Quarterly scientific journal

Rostrum of Asclepius Vol 22, Suppl. 1A (2023): January - March 2023

Vima AsklipiouRostrum of Asclepius Vol 22, Suppl. 1A (2023): January - March 2023


Post COVID – 19 syndrome | 144-153

Evridiki Kampa , Konstantinos Evgenikos , Nikolaos Biagis , Dimitrios Papageorgiou , Dimitrios Alefragkis



Introduction: The COVID-19 pandemic has infected many people locally, nationally and internationally by rapidly increasing morbidity and mortality rates, significantly disrupting globalization and adversely affecting the quality of life of the global population. Finally, there are reports of persistence of symptoms after recovery from the acute infection forming a new syndrome known as Long Covid.

Aim: The presentation of Long Covid syndrome as well as its characteristics that make it a new challenge for the health sector.

Materials and Methodology: A review of studies and reviews of articles published from 2019 to 2022 in English in the PubMed and Google Scholar databases with the following keywords: “Long Covid”, “Post-Acute COVID 19”, “ Acute COVID-19 ”, “Long term symptoms”.

Results: Long Covid syndrome includes symptoms as well as complications that may be long-term or late that persist or appear 4 weeks after SARS-COV-2 infection. Patients experience a number of symptoms, most notably fatigue, shortness of breath, cough, chest pain, palpitations, headache, weakness, and arthralgia and myalgia. It is considered timely to treat patients with all the strategies of the therapeutic quiver that is constantly evolving.

Conclusions: The burden on Long Covid that the health care map has to face worldwide is enormous because its effects are negative for both the patient and society. Further research into the spectrum called Long Covid is needed to find appropriate and correct coping strategies as this syndrome is expected to become a global public health priority. Finally, emphasis must be given to the rehabilitation of patients.

Keywords: Long Covid, Post-Acute COVID 19, Acute COVID-19, Long term symptoms

The psychological effects of the Sars-CoV-2 pandemic on the general population | 167-175

Dimitrios Papageorgiou , Stamatina Douki



Introduction: Infectious disease epidemics in recent years have had a significant impact on the general population of the various states, on their physical health, as well as on their mental well-being.

Aim: The aim of this study is to review and compose the existing international literature, which records the psychological effects of the Sars-cov-2 pandemic on the general population.

Methodology: A literature review of studies published in English language, from January 2020 to August 2021 in PubMed, Google Scholar and ResearchGate. Exclusion criteria were studies in a language other than English and type of article (letter to publisher, editorial article).

Results: The psychological effects of the Sars-CoV-2 pandemic on the general population observed to be: anxiety and fear for possible infection by the virus, sleep disorders, depressive symptoms, post-traumatic stress disorder (PTSD) and feelings of loneliness which were significantly associated with gender, age, income, employment status, marital status, exposure to social media for information about the virus, chronic organic and mental illness and abuse of alcohol.

Conclusions: A thorough review of the literature collected useful data that could contribute to design the strategies and public health interventions, the appropriate training of health professionals, the prevention and effective management of pandemic-like emergencies.

Keywords: Psychological effects, infectious disease, pandemic

Primary Care in Mental Health | 176-184

Georgia Toylia , Stamatina Douki



Introduction: Primary Health Care (PHC) is a key component, not only of countries’ health systems, but also of the general socio-economic structure, according to the Alma-Ata Declaration of 1978.

Aim: The aim of this study is the investigation of Primary Care in Mental Health in Greece.

Methodology: A review of studies and articles in the PubMed and Google Scholar databases was conducted as well as their synthesis. The exclusion criterion was the type of article (letter to the publisher and editorial article).

Results: Primary Care in Mental Health in Greece observed to be: lags behind the needs of the population, shortages of staff, mainly specialized mental health nurses or other professionals, a lack of infrastructure mainly in rural areas, underfunding, absence of an evaluation mechanism and ambiguity of the framework for cooperation between services.

Conclusions: It is clear the need for Primary Care in Mental Health in Greece, on the management of mental disorders, the detection of new and the holistic treatment of organic problems which needs further development with the promotion of appropriate programs.

