Quarterly scientific journal

Rostrum of Asclepius Vol 23, No. 3 (2024): July - September 2024

Vima AsklipiouRostrum of Asclepius Vol 23, No. 3 (2024): July - September 2024


From patient-centred care to person-centred care | 259-260

Christos Triantafyllou

Special Article

Commotio cordis: sudden death due to chest wall impact | 261-267

Eirini Nannou



Commotio Cordis is the sudden onset of ventricular fibrillation caused by blunt trauma to the heart. Although rare, it is an important cause of sudden death in young athletes.

This article focuses on the investigation of factors associated with an increased risk of Commotio Cordis following anterior chest wall impact. The recording of the triggering factors of this fatal arrhythmia could help in the creation of prevention protocols.

Inclusion criteria in this article were the studies that had been published in the English language. The following terms “Commotio Cordis pathophysiology”, “Commotio Cordis epidemiology”, “chest impact”, and “ventricular fibrillation” were searched individually and in combinations. Exclusion criteria were language other than English and type of article (letter to the editor, editorial).

Extrinsic risk factors are the point of impact on the chest, the time of the heart cycle at the time of impact as well as the size of the object. Biological characteristics such as gender, chest wall flexibility, and genetic susceptibility also play a role in Commotio cordis.

The Commotio Cordis phenomenon concerns the scientific community worldwide. Increased efforts are needed to prevent early recognition and treatment of blunt chest trauma during sports to reduce life-threatening arrhythmias associated with high mortality.

Keywords: Commotio cordis, ventricular fibrillation, sudden cardiac death, chest wall impact

Ethical issues and dilemmas of assisted reproduction-Women's age limit and third party genetic material | 268-278

Evanthia Boutzeti , Ioannis Apostolakis , Pavlos Sarafis



Introduction: Infertility is one of the main sources of concern for global health and although the evolving medical technology with the method of in vitro fertilization and the use of third party genetic material can be effective, there are ethical concerns about its use.

Purpose: This article analyzes the ethical concerns generally surrounding the use of new technology methods for medically assisted reproduction. In addition, it refers to ethical dilemmas regarding the use of third-party genetic material, such as gametes or fertilized eggs, and the legal establishment of the prospective donor regarding whether or not to disclose his identity in case of selection of his genetic material for procreation, issues that need thorough analysis.

Material and Method: An English language literature review was done on Scopus, Pubmed and Google Scholar international databases became by using the below keywords.

Results: Ethical concerns about medically assisted reproduction, the possibility of extending the age limit for women to have children and the use of third-party genetic material, should on the one hand be adequately examined in all their dimensions and on the other hand be systematically revised due to continuous scientific and technological developments.

Conclusions: Legislative changes, for fertilization with assisted reproduction or the transfer of third-party genetic material, are necessary at the global level and the moral dilemmas are manifold.

Keywords: infertility, medically assisted reproduction, moral dilemmas and concerns, women solar restrictions, others genetic material

The consequences of the Burnout Syndrome in the workers of the health services and the interventions to address it. | 279-288

Kyriakos Pailas



The impact of the Burnout Syndrome in the workers of the health services and specifically in the medical and nursing workforce is multidimensional. The consequences have direct connection with the health level of the workforce of health services, the quality of the given services to the patients as well as the effectiveness of the health system of a country. In the present study will be analyzed both the forementioned consequences that arise and the interventions of prevention of the Burnout Syndrome in individual and operational-organizational level. The preventive measures have objective on the one hand to improve the health of the workforce in the health units and on the other hand to optimize the efficiency and the effectiveness of all the grades of healthcare and generally the satisfaction of the patients from the health system. The Burnout Syndrome of the health professionals is a chronic problem and this specific disharmony, on which their mental and physical supplies come to imbalance with the increased working demands, don’t revealed instantly. On the contrary it is caused from components which gradually affect negatively their work welfare. These factors, such as the lack of personnel, the ambiguity of working roles, the absence of support from the head of the departments and the managers in the place of health and the deficiency of the administration in the discovery of alternative ways of the Burnout Syndrome confrontation, don’t create added value in the prevention and the treatment of the phenomenon.

Keywords: Burnout syndrome, quality of health services, workforce health level, effectiveness of health system

The importance of nutrition in the prevention and treatment of idiopathic inflammatory bowel diseases | 289-301

