Quarterly scientific journal

Rostrum of Asclepius Vol 21, No. 2 (2021): April - June 2022

Vima AsklipiouRostrum of Asclepius Vol 21, No. 2 (2021): April - June 2022


Professionalism in nursing | 130-131

Olga Kadda

Special Article

Adverse selection in private health insurance. The structure and evolution of healthcare expenditure in Greece | 132-147

Stylianos Lianos , Charalampos Platis



The present article attempts to analyze the concept of adverse selection in private health insurance, the causes for its occurrence, as well as its effects. Reference is also made to the ways in which insurance companies try to deal with the phenomenon of adverse selection. The main conclusion that emerges is that adverse selection may have a significant impact on the insurance market, causing its destabilization, but also indirectly leading to the manipulation of health insurance plans, in order to discourage patients from insurance.

In order to understand the effect of adverse selection in the private health insurance market, it is important to analyze the evolution and structure of health expenditure, especially private, and the reasons behind the low participation in the overall health expenditure.

Thus, an attempt is made to depict and analyze the evolution and structure of health expenditure in Greece from 2009 until today. The main conclusions, in addition to the sharp downward trend in total health expenditure, both as a whole and as a percentage of GDP, relate to the particularly high out-of-pocket private health expenditures leading to impoverishment of Greek households, as well as the increase in the share and volume of private insurance expenditures, which demonstrates the tendency of substitution of reduced public expenditure by private insurance.

Keywords: Adverse selection, private insurance, structure of health expenditure, financing of health expenditure, out of pocket payments

Quality indicators as tools for measuring the quality of health care. The case of the ICU | 148-167

Dimitrios Kosmidis , Antigoni Fountouki , Sotiria Koutsouki




Understanding the variability of healthcare quality can only be achieved only by collecting specific data. Intensive care units were the ideal place to implement the first efforts for quality improvement through the adjustment of indicators mainly due to the high cost and well well-organized healthcare. Quality indicators consist of data that can represent some aspects of quality and can be used as tools to improve it. The Structure, the procedures, and the patient outcomes constitute the primary basis for the detection, identification, and use of appropriate quality indicators. Surveillance indicators and safety indicators are limited by identifying individual events or phenomena that are inherently undesirable and indicate the need for further analysis and investigation in order to be avoided. «Good» indicators must be able to evaluate important and measurable aspects of quality, be scientifically proven and lead healthcare improvement. They can be applied repeatedly in a healthcare setting for internal control, monitoring and quality improvement or for benchmarking between health structures. In most of these efforts, the approaches for representative indicators concern the quality of intensive care at the interprofessional level, while the first attempts to detect quality indicators related specifically to nursing care are observed. Although quality indicators as a tool of measurement have been thoroughly discussed and suggested decades ago, the implementation of a commonly accepted set of indicators at an international level for intensive care has not yet been established.

Keywords: Quality indicators, quality measures, intensive care unit

Electronic Health Record and Primary Health Care in Greece: The Case of Local Health Units | 168-183

Periklis Rompolas , Panicos Masouras , Sotiris Avgousti



The field of health today, influenced by technological developments, is in a dynamic stage of total transition from the handwritten file to the Electronic Health File. In Greece, especially for Primary Health Care, although the efforts have been timeless and in some cases fragmentary, since 2017 the introduction of the Electronic Health File in the newly established Local Health Units has been a technological innovation. Despite the shortcomings regarding the specialization of users, the interconnection of information with hospital units, as well as software compatibility problems, the capabilities it provides are the framework for continuous and quality health care that will be evidenced at the primary level, but will be disseminated to other levels of care. And it is an event that can be the focus of current and future e-health policies driven by health professionals as users of the Electronic Health Record.

Keywords: Electronic record, primary care, TOMY

Non pharmacological treatment in dementia | 184-195

Foteini Kolentsi , Theodosios Kokkios



Dementia is a multifactorial disease of the elderly. Dementia is defined as the loss of the mind, in other words it is the cognitive discount with memory and personality impairment. Behavioral and psychological disorders are a major problem of the disease, as they affect the speed of mental retardation of the elderly, worsening their daily life by making it difficult, accelerating their institutionalization and burdening their caregivers. Although medications are necessary and useful to treat only a few symptoms of dementia, non-medications come to enhance the therapeutic effect of the available drugs with the particular advantage of being free of side effects, flexible and adapted to the needs of each patient. The purpose of this review is to highlight the importance of major non-pharmacological interventions in the treatment of dementia in the elderly population. For the writing of this review, the data used were drawn from scientific articles, indicative studies and reviews from the international literature. In conclusion, non-pharmacological interventions are necessary and helpful in combating behavioral disorders in dementia.