Keywords: Primary health care, mental health, patients

The PICS (Post Intensive Care Syndrome) | 154-166

Martha Kelesi-Stavropoulou , Nikoletta Margari , Dimitris Moustakas , Nikolaos Biagis , Vagianni Solakidou , Aggeliki Christodoulou , Stamatina Douki , Dimitrios Papageorgiou



Introduction: Patients treated in intensive care units, they can show long term damage both physical and cognitive and psychiatric. The situation which can occur after entry of the patient into the ICU, but also to continue after his discharge and may include any physical, cognitive and/or psychological impairment defined as Post Intensive Care Syndrome (PICS).

Aim: The aim of the present bibliographic analysis was to investigate the theoretical and clinical aspects of the Post-ICU Syndrome (PICS) in modern literature.

Methodology: A study of contemporary literature was conducted, including articles and published research studies of the last two years (2020-2022) in the English language, on international scientific databases (PubMed, ScienceDirect, Medscape, WHO, NHS).

Results: The complications that can occur during the syndrome after the ICUs can be classified into physical, psychiatric/psychological and cognitive, while there can often be an overlap between them complications between these categories. Significant complication in its context PICS is the delirium that is observed in significant percentages of those hospitalized in the ICU. PICS beyond the patient itself affects and his close people, a situation called family – PICS (fPICS). THE The treatment of PICS is multifactorial and can be simplified with use of ABDCEF – bundle.

Conclusions: PICS is a clinical entity with importance in the quality of life and functionality of patients and their families. Once PICS is recognized, recovery, management and follow-up of the patient should be carried out by a specialist interdisciplinary team. Further studies are needed on the pathophysiological mechanisms, genetic factors and screening.

Keywords: PICS, FPICS, intensive care unit, delirium, follow-up

Special Article

Current challenges in Primary Health Care | 200-209

Nikolaos Patineas , EIRINI MAKRIDOU , Despoina Kosmidou



WHO has identified Primary Health Care (PHC) as a key priority for all its Member States. Safe and accessible PHC is an international policy objective. The 2018 Astana Declaration, following the Declaration of Alma Ata, to update the goals and reaffirm the need to support and invest in PHC to address modern health challenges. These challenges were the mapping of the Primary Health Care services provided in Greece, the response rate of Primary Health Care Units in addressing the increased needs that existed during the pandemic and all the weaknesses that were revealed during the COVID-19 health crisis. One of the most important challenges currently is to highlight the long-standing problems that stigmatize PHC in Greece, as well as the possible solutions and the prospects that exist for improving PHC.

The pandemic highlighted the long-standing inadequacies of the National Healthcare System and especially of the PHC, such as fragmented primary care and its subsequent underfunding. There are significant organizational gaps, understaffing of public hospitals and health care facilities and a limited number of staff employed in PHC compared to other European countries. In addition, lack of PHC units during the pandemic led to an outbreak of diseases and worsened health outcomes of people living with chronic conditions due to PHC staff mainly being working in the vaccination centres, thus leaving unattended all other PHC needs of the citizens. 

The need to strengthen PHC structures is paramount to address the current challenges. The development of an integrated PHC network and the development of more multidisciplinary teams of health care professionals to provide more efficient health services is an immediate priority and should be addressed accordingly by the state.

Keywords: Primary health care, challenges, health care services, national health system

Original Paper

The Ιinvestigation of mental health of healthcare staff during the coronavirus pandemic in a Greek hospital | 210-224

Eleni Foti



A big amount of studies has shown that the war with corona virus has burdened the mental health of an important number of the health personnel.

