Quarterly scientific journal

Rostrum of Asclepius Vol 21, No. 3 (2021): July - September 2022

Vima AsklipiouRostrum of Asclepius Vol 21, No. 3 (2021): July - September 2022


Organizational culture in the field of health | 347-349

Olga Kadda


Prostate cancer and sexuality. The role of nurses in improving the quality of patients’ life: Review | 350-360

Varvara Karageorgiou


Introduction: The growing number of prostate cancer survivors with long-term side effects, which affect the quality of life, has created the need to acquire more knowledge about holistic nursing care for these patients. Aim: The investigation of the role of nurses in improving the quality of life in relation to the sexuality of patients with prostate cancer. Methods: A review of studies included searching for reviews and research studies in Google Scholar and PubMed databases, as well as hand-picking books, which refer to the sexuality of patients with prostate cancer and published from 2014 up to 2020. The keywords were used: “prostate cancer”, “quality of life”, “sexuality”, “sexual dysfunction”. Results: Of the studies have shown that treatments for prostate cancer have a negative effect on patients' sexuality and not the cancer itself. Due to the chronicity of this cancer, in contrast to the metastatic course in general, survival is the primary issue, but next comes the good health quality of life. The quality of men’s life with prostate cancer is affected by their sexual function, as it is a major issue in their lives. Conclusions: The role of nurses in the context of nursing evaluation is crucial in the quality of patients’ life with prostate cancer. These patients need providing appropriate care by health professionals and through studies they express their gratitude to those doctors and nurses who devote their time for questions and concerns. Researches need carrying out in order to examine effective methods to manage the sexual side effects of the treatments of prostate cancer. Keywords: prostate cancer, quality of life, sexuality, sexual dysfunction

Keywords: prostate cancer, quality of life, sexuality, sexual dysfunction

Special Article

The applications of lean management in modern healthcare | 361-387

Dimitrios Kalogeropoulos , George Moussa , Alexandra Skitsou , Panagiotis Xenos , George Charalambous


Emphasis on quality and reducing costs has steered many healthcare organizations to reform their whole philosophy changing their management, processes, and quality control infrastructures. Incidents and quality problems consist two of the main issues that indicate why health care leaders need to reform health care service. The evolution of production systems is closely associated with the story of Toyota Motor Company (TMC) that has its roots back in 1918. “Lean thinking” is one of the most revolutionary concepts that have been introduced. The term “lean” was coined in 1990 after the analysis of the Toyota model that led to the “transference” thesis supporting the idea that manufacturing issues and technologies are universal in all production systems and that these concepts can be emulated even in non-Japanese organizations. Lean is a versatile concept that urges organizations to increase their efforts in various levels at the same time. Some authors suggest that a successful implementation encompasses achieving main strategic components of lean, implementing practices to support operational aspects, or providing evidence that the improvements are sustainable in the long term basis. The implementation of lean principles and tools in healthcare has gradually led to a significant improvement in quality and efficiency. However, the transition to lean requires a substantial investment of time. This study investigates the challenges and opportunities faced by healthcare organizations that intend adopting a lean mentality.

Keywords: Lean management, improvement, quality, healthcare, waste

Original Paper

Investigation of the ethical stop in the medical and nursing staff of pediatric Intensive Care Unit | 388-411

Ioannis Koutelekos , Paraskevi Feizidou , Theodoros Argyropoulos , Amalia Yfanti , Dalia Megina , Eleni Evagelou



Background: Part of the concerns of ICU staff relate to decisions to support certain patients and the impact of these decisions on the emotional state of health professionals.

Purpose: The purpose of this study was to investigate the ethical impasse of nurses and doctors in pediatric ICUs in Greece regarding "futile treatment".