Keywords: Dementia, old age, cognitive impairment, non-pharmacological interventions, behavioral disorders

Original Paper

Respiratory function in patients with chronic non-spinal pain in comparison with healthy people and patients with chronic neck pain: a pilot study | 196-212

Zacharias Dimitriadis , Eleni Kapreli , Nikolaos Strimpakos , Jacqueline Oldham



Introduction: Patients with chronic neck pain present respiratory dysfunction. However, there is no information regarding the difference between their respiratory function and the respiratory function of patients with chronic non-spinal pain.

Purpose: A comparative study of the respiratory function between patients with chronic non-spinal pain and patients with chronic neck pain and healthy individuals.

Materials and Methods: The respiratory function of 10 patients with chronic non-spinal pain was assessed with a mouth pressure meter, transcutaneous blood gas monitoring and spirometry. Their values were compared with the corresponding values of 45 patients with chronic neck pain and 45 healthy individuals. Comparisons were performed with ANCOVAs by controlling for the potential confounding influence of gender, age, height and weight.

Results: Patients with chronic non-spinal pain had significantly reduced maximal expiratory pressure in comparison with the control group (p<0.05). No other significant differences were observed in comparison with the other groups (p>0.05). Based on adjusted means, respiratory indices such as maximal inspiratory pressure and maximum voluntary ventilation were found to be different between the groups.

Conclusions: The observed differences in respiratory function between the patients with chronic non-spinal pain and the other two groups reveal that the respiratory dysfunction may be due to both biopsychological and biomechanical/sensorimotor causes which may differ for each index of respiratory function. However, these pilot findings should be further investigated in a bigger sample for the extrapolation of more valid conclusions.

Keywords: Neck pain, spinal pain, respiratory function

Pharmaceutical poisoning management at the Emergency Departments of a provincial hospitals | 213-228

Maria Stravogianni , Eleni Simeonidou , Christina Marvaki , Apostolos Vasileios Mellios , Antonia Kalogianni , Georgia Toylia



Background: Medicinal products’ overdose is one of the most common causes of poisoning. It is treated primarly in the emergency department (E.D.) of a hospital.

Aim: The purpose of this study is to assess the management of drug poisoning in the E.D. in a hospital.  

Material and Methods: This is a retrospective study conducted at the General Hospital during the years 2008,2009,2015,2016 and 2017. The studied sample consisted of 258 patients over the age of 15 (>15) who were admitted to the E. D. Demographic characteristics, dates of occurrence, cause and time of incidents, time and way of patient transport, underlying diseases, ABCDE system, laboratory and radiological examination, electrocardiogram, length of hospital stay and the final outcome were recorded in all patient cases. The dada was processed with the use of the statistical package SPSS23.

Results: 65,9%(n=170) were female and 33,3%(n=86) were male with an average age of 39,8 years. The most common causes of drug poisoning ware the intake of benzodiazepines at 41.5% (n = 107) and painkillers at 18.6% (n = 48). In most cases 99.2% (n = 239) hematological (blood) and biochemical tests were conducted which revealed that 7 out of ten cases were associated with a mental illness, while 58,2% of the patients’ stay time at the ED was less than an hour.

Conclusions: The results showed that a large percentage of patients had unnecessary admitted to a clinic. The examinations performed at the E.D., in most cases, were unnecessary and the patients stay time was short. Improper recording of the patients’ handwriting records was noticed.

Keywords: Emergency department, overdose, pharmaceutical poisoning, acute poisoning

Correlation of the musculoskeletal problems of the nursing staff and the intention to leave work, in a Greek hospital | 229-250

Georgia Tsapalou , Olympia Konstantakopoulou , Kostantinos Kaliarntas , Antonia Kalogianni , Theodore Kapadochos



Background: Musculoskeletal problems are very common in the nursing profession and multiple risk factors have been investigated, in recent years, in an effort to address them.