Aim: The present study aims at the investigation of anxiety and fear of to the the coronavirus in health personnel in a public hospital as well as to be considered if the anxiety and the fear of Covid-19 finally affect his mental health and well-being

Material and Method: The present study is a cross-sectional study where the quantitative methodology approach was adopted using appropriate weighted tools. It was conducted in the period October 8-17, 2021. In the present study the population-source is the total of the health personnel (medical, nursing, administrative) that works at General Hospital of Arta. For the selection of sample the method of layered sampling was used and 100 employees, who belong to medical, nursing and administrative service of the hospital where they were also the sample of the study, were used. A written questionnaire was used for data collection where the tools, coronavirus anxiety scale (CAS), obsession with COVID-19 scale (OCS) and coronavirus reassurance-seeking behaviors scale (CRBS), were used. The static analysis was performed using the Software SPSS v23.0

Results: 7% of the respondents experienced a corona virus-related dysfunctional anxiety, 11.11% of them experienced persistent and thinking and 9.47% developed activities for reassurance search. At the same time from the total of respondents, 16% had high levels in at least one of the three scales, while 2% had high levels at all the scales. Women and people who live with chronic patients have more anxiety for Covid-19. The correlation test Spearman showed an important positive correlation between all the psychological morbidities

Conclusions: The findings of the study prove low prevalence of mental health problems to the staff of Arta’s Hospital during the pandemic Covid-19, with positive correlation between them.


Enhanced Recovery after Surgery Protocol in Major Oncological Gynecological Surgery | 225-240

Maria Bourazani , Dimitrios Papatheodorou , Sofia Poulopoulou , Antonios Anagnostopoulos , Georgios Vasilopoulos , Georgia Fasoi , Martha Kelesi-Stavropoulou



Introduction: In recent decades, ERAS (Enhanced Recovery After Surgery) protocols have been developed and implemented, aiming at the safe and rapid recovery of women with gynecological cancer after a surgical procedure, as well as reducing the length of stay (LOS) at the hospital.

Aim: To compare the effectiveness of the ERAS protocol and the conventional recovery method, in the postoperative course of patients undergoing major oncological gynecological operations due to cancer of the internal genital organs.

Methods: This is a prospective randomized single-center study of 100 women with cancer of the internal genital organs undergoing a major gynecological oncological operation, at a tertiary Oncology center in Athens. Patients are randomized into two equal groups: A following the ERAS protocol and B following conventional postoperative care. Parameters to be compared include LOS in hospital, time to initiation of feeding and mobilization as well as assessment of postoperative pain as reported by patients on Numerical Pain Scales (NPS).

Results: According to the results of the pilot study where the sample consisted of 61 patients (35 in group A and 26 in group B) with a mean age of 52.9 years (SD=11.7) it appeared that the hospital stay was significantly longer in the group B compared to group A (5.1±2.4 days vs. 3.1±1.3 days, p=0.001). Pain levels according to NPS were higher in group B at all time points except baseline. There are studies that highlight the contribution of ERAS programs to the reduction of LOS, the effective management of post-op pain, as well as the rapid feeding and mobilization of patients undergoing major gynecological oncological operation.

Conclusion: ERAS protocols promote timely feeding and mobilization, offer more effective post-op analgesia, improve the experiential post-op experience of patients, therefore increase their satisfaction, reduce LOS and hospitalization costs. Future studies, well conducted, may increase the certainty of these findings.

Keywords: ERAS protocols, rapid postoperative recovery, hysterectomy, major gynecological surgeries

Systematic Review

ICU Follow – up Clinics: The European reality | 254-268

Marios Charalampopoulos , Panagiota Triantafyllaki , Martha Kelesi-Stavropoulou , Evridiki Kampa , Areti Stavropoulou , Stelios Parissopoulos , Dimitrios Papageorgiou



The ICU Follow up Clinics support and treat the adult patients at the community, in order to cover the needs that occurred after their discharge from the ICU at the hospital.

Aim: The aim of this systematic review was to study the effectiveness and the way of the operation management of the ICU Follow up Clinics at adult patients after their discharge from the hospital.

Methods: A search was performed at the Greek and international literature, as well at the online Databases Pubmed, Cochrane, Emdase, Google Scholar. Exclusion and integration criteria were set for the studies found and a flow chart was created for the studies included.

Results: Through the search, 30 articles were found matching the subject under study and after further evaluation, 7 articles were included. The majority of the articles highlight the importance of these services at the patients’ follow up after the discharge. More specifically, through these services the mortality rate, the risk of recurrence and the readmission risk are decreased as well as the patients’ mental health is improved.