Material and Method: The sample of the study consisted of doctors and nurses from the pediatric ICUs of the "P.A. Kyriakou Children’s Hospital ", "Agia Sofia Children's Hospital " "Pentelis Children Hospital " "Ippokratio”hospital Thessaloniki, "University General Hospital of Heraklion Crete and University General hospital of Patras" with a capacity of 40 beds and employs 112 Nurses and 55 doctors. The duration of the study was six months. For  data collection was used a specially designed questionnaire, which was distributed to all employees of the above units and was answered by a total of 121 doctors and nurses. The questionnaire was created under the guidance of the research team based on international literature and professional experience, weighed to check its validity and small adjustments were made for the purposes of the study.

Results: The vast majority of respondents (81.8%) have applied in vain therapeutic interventions whose goal was not realistic while 77.7% felt that it does not contribute to treatment, but prolongs the path to death. 81.8% agree that the continuation of futile treatment should be a decision of the entire treatment team and there was a statistically significant correlation (p = 0.001) with the job of individuals, as supported by 97.8% of physicians and 72, 4% of nurses. Possible legal sanctions may affect the treatment plan in patients without life expectancy.

Conclusions: It is clear that the issues that cause a moral impasse in the ICU treatment team exist and are related to the futile treatment. They are often the cause of conflicts within the treatment group and cause them emotional burden.

Keywords: Pediatric ICU, vain treatment, moral deadlock, detention, withdrawal

Changes in dietary habits during the COVID-19 pandemic: epidemiological survey based on online questionnaire in a sample of Greek population | 412-421

Georgia Anna Katsampoula , Demosthenes Panagiotakos


Background: The ongoing pandemic of COVID-19 and the outset of quarantine affected all people’s daily life and changed their lifestyle and the dietary habits.

Aim: The investigation of the nutritional changes associated with socio-demographic characteristics during the COVID-19 pandemic in Greece.

Methods: Cross-sectional study conducted on December of 2020, through the process of anonymous questionnaires in which participated 2135 individuals, both men and women above the age of 17 in Greece.

Results: The 79.6% of the people responded stated that they observed a change in their dietary habits. These people were mainly women of a younger age and with a higher educational status. On total, 36,3% of the participants declared that these changes led them towards healthier dietary choices. When the analysis was mostly focused on those with an average, great or greater total nutritional change, the percentages of the respondents which followed healthier dietary were 40.1%, 34% and 45.2% respectively (p<0.001).

Conclusions: The lifestyle change during the pandemic seems that has led on a change towards healthier dietary habits in a remarkable percentage of the participants. Maybe this can be considered as one of the few positive impacts of this pandemic in the country.

Keywords: Dietary habits, COVID-19, cross-sectional study, epidemiology

Systematic Review

Compliance of nursing staff with ventilator-associated pneumonia (VAP) prevention bundle: A literature review | 422-433

Maria Gamvrouli , Christos Triantafyllou


Background: Ventilator-Associated Pneumonia (VAP) is one of the most common hospital-acquired infections, related with increased morbidity indicators. The implementation of care bundles can significantly reduce the incidence of VAP leading  to higher quality of care provided.

Aim: The investigation of the compliance rate of nursing staff with VAP prevention bundle.                                                                                                                                                                             

Methods: Search was performed on PubMed (April 06,2021) with the keywords: “nurse*”, “nursing staff”, “compliance”, “ventilator-associated pneumonia” and “VAP”, without time limit for the publication of scientific papers. Keywords were searched in the title and abstract of the studies. Studies were excluded if they were not published in English language, were conducted on animals and were case studies, editorials and letters to the editor.

Results: Of the scientific papers retrieved, 6 were included in the systematic review. In the majority of studies, the following care bundle for VAP prevention was implemented: 1) elevation of the head of the bed to 30°-45°, 2) performance of spontaneous breathing trials with sedatives turned off, 3) stress ulcer prophylaxis, 4) thromboembolism prophylaxis and 5) regular oral care with chlorhexidine. The compliance rate of nursing staff with VAP prevention bundle ranged from 5% to 87%.

Conclusions: There is a great variability in compliance rate of nursing staff with the VAP prevention bundle. Low compliance with VAP prevention bundles can lead to increased healthcare costs and low quality of healthcare.