Aim: The aim of the research was to evaluate the musculoskeletal problems experienced by the nursing staff of a public hospital and to investigate their relationship with the expression of intention to leave work.

Material and Method: A specially customized, anonymous questionnaire was used, which included the Greek version of the general Nordic for the Musculoskeletal Symptoms Questionnaire (NMQ), to measure employees’ musculoskeletal problems. Hundred and four questionnaires were completed by the nursing staff of a public hospital. Data analysis was performed with the statistical package IBM SPSS 21.0

Results: The largest percentage of participants reported musculoskeletal problems in various body parts. The study found that the most significant discomforts reported by nurses in the last 12 months were in the cervical area (61.5%), in the shoulder area/shoulders (61,8%) and  in the lower back (lumbar/sacrum area) (57,7%). The multivariate analysis showed a statistically significant relationship between the intention to leave work due to a musculoskeletal problem in the cervical area (p=0.035).

Conclusions: Nurses’ musculoskeletal problems seem to be quite common and able to lead a percentage of employees to the intention to leave the nursing profession. It is important to develop targeted programs to prevent musculoskeletal problems in the nursing profession.

Keywords: Musculoskeletal problems, intention to leave work, nursing staff, musculoskeletal disorders

Systematic Review

Triage assessment of registered nurses in the emergency department | 251-269

Elissavet Ioannidou , George Intas , Georgios Vasilopoulos , Antonia Kalogianni , Georgia Toylia



Introduction: The accuracy of the triage is calculated when the nurse agrees to categorize the specialist and classify both patients at the same triage level. Higher precision in triage represents better quality to emergency services.

Aim: The aim of this study was to investigate the effectiveness of triage by nurses in the Emergency Department.

Method and material: this study is a systematic review of the literature. The bibliography was searced through the Pubmed database. The keywords used are: nurses, triage, accurary, consistency, agreement, emergency nurse, triage nurse, doctor, triage skills. This systematic review included studies written in the English language ,published over the last five years, are original articles. Totally, 12 were selected.

Results: Most studies evaluated only nurses triage skills, while others compared nurses triage skills   with those of other health care physicians and some investigated the factors responsible for nurses triage skills. The nurses had a good knowledge and sufficient triage ability for moderate and light patients, but lack skills for critical ill patients.

Conclusions: The ability and theoretical knowledge of nurses for triage were found to be at a good level. The effectiveness of triage by nurses was comparable to that of physicians. Combined with appropriate training, nurses can take on the difficult task of triage in the Emergency Department of the hospitals.

Keywords: Screening, nurses, efficacy, knowledge, skills

Quality of life of patients with heart failure. A systematic review | 270-287

Evangelia Liogka , Christina Marvaki , Georgia Toylia , Olga Kadda



Background:Heart Failure (HF) is a chronic progressive disease, a major public health problem, as patients experience a variety of symptoms, both physical and emotional, that directly affect their daily lives and quality of life.

Aim: The purpose of this systematic review was to investigate the quality of life of patients with HF and the factors that affect it.

Material and Method: A systematic review of the literature was performed and a search for studies in the international databases PubMed, Google Scholar and Cochrane Database. A time limit was set regarding the date of publication of the articles (articles that have been published in the last 10 years). Ten studies were found that met the criteria for their participation in the review.

Results: According to the results of the studies the majority found that the quality of life of patients with HF is reduced, affecting both physical and emotional dimensions. Factors associated with a negative impact on quality of life were gender, age, severity of the disease, comorbidities, financial status, occupation and educational level.

Conclusions: The quality of life of patients with heart failure is affected by various demographic and clinical characteristics. Theassessment of the quality of life of patients with heart failure will help health professionals assess their needs and provide patients with personalized holistic nursing care.

Keywords: Heart failure, quality of life, nursing intervention

The role of family in care of surgical patient. A systematic review | 288-307

Aikaterini Stavgianoudaki , Styliani Tziaferi , Panteleimon Perdikaris , Petros Kolovos



Background: Family has a pivotal impact on the individuals’ health status and the society as well. Family involvement in care provision has been investigated in nursing literature.

