Rostrum of Asclepius Vol 24, No. 4 (2025): October - December 2025

ABSTRACT

Background: Dysfunctional Breathing (DB) is a pathological entity which describes the deviations in the normal biomechanical patterns of breathing. It is recognized in both adults and children. The article focuses on children visiting the pediatric pulmonology clinic without a prior diagnosis. Diagnosis is based on medical history and psychometric tools, such as questionnaires. Spirometry and plethysmography aid in identifying dysfunctional breathing. These children often experience increased anxiety, affecting both their quality of life and that of their families.  

Aim: The present systematic review aimed to summarize the available scientific evidence in DB in children.

Methodology: The relevant literature was searched in the PubMed database. The internationally recognized PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used, with the following keywords: dysfunctional breathing, psychological stress in children, and dysfunctional breathing and stress in children. Only nine studies met the inclusion criteria and were included in this systematic review.

Results: A total of 1,016 articles were initially identified. Subsequently, 968 articles were excluded based on their titles. The remaining 48 were further evaluated. Of these, 39 were excluded after a careful review of their abstracts. Nine studies were included in the systematic review. According to the included articles, DB coexists with childhood asthma and often confuses the final diagnosis. All articles agree on the existence of different patterns in breathing which affects the psychological state of children in their daily routine. The important role of the correct history is also emphasized as well as the importance of additional auxiliary diagnostic tools in the final diagnosis. Regarding the therapeutic approach, all studies recommend the participation of children in physiotherapy programs by specialists, which train breathing patterns and improve them. In addition, support from psychologists is needed.

Conclusions: It is a fact that DB concerns the pediatric medical community and a significant effort has been made to codify it, both diagnostically and therapeutically. Also, while it is mentioned that many times it can hide a pathological background in children and that it affects their psyche by adding more stress, there is not a significant amount of research that focuses only on the stress caused by dysfunctional breathing in children. Further well-designed worldwide studies are necessary to clarify this complex issue.

Keywords: Psychological stress, Dysfuntional Breathing, Dysfunctional Breathing in children

ABSTRACT

Career changes among nurses are a common phenomenon, as factors such as psychological pressure, professional burnout, and lack of job satisfaction drive many to leave the hospital sector for the field of education. The nature of the work and the demands placed on school nurses differ significantly from those in hospitals. Often, this transition may not always be smooth. Their primary responsibilities include the prevention and promotion of health within the school community. More specifically, they identify health issues, educate the school population by implementing health education programs, provide a sense of security and reassurance, help reduce student absences, and facilitate their integration into the school environment. School nurses' job satisfaction is enhanced by factors such as autonomy in decision-making, recognition of their role, appreciation and respect from colleagues, and opportunities for professional development. On the other hand, negative factors include a lack of resources (e.g., shortages in the school’s medical supplies) and infrastructure, a high student-to-nurse ratio, and the multiple roles they are required to fulfill. During the COVID-19 pandemic, they were burdened with challenging responsibilities and often faced negative reactions. Despite these challenges, the presence of school nurses contributes to improving students’ health, reducing barriers to the learning process, and supporting their academic progress.

Keywords: school nurse, job satisfaction, student health

ABSTRACT

The application of digital health and telemedicine aims to combat inequalities by providing more accessible and cost-effective healthcare. A central pillar is artificial intelligence, which enhances prevention and diagnosis, ensuring compliance with ethical principles. Key to the effectiveness of its implementation is the protection of personal data and the training of nurses.

Telenursing emerges as a key component in enhancing remote healthcare delivery, contributing to cost reduction, improved access, and better clinical outcomes. Nurses play a pivotal role in the integration of digital health technologies; however, the effectiveness of such interventions largely depends on appropriate training and the mitigation of the digital divide. Additionally, further research is required to ensure the safe and ethical management of health data within digital systems.

Digital health and telemedicine, supported by artificial intelligence, offer new opportunities for improving home-based healthcare while ensuring patient safety. Furthermore, the evolving roles of nurses require ongoing education and appropriate resources to promote equity and enhance the quality of healthcare services.

Keywords: Digital health, nursing remote care, telemedicine, telehealth, new role of nurse

ABSTRACT

Introduction: Patients with COVID-19 experience a higher burden during the weaning process, with lower rates of successful extubation compared to non-COVID-19 patients. Additionally, there is an increased need for prolonged respiratory support and longer stays in the Intensive Care Unit (ICU).

Aim: This systematic review aims to investigate and identify the main factors contributing to unsuccessful weaning from mechanical ventilation in patients with COVID-19, in order to support clinical decision-making and improve patient prognosis.

Methodology: A systematic search of the international literature was conducted using the electronic scientific databases PubMed and Scopus. The search was carried out in English, and primary studies published between 2020 and 2025 were included.