Keywords: Nursing staff, prevention bundle, ventilator-associated pneumonia

The effect of music therapy, on stress reduction in patients with mechanical respiratory support | 434-445

Stella Demetriou , Antonia Kalogianni , Christina Marvaki , Ioannis Kalemikerakis


ABSTRACT Introduction: Mechanical ventilation often causes great discomfort and stress to patients. Feelings of shortness of breath, helplessness, uncertainty about the environment, suffering, isolation from others and fear contribute to high levels of stress. Aim: The purpose of this review was to investigate the effectiveness of music therapy in reducing stress in patients with mechanical respiratory support. Methods: The method used was to search the Greek and international literature in the PUPMED database. The selection criteria of the studies were a) randomized studies b) studies involving adult patients in mechanical ventilation c) intervention: any form of music therapy was applied d) comparison: with no use of music e) the main outcome of the studies was the assessment of stress (decrease or increase). Results: The total number of studies included in this review was five. In both of them, music therapy was effective in reducing stress. In the other two studies the results were contradictory while in one study music therapy was not effective in reducing stress. Conclusions: Although many studies present a positive picture of the use of music therapy in stress reduction there is no general acceptance of music therapy as a complementary therapy. Further research is therefore needed to assess whether or not music therapy is beneficial in reducing stress. Keywords: Music Therapy, Impact, Stress Mechanical Support.

Keywords: music therapy, impact, stress, Mechanical Support

Causes of heart infections: Infective endocarditis | 446-463

Anastasia Kampouri , Nikolaos Biagis , Maria Chounti , Dimitrios Papageorgiou



Background: Infective Endocarditis is a rare but life – threatening infection of the internal cardiac tunic. It is divided into endocarditis of natural valves, prosthetic valves or endocarditis of implanted cardiac devises. Fast diagnosis and therapeutic treatment are important factors on which prognosis depends. Finding the microbiological factor that causes IE along with the knowledge of its characteristics and the region that the pathogen is located are of great importance for the design of the therapeutic plan of care.

Aim: The aim of this study was the systematic review of research articles according to the microbial pathogens that cause infective endocarditis.

Method: The methodology of the study included the review of articles of the international scientific literature. Usage of international databases was taken place, such as PubMed, Google Scholar and the scientific journal of Elsevier. The search was conducted amongst articles that were published during the time period of 2016 – 2019 and were written in English.

Results: A systematic research of articles was performed and all studies that did not comply with the set criteria were rejected, 13 articles were found that they agreed with the criteria of the applied methodology. These articles were analyzed in a single topic group, one that deals with the microbial etiologies that create infective endocarditis. The results agreed with each other according to the most common pathogens, by showing that staphylococci, streptococci and enterococci were the most common pathogen microorganisms that cause infective endocarditis.

Conclusions: Infective endocarditis is a disease whose etiology lies on a variety of microbiological pathogens, where the patient characteristics, the characteristics of the microorganism and its type and the fast recognition of the pathogen are an important pillar of treatment of these patients. New technics are believed to improve to the greatest extent possible the recognition of microbial factors.

Keywords: Infective, endocarditis, etiology, causes

Efficacy of early tracheostomy in duration of respiratory support | 464-479

Evangelia Dimitrakaki , Ioannis Kalemikerakis , Dimitrios Papageorgiou



Introduction: Progress in treatment of critical ill has as a result more frequent use of prolonged mechanical ventilation. If intubation is predicted to be long-term, a tracheostomy is often recommended.

Aim: The aim of the review was to investigate the efficacy of early tracheostomy in mechanical ventilation duration, compared to late tracheostomy.

Material and Method: International bibliography at online bibliographic database Pubmed research was conducted in order to identify all randomized or not clinical trials. For the selection of articles, were used combined criteria of inclusion and exclusion and time limitation. The prerequisite criteria for the selection of studies were: the English language, publication date (2009-2019), population who underwent tracheostomy and tracheostomy timing in relevance with mechanical ventilation duration. Studies that were excluded were those of which: the title of the article was not relevant to the subject of the systematic review, the sample was not about human species or concerned premature infants, tracheostomy cases were performed at emergencies (inability of endotracheal intubation).

