Quarterly scientific journal

Rostrum of Asclepius Vol 22, No. 3 (2023): July - September 2023

Vima AsklipiouRostrum of Asclepius Vol 22, No. 3 (2023): July - September 2023


The crucial role of nursing management in the Intensive Care Unit | 523-525

Anastasios Tzenalis


Bioethics and clinical trials on animals | 526-541

Photini Masoura , Ioannis Azelis , Alexandra Skitsou , Alexandra-Nektaria Laizinou , Elpida Mitsoula , George Charalambous


Introduction: The number of animals used in research has increased following the progress and development of medical technology. Every year, millions of animals are used around the world. The pain, distress and death experienced by animals during scientific experiments have been a matter of debate for many years. In addition to the strong ethical issue, there are further drawbacks of these experiments, such as the need for skilled human resources, time consuming protocols and high costs. Now, several alternatives to animal testing have been developed to overcome the disadvantages associated with them but also to avoid unethical procedures.

Aim: The aim of this review was to designate the specific field of tissue engineering that can be an essential tool in the future and lead to the reduction of animal use and the application of the 3RS.

Material - Methods: We used the online data base PUBMED to choose the studies that describe the products of tissue engineering that are being used instead of living animals in experiments. The research took place the months June- August 2018 and again in March of 2021.

Results: Five studies are analyzed: 3 refer to full thickness skins and experimentally demonstrate that it is possible to manufacture materials that can be used for in vitro investigations and the other 2 refer to rebuilt

human epidermis where experimentally using different chemicals controls their reaction to that’s all.

Conclusion:  The new technologies developed in the field of tissue engineering allow us to build functional tissues that can be used as models for risk assessment for humans that may conceal some chemical substances used in the production.

Keywords: tissue engineering, alternative solutions, experiments on animals, bioethics

The health belief model in patients with diabetic retinopathy: possibilities and limitations | 542-557

Anna Patsopoulou , Stergios Kravaritis , Stilianos Terzoudis


Introduction: Diabetic Retinopathy (DA) is the most important complication of Diabetes Mellitus (DM) worldwide. The most important theoretical tool for the study is considered to be the Belief Model for Health (HBM). 

Aim: The present study aimed to describe the HBM and its factors as a framework for studying diabetics for the prevention of DR  as well as the critical view of the model.

Material and method: The review of the Greek and international literature was based on the search through the electronic databases Medline OvidSP, PubMed publisher and Google Scholar with the following keywords: Health Belief Model, self-efficacy, behaviour.

Results: HBM is a useful tool for the implementation of prevention and health promotion programs, such as that of diabetic retinopathy for diabetic patients. The indicators of the expanded HBM (severity, vulnerability, existing obstacles, expected benefits, indications for action and self-efficacy) have a significant impact on the beliefs. Several studies have found the inability of the model to include behaviours that have to do with habit, environment, emotional motivation, demographic characteristics and socio-economic context.

Conclusions: HBM is perhaps the most useful tool in the effort to modify the preventive behaviour of diabetic patients towards DR. Interventions in the population of diabetic patients are considered necessary. The critical view of the model presents weaknesses and limitations that should be the driving force for further analysis and more complete application of the model.

Keywords: Health Belief Model, self-efficacy, behaviour

Therapeutic relationship between a nurse and a psychiatric patient at the public hospital | 558-571

Dimitra-Nikoletta Petrouli , Maria Kriki , Loukas Zilfidis , Fotini Athanasiadou


Introduction: The therapeutic relationship is a key factor in the nursing role and the key to achieving positive results especially for recipients of mental health services. That's why nurses need to find ways to promote it.

Aim: The aim of this study is to investigate the therapeutic relationship and new data in psychiatric patients in the public hospital.

Material - Methods: Articles from official databases of the last five years by Google Scholar and Pubmed were used. There are some articles that belong to the decade. The use of these articles has been limited by the number of articles in the last five years.

Results: Nurses' relationship with patients changes as a result of the experience. They acquire a more professional way of caring and develop defense mechanisms to deal with people and situations that used to upset them. Despite the pressure from the work environment, nurses feel able to develop satisfactory therapeutic relationships with patients. People who have developed the skills of self-knowledge and empathy calmly face the important events of work life, are usually calm, can reduce anxiety and control their impulses.

Conclusion: Psychiatric nurses are aware of the importance of a therapeutic relationship to people who have mental health problems in a hospital. Nevertheless, a review of the scientific evidence shows that theoretical knowledge alone is not sufficient to establish an adequate therapeutic relationship. Strategies for promoting change are therefore needed to enhance this relationship. The objectives of the studies are to create changes in the way nurses establish the therapeutic relationship in a public hospital, based on participatory action research and evaluation of the effectiveness of data application through this method.