Results: Through the search strategy, a total of 1,523 articles were retrieved, of which 9 primary studies were included and evaluated in the present systematic review. All included studies explore and address the presence of factors contributing to unsuccessful weaning from mechanical ventilation in COVID-19 patients, in comparison with the respective control groups.

Conclusions: Unsuccessful weaning from invasive mechanical ventilation in patients with COVID-19 reflects a set of interacting factors related both to patient-specific characteristics and to parameters concerning the disease itself, mechanical ventilation, and the required clinical interventions.

Keywords: extubation failure, COVID ICU, COVID patients, weaning failure from mechanical ventilation

ABSTRACT

Background: Primary care in maxillofacial surgery concerns maxillofacial trauma and some dental conditions treated in Primary Health Care (PHC) settings. Barriers to access to maxillofacial surgery include financial constraints, lack of insurance coverage, difficulty in travel, lack of subsidized programs, dissatisfaction with the quality of services and organizational issues, and were found to be related to gender and educational level.

Aim: The aim of this systematic review was to highlight the care and management of maxillofacial surgical problems in PHC.

Methodology: This systematic review was conducted in accordance with the PRISMA guidelines. For the needs of the study, a search was carried out in the Medline/PubMed, Scopus and Google Scholar databases to find articles published from 2015 to 2024, with search terms primary health care AND (teeth OR orthognathic) AND (surgery OR primary surgery care OR day care surgery OR ambulatory surgery). Inclusion criteria were studies directly related to the topic, in English, published in journals with a peer-reviewed evaluation system. During the initial search, 78 articles were found, of which 12 were included in the study.

Results: In relation to the factors that prevent attendance at primary health care for maxillofacial surgery problems, it was observed that citizens were unaware of the type of dental services provided to them in these structures, even in countries where primary health care was very developed. Reorganizing primary care around the care of the individual involves moving many surgical procedures, including selected orthodontic procedures, from hospital care to primary care and this should be a major concern for most governments.

Conclusions: The results of this review showed the increasing demand for maxillofacial surgeries while it was revealed that the ignorance of citizens about the benefits of primary health care was the main factor in non-attendance at the General Hospitals for maxillofacial surgeries, together with the low socioeconomic status of citizens. At the same time, the geographical area of residence and the distance from the General Hospitals affected the attendance at them.

Keywords: Primary Health Care (PHC), maxillofacial surgical problems, socio-demographic characteristics

ABSTRACT

Background: Malignant melanoma is the most fatal form of skin cancer, with its incidence rates increasing worldwide. Prevention strategies are crucial and have tremendous potential to reduce both the incidence and mortality associated with the disease.

Aim: The aim of this systematic review was to investigate the knowledge, attitudes, behaviors and perceptions of the population from different countries regarding malignant melanoma and prevention.

Methodology: A systematic literature review was conducted using the electronic database "PUBMED." The keywords used were "melanoma," "skin cancer," "prevention," "knowledge," "attitudes," and "behaviors." In this study were included articles in the English language published in the last five years (2018-2022). Out of the initially identified 186 articles, a total of 12 were ultimately used.

Results: The results showed that the level of knowledge regarding melanoma and risk factors is limited. Additionally, the preventive measures and self-protection practices implemented internationally are insufficient, as the majority of the studied articles indicated improper and inadequate use and implementation of the recommended protective measures. A significant correlation was found between low educational level and low knowledge about the disease. Furthermore, a correlation was identified between younger individuals and inadequate preventive measures and self-protection practices.

Conclusions: Based on the studied articles, direct and combined interventions with information and implementation of educational programs are crucial to bring about immediate changes in attitudes and behaviors. The ultimate goal of these interventions should be the reduction of malignant melanoma incidence rate, mortality from the disease, and healthcare.

Keywords: Melanoma, Skin cancer, Prevention, Knowledge, Attitudes

ABSTRACT

Burns are a major public health problem and can lead to high morbidity and mortality. They are considered one of the most devastating injuries worldwide and the fourth most common after road traffic accidents, falls and interpersonal violence.

Burn injuries can affect human life, physical and mental health, functional skills and performance. Particularly severe burns are accompanied by strong immune and inflammatory responses, as well as metabolic changes and shock, which can lead to multi-organ failure and death.

The management and classification of burns has changed significantly in recent decades. Advances in medical and nursing science, in the fields of treatment and care respectively, have brought about innovative changes regarding the management of burns with the aim of providing the right nursing care with satisfactory long-term outcomes. Nurses, who are involved in the care of these patients, are faced with a wealth of information for their more effective management. From acute care in the intensive care unit to rehabilitation and long-term care with the aim of reintegration into the community. The role of the nurse is important. He must have critical thinking, knowledge, clinical experience and interpersonal communication skills both with the rest of the work team and with the patient himself. Nurses are the front line in the healthcare delivery system.

Keywords: Brn, conservative treatment, prevention/management of complications