Conclusions: The main aim of these Services is the follow up of the adult patients after discharge, the consultation and the apply of therapeutical protocols in order to face the primary pathological cause, as well as matters that occurred as a result of the hospitalization. At the same time, they can help to detect the needs of the patients occurred after the discharge so that finally, to improve the care given and the patients’ outcome.

Keywords: Critical ill patient, post ICU complications, ICU follow up services

Extracorporeal Membrane Oxygenation (ECMO): Inclusion criteria for patients with ARDS due to COVID 19 disease | 241-253

Panagiota Triantafyllaki , Theodore Kapadochos , Antonia Kalogianni , Georgia Toylia , Stelios Parissopoulos , Dimitrios Papageorgiou



Introduction: At the end of 2019 in the city of Yuhan, China, a virus of the family of coronaviruses first appeared, mainly affecting the respiratory system, which was called SARS-COV-2 and causes COVID-19. Although in most patients it occurs with mild symptomatology, however, a significant percentage (15-30%) will develop severe respiratory distress (ARDS) with increased chances of intubation and mechanical ventilation. In special cases of severe disease, where the oxygenation of the patient is not improved by the use of the ventilator, extracorporeal membrane oxygenation (ECMO)  can be applied a technique that has been used in previous pandemics that affected the respiratory system.

Aim: The aim of the study was to investigate the evidence of appliance of the ECMO, based on international literature, of the extracorporeal membrane oxygenator in patients with severe respiratory failure due to Covid-19 disease.

Methods: Articles were searched in the international bases of scientific studies such as PubMed, PubMed Central, Medline, Cochrane Library and Google Scholar. This review was carried out using, meta analysis and international guidelines.

Results: Six (6) articles were included where there was an agreement on the basic characteristics of patients, which can be considered as selection criteria. The primary criteria indicate the age, where the patient must be under 65 years old and the body mass index (BMI) that must be below 40. In addition, it is very important that there is no serious underlying pathology such as multi-organ failure syndrome. Also, the mechanical ventilation should not exceed seven (7) days until the placement of the ECMO, while all the other therapeutic methods such as the prone position, neuromuscular blockers and the appropriate positive end-expiratory pressure of the airways (Positive end-expiratory pressure - PEEP) should be already applied.

Conclusions: The application of ECMO is widely used as a treatment for patients with severe COVID 19 disease. However, in order to have the best therapeutic results while reducing hospitalization costs, it is necessary to follow the guidelines regarding the selection of patients who will benefit substantially.


Research Protocol

Application of the Transtheoretical Model as an intervention for the development of nurses' leadership behaviour | 269-283

Georgia Papantoniou , Martha Kelesi-Stavropoulou , Aspasia Goula , Georgia Thanasa , Evridiki Kampa



Introduction: The need for leadership development in health services has been recognized by the World Health Organization , supporting the need to strengthen leadership at all levels. The design and development of programs to enhance leadership characteristics and improve leadership behavior has been a global initiative that can create successful leaders across all health professionals.

Aim: The present study attempts to investigate the modification - development of nurses' leadership behavior by testing the application of the theory of the Transtheoretical Stages of Change Model to nurses.

Material and Method: This is a productive mixed (quantitative and qualitative) evolutionary research by testing the application of the theory of the Transtheoretical Model of Stages of Change  and the Motivational Interviewing in nurses who perform management tasks in public hospitals, using self-completed questionnaires and semi-structured interviews.

Expected outcomes: The expected outcomes focus on increasing the leadership characteristics of nurses working in the public hospital and performing administrative tasks and modifying their leadership behavior in their workplace by improving the treatment , management and implementation of the procedures existing and prescribed by the internal functioning of the organization.

Conclusions: The Transtheoretical Model (TTM) works as an intervention that explores the stages of behavior change in many situations and it is believed that it can be used to modify nurses leadership behavior.

Keywords: Leadership, nursing, Transtheoretical Model, leadership behavior

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