Keywords: therapeutic relationship, nurse, psychiatric patient, public hospital

Special Article

The effect of the application of public relations in the employees’ efficiency in health services | 572-580

Kyriakos Pailas


The public relations as a main pillar of internal marketing of a providing health services organization, constitute an integral part of them. Their application is done in the internal clients, who are the medical, nursing, administrative and other personnel and the middle and senior management staff of the organization too. The role of the application of the public relations that take place in the structures of providing health services is major. Parameters as the gender, the age, the kind of occupation and the forms of job relations show the different components that have direct impact in the behavior and the attitude of the health professionals. The adoption of methods and tactics of public relations and the application of internal marketing in the health services considered indispensable for the accomplishment of positive balance in the mental and physical well-being of the health professionals and the increment of the population health level across the efficiency of the health system. The application of public relations in the units of providing health services concerns all the levels of care and the responsibility of their proper planning and implementation is domain of the leadership of the organization. The department of the public relations as well as the human resource management department either together or separately appear to fulfill the commitment of the leadership of the health unit to maximize the benefit of the individual and the collective improvement of the health professional.

Keywords: public relations, internal marketing, health services, health professionals

Pathogenesis and diagnostic approach of idiopathic inflammatory bowel diseases in childhood | 581-596

Georgios Katsaras , Petrina Samartzi


Idiopathic inflammatory bowel disease (IBD) is a group of disorders whose common feature is inflammation of the gastrointestinal tract, including Crohn's disease (CD) and ulcerative colitis (UC). The purpose of this article is to review the Saxon literature regarding the epidemiology, pathogenesis and diagnosis of IBD. In recent years, the incidence of CD seems to be increasing, while that of UC remains unchanged. The genetic predisposition, the external environment, the intestinal microbial flora and the immune responses are involved in the pathogenesis of IBD. Most of the clinical symptoms and signs of IBD are common in all categories. No laboratory test is pathognomonic for IBD, and faecal calprotectin is a more reliable biomarker regarding diagnosis than other inflammatory markers. There are many imaging modalities, with most recent the capsule endoscopy, each of which is superior to the other depending on the stage and manifestations of the disease. Lifestyle changes in recent decades have led to an increased incidence in IBD in childhood. Advances in biomedical technology have led to new methods, laboratory and imaging, resulting in a more reliable diagnostic approach.

Keywords: inflammatory bowel disease, Crohn disease, ulcerative colitis, childhood

Nurse managers and patient safety: development and implementation of a European training program | 597-607

Georgios Efstathiou , Theologia Tsitsi , Panayiota Andreou , Alvisa Palese , Jessica Longhini , Maria Schubert , Nicole Zigan , Susanne de Wolf-Linder , Renate Stemmer , Christina Strohm , Evridiki Papastavrou


Modern health care systems need dynamic leaders, empowered with current and evidenced based practices and knowledge. Nurse managers belong to the above leaders. Their role in ward management is crucial. For this reason, nurse managers need to be empowered in order to become acquainted with skills and knowledge that will facilitate them to play their managerial role in a satisfactory way. More specifically, the need to have skills on safe staffing, communication, conflict management and rationing of nursing care. The present article describes the process that was followed for the development of an online educational tool, for the empowerment of nurse managers. The development of the tool was part of the Erasmus+ project Nurse Managers For Safety. Four countries and five partners (Cyprus, Italy, Switzerland and Germany) formed the research consortium (four universities and a technology-expert partner). The four universities, through literature review and focus groups discussion, designed the content of the online tool (scripts, power point presentations, videos), in various languages with additions subtitles. The online tool includes a selection of topics and challenges which nurse managers come across with daily. The pilot implementation of the tool has indicated the importance of such projects and the complexity of the responsibilities nurse managers have.

Keywords: empowerment of knowledge, nurse managers, online tool, manager skills

Original Paper

Study of vitamin B12 in pregnancy | 608-619

Vasiliki Gougoutsi , Argyrios Tsades , Maria Tolia , Abraham Pouliakis , George Intas , Eudoxia Rapti , Styliani Kokori


Background: Vitamin B12 deficiency often occurs during pregnancy and has been associated with an increased risk of common pregnancy complications, including miscarriage, low birth weight, etc.

Aim: The aim of this study was to measure the levels of vitamin B12 in pregnant women during the three trimesters and their correlation with hematological factors.

Materials and Methods: The study involved 145 pregnant women aged 31.9 ± 5.5 years. Blood samples were collected from the C-Obstetrics and Gynecology Clinic of the General University Hospital «Attikon». Hematological factors analysis was performed on the same day of the collection on a Counter Sysmex XE-2100 (ROCHE) analyzer.