Results: In this review 14 clinical trials were included. In 11 studies was detected that early tracheostomy had a positive effect on mechanical ventilation duration, while in 3 studies no statistically significant relationship was found between early tracheostomy and mechanical ventilation duration.

Conclusions: In patients with a high risk of mortality and morbidity, the concept of an early tracheostomy has significant benefits. However, better prognostic indicators are needed to further identify patients who may benefit from early tracheostomy during respiratory support.


Keywords: Critically Ill, early tracheostomy, late tracheostomy, tracheostomy time, tracheostomy timing

Breastfeeding. Advantages – disadvantages and problems: A systematic review | 480-494

Photini Masoura , Elpiniki Biskanaki , Alexandra Skitsou , Georgia Pontiki , George Charalambous


Background: Today, questions arise about breastfeeding benefits, disadvantages, whether the woman's body will return to previous situation, whether the mental capacity of people is increased , whether women with health problems can breastfeed, financial advantages or disadvantages and guidance of new maternal health care providers . Aim: This is a systematic literature review that investigates the benefits of, risks of, and questions about breastfeeding. Methods: A literature search was performed in Pubmed for "breastfeeding", "benefits", "benefit" in April 2019. We found a total of 61 studies. A total of 13 studies met our criteria . It included studies in English, French and Greek. It was repeated in May 2020 . 14 new studies were found, 2 of which met our criteria and were included in the final review. Results: We found results: 1]- showed "a correlation of breastfeeding and benefit" 2]- showed "no correlation of breastfeeding with any benefit" and 3]- identified "studies that recommend interventions”. In the positive results we include, an increase in the verbal ability of men who were breastfed, the restoration of the body of breastfeeding women, the saving of health costs, studies that suggest interventions. Conclusions: Breastfeeding remains important. Positive results were found in the economic benefits, in the restraint of expenses, in the aging process of men, in the return of the figure of women. Negative concerns are related to the diagnostic function, that is not negatively associated with breastfeeding, but simply did not detect a positive outcome associated with all the ages groups.

Keywords: Breastfeeding, benefits, benefit

Quality of life of patients after coronary artery bypass graft | 495-514

Vasiliki Geka , Antonia Kalogianni , Niki Pavlatou , Theodore Kapadochos



Background: Cardiac surgery is a large part of the final treatment of patients with acute coronary syndromes. After surgery, it is especially important for patients to maintain a good quality of life.

Aim: The purpose of this systematic review was to study the postoperative short- and long-term quality of life of patients who have undergone coronary artery bypass graft (CABG), as well as the factors that affect it.

Method: The literature was reviewed in the international PubMed and Science Direct database with the terms: (quality of life OR health related quality of life) and (coronary artery bypass grafting OR CABG). The review included primary studies in English that were published from 1/1/2010 to 1/10/2020 and related to the postoperative evaluation of the quality of life of adult patients who had undergone CABG.

Results: The review included 22 studies. The majority of studies are prospective follow-up studies, conducted in European countries, using the Short Form as a quality assessment tool and assessing the postoperative quality of life up to 12 months after surgery. Overall, all studies evaluated quality of life up to 12 years after cardiac surgery and found that the postoperative quality of life was significantly higher than the preoperative, with the maximum improvement in quality of life being observed up to 5 years after surgery. Prognostic factors of postoperative quality of life were found to be the presence of comorbidities such as diabetes, COPD, peripheral vascular disease, stroke and kidney disease, depression, smoking, severity of angina, cognitive function (due to stroke or dementia) and obesity. Men also had a greater improvement in postoperative quality of life than women. The improvement in postoperative quality of life did not differ between those undergoing conventional CABG and off-pump CABG.

Conclusion: CABG seems to have a positive effect on patients' quality of life. However, more randomized clinical trials are needed to evaluate various potential prognostic factors for quality of life.

Keywords: Coronary artery bypass graft, quality of life, patient

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