Dimitrios Papageorgiou , Anastasia-Maria Sgouraki , Alexandros-Pantelis Tsigkas


Inflammatory bowel disease is a general term used to describe diseases that involve a chronic inflammation of the digestive tract. The idiopathic inflammatory bowel diseases (IBD) are: Ulcerative colitis, which refers to the long-term inflammation of the lining of the large intestine (colitis as inflammation of the "colon") and Crohn's disease, which refers to the possible inflammation of the entire digestive tract. , which can often spread deeper than the affected mucous membrane. Diet is one of the environmental factors that regulate the intestinal microbiota, perhaps, it could play a role in the prevention and management of IBD. Consuming a Western diet has been associated with an increased likelihood of gut inflammation. It is important to evaluate the effect of nutrients and foods on the risk of IBD, as well as the effect of dietary patterns and interventions in their management. The intake of fruits, vegetables, probiotics, polyphenols and omega-3 fatty acids may have a protective role in the occurrence of IBD, while the consumption of a high amount of total lipids, omega-6 fatty acids as well as animal proteins increase the risk. According to the literature, a number of different diets have been studied such as exclusive enteral, low fermentable oligo-, di- and monosaccharides and polyols (FODMAP) diet, special carbohydrate diet, anti-inflammatory, Mediterranean, semi-vegetarian and Paleolithic diets and may address symptoms and possibly reduce inflammation. These diets are not suitable for all patients with IBD and the type of the prescribed diet should be depended on age, disease activity, and relevant surgeries.

Keywords: Diet, nutrition, prevention, treatment, inflammatory bowel disease, Crohn s disease, ulcerative colitis

Original Paper

Nursing Staff in Emergency Departments, Intensive Care Units, and Cardiology Units: Demographic Profile and Knowledge in Advanced Life Support Before and After the COVID-19 Pandemic | 302-323

George Kipourgos , Grigorios Kourtis , Konstantina Karanikola , Eleni Albani , Anastasios Tzenalis



Introduction: The COVID-19 pandemic has changed the daily practice in the assessment and management of patients with cardiopulmonary arrest and as a consequence emergency guidelines have been issued by the European Resuscitation Council. ED and ICU, due to their statistically frequent involvement with such incidents, must be aware of the change in protocols and able to balance the risk and the possible benefit for the patient.

Purpose: To investigate the possible correlation of the demographic profile of the nursing staff, working in EDs, ICUs and CCUs, regarding the cognitive background of advanced life support, both in the directives that were in force before, and in those issued as an emergency during the pandemic.

Material and Method: The present research study is a cross-sectional descriptive correlation study, which was conducted online exclusively among the nursing staff of the National Health System of Greece, during the months of January-March 2022.

Results: Adequate knowledge background was shown to have only 13.7% of the participants regarding the guidelines before the pandemic and 12.7% during the pandemic. A statistically significant positive correlation emerged between master's and doctoral studies, work department, attendance of an educational program and the incidence of cardiopulmonary arrest, as it pertained to the protocol that was in force before the pandemic. Accordingly, regarding the emergency guidelines related to the pandemic, the factors that demonstrated a strong statistical relationship with a high level of knowledge were older age, permanent employment, long-term professional experience, as well as attending an educational program and the frequency of dealing with interruption incidents .

Conclusions:  The nursing staff of EDs and Intensive Care Units are very often involved in situations of advanced life support and resuscitation, so by definition they must have a sufficient level of knowledge and be up-to-date with the current guidelines. The search for their demographics and the possible correlation of some factors with the cognitive background will help in future improvement.

Keywords: nurse AND in-hospital arrest, in-hospital arrest, Advanced Life Support, Covid-19

Effect of ARDS on cardiac function and frequency of cardiac arrhythmias | 324-343

Maria Vachla , Olga Kadda , Spyridon Dritsas , Konstantinos Papamihail , Georgios Triantis , Christina Marvaki



Introduction: Acute Respiratory Distress Syndrome (ARDS), is a syndrome of inflammatory lung damage, where, according to the Berlin definition, diagnostic criteria are its onset within one week, worsening severe hypoxemia, imaging findings and the defined origin of edema. ARDS is a high morbidity and mortality syndrome. Mortality ranges from 46% to 60%.

Aim: The aim of this study was to investigate the effect of ARDS on the occurrence of cardiac arrhythmias in patient’s treatment in Intensive Care Unit.

Material -Method: This was a retrospective research study, the sample of which was 50 patients   with ARDS on mechanical respiratory support, who were hospitalized in ICU covid-19 of a large provincial Hospital, during the period August 2021 to January 2022. The sample was collected based on the rules of random sampling. The data collection sheet included the following parameters: patient demographics, marital status, duration of hospitalization, personal history and comorbidities, mechanical ventilation conditions, blood gases, medication, episodes and type of arrhythmias. Statistical analysis was performed at a significance level of p=0.05.

Results: Fifty patients with ARDS participated in the study. Twenty-two patients (44%) were male and 28 (56%) were female. The mean age of the patients was 66.6 (13.92) years, with a mean ICU stay of 14.38 (10.48) days. The correlation study showed that 17.9% of patients with severe ARDS at ICU admission and 50% with moderate ARDS were associated with the presence of PVC arrhythmia (ρ=6.63, p=0.036), 50% of patients with severe ARDS during ICU stay and 9.1% with moderate ARDS was associated with having hypo-hyperthyroidism (ρ=11.19, p=0.004).