Results: Vitamin B12 levels decreased significantly during pregnancy. The percentage of pregnant women who developed vitamin B12 deficiency at the end of the third trimester almost doubled compared to the second trimester and approached 47.2%, i.e. almost half of the pregnant women in the study sample. Regarding the first and second trimesters of pregnancy, the incidence of vitamin B12 deficiency did not show any statistically significant or marginal correlation with clinical hematologic parameters, the presence of iron deficiency anemia and iron deficiency, the age, and the history of pregnant women. Finally, it was found that in all three trimesters vitamin B12 is not a statistically significant factor in the formation of Hgb.

Conclusions: The evaluation of the levels of vitamin B12 in the plasma of pregnant women during the third trimester of pregnancy showed that B12 levels decrease significantly during pregnancy. In addition, in the first and second trimesters of pregnancy, low levels of vitamin B12 did not show a statistically significant or marginal correlation with blood parameters. In conclusion, control of vitamin D levels should be performed at the beginning of pregnancy in order to receive appropriate treatment, especially in high-risk groups.

Keywords: Vitamin B12 deficiency, pregnancy, hematological factors

Systematic Review

Τhe impact of COVID-19 infection on incidence of surgical site infection: Α systematic review | 620-630

Christos Triantafyllou , Maria Gamvrouli


Introduction: The Coronavirus disease 2019 (COVID-19) placed unprecedented pressure on the healthcare system. COVID-19 is highly contagious, and the severity of cases varies. For this reason, extensive measures have been taken to prevent the spread of the infection in hospitals. According to the Centers for Disease Control and Prevention (CDC), COVID-19 has greatly affected the incidence of healthcare-associated infections, including surgical site infections (SSIs).

Aim: The investigation of the impact of COVID-19 on the incidence of SSI.

Methods: A systematic review of the literature was conducted in the international electronic database "PubMed" with the keywords: "COVID-19", "surgical site infection*", "SSI" and in the Greek electronic database “IATROTEK-online” with the keywords: "surgical site infections" and "COVID-19”, without time limit for the publication of scientific papers. On PubMed, the keywords were searched in the title and abstract of the studies. Studies were excluded if they were not published in English and Greek language, were conducted on animals, and were case studies, editorials, and letters to the editor.  

Results: Of the 32 scientific papers retrieved, seven were included in the systematic review. In 5 of the participating studies, the incidence of SSIs during the COVID-19 pandemic period was decreased by 30.7% to 100% compared with the period before the pandemic due to the increased use of personal protective equipment and the implementation of site-specific protocols concerning the management of patients preoperatively, intraoperatively and postoperatively. In one of the remaining studies, the incidence of SSIs did not change during the COVID-19 pandemic period, while in the other, the incidence increased.

Conclusions: The increased use of personal protective equipment and the implementation of site-specific protocols concerning the management of patients preoperatively, intraoperatively, and postoperatively, due to the COVID-19 pandemic, has led to a reduction in incidence of SSIs.

Keywords: COVID-19, surgical site infection, personal protective equipment, incidence

Research Protocol

Health related behavior change program of diabetic patients with the use of transtheoritical – stages of change model and motivational interviewing | 631-646

Georgia Thanasa , Irini Giagourta , Labrini Papanastasiou , Eugenia Vlachou , Evridiki Kampa , Martha Kelesi-Stavropoulou


Introduction: Effective support of diabetic patients is a standing challenge for health systems worldwide. WHO anticipates that Diabetes is a chronic disease that can be managed with the implementation of interventions aiming in effective glycemic control, behavior modification, patient adherence on prevention of diabetes complications.

Within models and interventions that have been applied mostly for the support and modification of health related behavior of diabetic patients are the Transtheoritical Model of Di Clemente και Prochaska and the Motivational Interviewing of Rollnic and Miller.

Aim:  The aim of the study is the investigation of the modification of health related behavior of the study population concerning physical activity, diabetes management and adherence on diabetes prevention as well as the comparison of the effectiveness of a diabetic patient consulting with the application of the Transtheoritical Model and the Motivational interviewing with a short 10min consulting /informative session offered to the control population group.

Material and Method: Target population is diabetic patients that will form two groups (experimental and control). Present study is an applied summative mixed research (qualitative and quantitative). The conceptual framework of both the Trantheoritical – Stages of Change Model and Motivational Interviewing will be the method of choice to be applied and evaluated to the experimental population group. Intervention will consist of the form of MET (Motivational Enhancement Therapy) of four sessions with telephone sessions in between. Present study is expected to improve health related behavior of the experimental study population concerning the physical activity and adherence to disease prevention of implications and strongly support patient satisfaction, motivation and management of diabetes as to their choosing beneficial health related behaviors in comparison to the control study population and the traditional consultation of educational/informative style.

Conclusions: Up-to-date literature supports that systemic support behavior interventions that use targeted methodology seems to prevail over traditional diabetic patient support methods through boosting their motivation and promoting self empowerment. This study is expected to enhance existing knowledge of the diabetic patient management both in national and international level.

Keywords: diabetes management, health promotion, Health related behavior modification, Transtheoritical Model, Motivational Interviewing

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