Aim: To investigate family role in care provision to surgical patient.

Methodology: A review of the contemporary literature was conducted on the database PubMed/Medline and the search engine Google Scholar with the keywords: «family influence», «family role», «surgical patient» and «surgery». Data were extracted according to eligibility criteria, analyzed and synthesized.

Results: From the analysis of the results of the studies included it was found that the active family involvement contributes to the management of perioperative pain in pediatric patients, while, at the same time, ensures the follow up process and an effective communication with the health care professionals postoperatively. Among family members, spouses/husbands provide psychological support to the adult surgical patients and have a significant impact on the decision-making process regarding to the surgical procedures.

Conclusions: Family members support and enhance the decision making process related to surgical procedures of the adult surgical patients in the context of a partnership – the family act as a partner in surgical care provision. Moreover, the essential and active involvement of the family facilitates the care provided to pediatric surgical patients so the family acts as a facilitator in surgical care provision.

Keywords: Family, pediatric patient, surgical care, surgical patient, surgery

The effect of music therapy on stress levels in intubated patients in intensive care units: A systematic review | 308-328

Maria Kikiza , Antonia Kalogianni , NIkoletta Rovina , Georgia Toylia



Introduction: In recent decades there has been a growing interest in the impact of music on stress management in patients with mechanical respiratory support in Intensive Care Units. The need to find new alternative methods of intervention, less expensive and harmful, makes music therapy the most appropriate proposal.

Purpose: The purpose of this review was to evaluate the effect of music therapy in reducing the manifestations of anxiety in intubated patients in the ICU.

Methodos: Randomized clinical trials were sought on the effect of music on the stress levels of mechanically ventilated adult patients in the ICU. Stress was assessed by recording normal parameters (heart and respiratory rate, blood pressure, O2 saturation) and by stress scales. Data retrieval and collection was performed via the Medline and Cochrane Database digital databases. Included studies were in English, during the period 2000-2020.

Results: A total of four randomized clinical trials (306 subjects) were included. The main findings of all four studies were the reduction of heart rate, respiratory rate and blood pressure in the intervention group. At the same time, patients experienced periods of calm and relaxation behaviors. No research has shown any negative effects from the use of music.

Conclusions: The results of the studies document the short-term positive effect of music on the stress of mechanically ventilated patients in ICUs. At the same time, they are alerting the scientific community to conduct more research that will certify the long-term positive effect of music on the stress of intubated patients.

Keywords: Music, anxiety, mechanical ventilation, intensive care unit

The role of chemoprophylaxis in the prevention of surgical wound infections: Systematic Review | 329-346

Areti Pappa , Georgios Vasilopoulos , Eleni Dokoutsidou , Georgia Fasoi



Introduction: Surgical site infection (SSI) is the third most common cause of nosocomial infections and the most common complication in surgical patients. Antibiotic prophylaxis aims to prevent the intraoperative infections, which are located in the area of the surgical wound and lead to abscesses and other deep-seated infections.

Aim: The purpose of this systematic review was to study the role of chemoprophylaxis in the prevention of infections in general surgery and breast surgery in adults.

Methodology: A systematic review of the literature and search of articles in the international databases Pubmed, Scopus, CochraneLibrary was carried out through a process of review / evaluation of articles. A timeline was set regarding the date of publication of the articles (articles that have been published in the last 5 years, 2015-2020).

Results: The review found 7 articles that met the criteria for their participation. The use of chemoprophylaxis preoperatively in potentially septic surgeries, mainly for enterectomies, appendectomies, is associated with reduced rates of LXT. While there is a difference, in aseptic or clean operations, such as mastectomy or hernias, in which no preoperative antibiotics were given. In these results, there were no differences between the control groups and the intervention groups that separated the patients.

Conclusions: To prevent infection it is important to make proper use and selection of the appropriate antibiotic. Unnecessary use of antibiotics to prevent SSI has negative effect, as it cause resistance to gems and increase the cost of treatment. For this reason, health professionals should consider all risk factors that may affect the duration of perioperative chemoprophylaxis as well as the type of antibiotics to be used, such as age, co-infection in a remote area, metabolic diseases, long surgeries, poor hemostasis.

Keywords: Chemoprevention, antibiotics, surgical procedures, infection

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