level, ratings relationship with other demographic data, as well as some possible causal factors as independent variables for interpreting the variation of scores were calculated. Results: The research tool showed satisfactory reliability (Cronbach's α=0.706) and content validity (CVI = 0.907). The average knowledge score of the sample was 16.87 and this level was rated as "very good". Differences in ICU, Anesthesiology and A&E scores were mainly attributed to the background and expertise of the nurses. Multiple regression identified specific hospitals, department, type of hospital (provincial or big city), frequency of training, empirical (professional) knowledge, BLS and ILS certification as independent variables for interpreting the variation in the level of the nurses’ knowledge. Conclusions: Overall, the knowledge of airway management of the nurses in this study is considered ‘good’ to ‘very good’. However, it is necessary to incorporate on a regular basis a continuous and specialized training program, at least in some critical care units. Factors affecting the theoretical performance of nurses need to be further studied for safe conclusions.

Keywords: airway management, nurses, knowledge, nursing care

Health services quality: recording views and degree of patient satisfaction | 354-369

Athina Papageorgiou , Vasiliki Papanikolaou , Alexandra Skitsou , Petros Galanis , George Charalambous



Introduction: Patient’s views regarding the quality of health services and their satisfaction from them are important criteria as they contribute to tracing the critical dimensions that need improvement and to discovering the necessary solutions.

Purpose: Investigating the quality of health services through the recording of views and the degree of patient satisfaction.

Material and Method: A cross-sectional study was conducted with convenience sampling. The people studied were 102 patients hospitalized in clinics of the general hospital of Thessaloniki. The appropriate standardized SERVQUAL questionnaire was used for the data collection. Data analysis was performed with the IBM SPSS 24.0 version software program.

Results: It was found from the results of the study that patient satisfaction regarding health services is high (85%). Moreover, it was found that patients consider all dimensions equally important: assurance (87%), empathy (86%), responsiveness (85%), tangibles (84.5%) and reliability (83%). It was also concluded from the study that there was a deviation between the desired and the perceived quality of services regarding the dimension of assurance (0.57%) and of responsiveness (0.43%).

Conclusions: Patient satisfaction from the quality of services of the general hospital of Thessaloniki was high while at the same time, some fields that need improvement stood out. Such findings, in combination with integration in the system for managing the evaluation of the quality of health services provided, can be important material for the management of the hospital and significantly contribute to the upgrading of the hospital. There is also a need to continuously measuring patient satisfaction aiming at upgrading health services.

Keywords: patient satisfaction, quality of services, Servqual

Systematic Review

Knowledge, attitudes and perceptions of nurses during the COVID-19 pandemic. A systematic scoping review | 370-393

Dimitrios Kosmidis , Antonia Sarra Machmount



Introduction: The COVID-19 pandemic has been a major issue for health care delivery structures, which have been under constant pressure since its commencement. Health professionals, particularly front-line nurses, face extremely difficult working conditions, which have been documented in many studies internationally.

Aim: The main objective of this paper is to explore nurses' knowledge, attitudes and perceptions of the current pandemic, with a particular focus on issues that concerned their professional lives.

Material - Methods. A systematic critical search of the international literature was conducted in 2020-2021. The search terms used were: "nursing", "coronavirus", "pandemic", "knowledge", "attitudes", "perceptions", and their derivatives, synonyms and combinations in Pubmed. Once relevant studies were identified, a data extraction process was initiated for the purpose of this critical review.

Results: After careful perusal of 1277 original literature references, the analysis ultimately included 38 research studies on nurses' knowledge attitudes and perceptions during the COVID-19 pandemic. These were categorized under five themes, i.e. ‘nurses expressed problems of understaffing and increased workload’, ‘strong psychological effects’ (discomfort, fear, symptoms of anxiety and depression), ‘concerns about resource adequacy’ (mainly lack of personal protective equipment) and ‘difficulties in communication and seeking further information and education’.

Conclusions: During the pandemic, nurses, especially those on the front-line, reported multiple problems and concerns, both on a professional and personal level. The recognition of these problems can be useful and taken into account in central planning for possible future crises.

Keywords: Knowledge, attitudes, perceptions, COVID-19, pandemic

Investigating the effectiveness of mobile Health applications in the self-management of Chronic Obstructive Pulmonary Disease | 394-410

Vasileios Ravikalis



Introduction: Chronic Obstructive Pulmonary Disease (COPD) constitutes main cause of morbidity and mortality worldwide. Specifically, it constitutes the fourth cause of death. According to the World Health Organization (WHO), COPD is estimated to be the third cause of death and the seventh cause of morbidity worldwide by 2030.

Objective: The aim of this study is to explore the effectiveness of m-Health apps in self-management of COPD.

Method: In this study English articles from literature were included from June 2014 to June 2019, which were digitally available in PubMed and google scholar. For the research, included keywords were combinations of the keywords “mobile health”, “m-Health”, “m-Health apps”, “COPD”, “self-management”, “self-management of COPD”, “exacerbation”.

Results: COPD is a lung disease that is characterized by a persistent reduction of airflow. It develops slowly and usually becomes apparent after 40 or 50 years of age. The most common symptoms of COPD are breathlessness, chronic cough and sputum (mucous) production. Patients with COPD are susceptible to the risk of frequent episodes of exacerbations. Consequently, they have high risks of hospital readmission. Specifically, one in eight emergency admissions relating to COPD and one in three patients with COPD being readmitted within 28-30 days of a hospital admission for an exacerbation. Effective self-management of COPD through clinical and social support, is essential to improve outcomes such as the patient’s quality of life and to reduce hospital admissions. In order to assess the increasing burden on both the individual and the health system, a literature review was conducted for the past five years of relevant researchers. The results of the review showed significant change in the awareness level, behavioral intention and compliance in medicine use. Conclusion: The m-Health apps can empower the patients of COPD, improve their quality of life and increase their intentions in health behavioral tasks.   

Keywords: Mobile health, m-Health, m-Health apps, COPD, self-management of COPD

Correlation between contrast-enhanced ultrasound findings and pathological prognostic factors in breast cancer: A systematic review | 411-427

Irene Vraka , Petros Galanis



Introduction: Breast cancer is the most frequent cancer among women and diagnostic imaging aims to reliably define the prognosis for each patient, in order to determinate the best therapeutic protocol, specified to the tumor characteristics, maximizing its effectiveness and minimizing its side effects.

Aim: To investigate the correlation between contrast-enhanced ultrasound findings and pathological prognostic factors in breast cancer.

Material and method: A systematic literature review was conducted on PubMed and Scopus from the onset of databases due to 15 December 2019 using the following key-words: contrast-enhanced ultrasound, breast cancer, prognostic factors.

Results: We found 13 studies that support the relationship between contrast-enhanced ultrasound findings (e.g. lesion's enhancement degree, blurring lesion margins, internal lesion homogeneity or heterogeneity, sentinel lymph node enhancement etc.) and pathological prognostic factors in breast cancer, such as tumor size, grade of cancer, crude necrosis, progesterone and estrogen receptors, HER2 receptor, and Ki-67 and p53 proteins expression. 

Keywords: contrast-enhanced ultrasound, Breast cancer, prognostic factors

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