Conclusions: In conclusion, the results showed that the severity of ARDS was not affected by the different types throughout the patient's stay in the ICU. Factors such as age and gender did not appear to interact with the PO2/FiO2 ratio, in contrast this ratio appeared to be influenced by the days of the patient's hospitalization.

Keywords: COVID-19, ARDS, Arrhythmia

Systematic Review

Central venous line’s infections in children with cancer: Systematic Review | 342-358

Anna Marina Liapi , Christina Marvaki , Ioannis Koutelekos , Evangelos Dousis



Introduction: Central Line-associated Bloodstream Infections (CLABSI's) burden the health care of children with cancer.

Aim: The purpose of the study was to investigate CLABSI’s in children with cancer.

Material-Method: Systematic review of the literature carried out from 2012-2022, with a search for articles using keywords in international bibliographic databases (PubMed, Scopus). The study sample includes published research articles addressing the treatment, incidence, and risk factors for CVC infections. The inclusion criteria for the articles in the study were: 1. to be written in the English language, 2. to concern children (<18 years old) with cancer who carry central venous line (CVL), 3. to concern the CLABSI’s of these children. After searching the databases a total of 12 articles were retrieved.

Results: CLABSI’s in children with cancer concern 4.5-29% of those children with CVL’s. The most common organisms seen in CLABSI’s were coagulase-negative staphylococci and Klebsiella pneumoniae and fungi. The factors related to the occurrence of CLABSI’s in children with cancer mainly concern the degree of acute illness, the degree of neutropenia, the type of catheter, the intensive administration of chemotherapy, parenteral nutrition, the length of hospital stay, the place of admission of the catheter, antibiotic use, CVL insertion day and function, number of blood transfusions and number of blood tests. Compliance of health professionals with recommended measures for CVL care remains high while compliance of parents/families is low.

Conclusions: Healthcare professionals caring for children with cancer should systematically monitor for the occurrence of CLABSI’s, take measures to limit the factors that influence their occurrence, and inform/educate parents to comply with the guidelines for care of CVL’s.

Promoting quality of life through education in colon cancer patients with permanent stoma | 359-378

Athanasia Belba , Georgia Fasoi , Evridiki Kampa , Martha Kelesi-Stavropoulou



Introduction: Colorectal cancer has a high prevalence worldwide, being the third most commonly diagnosed cancer in men and the second most common in women. The placement of stoma in people with colon cancer is a frequent management of the condition, however it has been shown that while it greatly affects the quality of life of the people, the educational interventions that could help them have not been examined.

Aim: The investigation of the effects on the quality of life of people with permanent stoma and the importance of education in the management of possible difficulties.

Material - Method: A bibliographic search of the last decade was carried out, using keywords in the databases: Pubmed, Scopus, Google Scholar.

Results: The search yielded 9 studies that met the inclusion criteria. From the studies it appears that the patients who were trained either by the nursing staff or by educational programs and psychotherapeutic interventions (individual or group) before and after the ostomy surgery, presented fewer post-operative complications and returned to society and their daily activities more quickly from uneducated patients.

Conclusions: The importance of education for patients with permanent stoma after colon cancer surgery can improve their postoperative course, increase their self-care ability, reduce their negative emotions, enhancing their quality of life.

Keywords:  education, colorectal cancer, stoma, quality of life

Case Study

Exploring the Intention of Vulnerable Communities to Seek Primary Healthcare Support and the Role of Community Nurses | 379-393

Alexandra Chaitidou , Agathi Argyriadi , Stiliani Kotrotsiou , Alexandros Argyriadis


Introduction: Vulnerable communities often face barriers to accessing primary healthcare services, which can lead to disparities in health outcomes. Recent research also highlights the fact that many of them do not seek Primary Healthcare Support for several reasons. Community nurses play a vital role in bridging this gap by providing essential healthcare support and fostering trust within these communities. Aim: This research seeks to investigate the factors influencing the intention of vulnerable communities to seek primary healthcare support and to examine the role of community nurses in promoting healthcare access and utilization. Method: The case study method was employed to gather comprehensive insights into the experiences of vulnerable communities and the contributions of community nurses. The participant was a young man with mental health challenge, from Greece. Results: The results of this study showed that many people who are characterized by vulnerability, such as those with low income, mental illness, or chronic health conditions, hesitate to seek primary healthcare. The study found that these individuals often face barriers to accessing healthcare, such as lack of transportation, child care, or health insurance. They may also feel stigmatized or judged by healthcare providers. As a result, they may delay or avoid seeking care altogether, which can lead to their health problems worsening. Conclusions: The findings underscore the critical role of community nurses in addressing the intention of vulnerable communities to seek primary healthcare support. By addressing barriers and establishing trust, community nurses contribute to improved healthcare access and engagement. Enhanced collaboration between healthcare providers and community nurses can lead to more effective interventions that cater to the unique needs of vulnerable communities.

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