Hospital Chronicles (E-Journal)
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Psychosocial Effects of Iron Chelation on Thalassemia Patients
Full text linkIntroduction: Hemodialysis is a serious consequence of transfusions in the treatment of b-thalassemia major. Iron deficiency burdens the psychology of patients and due to the complexity and long process can be abandoned as a treatment.
Aim: To study the perceptions and limitations experienced by patients undergoing iron deficiency, as well as the psychological effects.
Methodology: The study was conducted in the Mediterranean Anemia Unit of Evangelismos Hospital. The study included patients with b-Mediterranean anemia, who were informed about the purpose of the study and gave signed consent. The research is a qualitative study with semi-structured interviews.
Results: The analysis of 70 patient interviews (32 men - 38 women) showed that the majority of patients (54 participants) are regular in iron deficiency therapy, as they find that it improves survival expectancy. Six participants are not regular, as they feel that it limits them significantly, while the rest try to be regular, as they recognize its benefits. 41 participants have a positive attitude towards treatment, of which 13 state that treatment improves their quality of life, while the remaining 29 have a negative attitude towards treatment. Regarding the existence of a supportive environment, 47 participants state that they have a supportive family environment, while 11 participants state that they hide from the family environment and 12 participants have experienced or are still experiencing the stigma due to the disease.
Conclusions: It is important to facilitate patients with iron deficiency treatments, which do not limit their daily life. Also, the psychological support of patients with thalassemia is important, so that they overcome the obstacles of the disease and live a life with fewer obstacles
Late Diagnosis of Anencephaly During the Second Trimester of Pregnancy and Obstetric Outcome
Full text linkDiagnostic Value of Assessment Tools for Sciatica in Clinical Practice: A Systematic Review and Narrative Synthesis
Full text linkBACKGROUND: Sciatica is one of the most common reasons for seeking healthcare for musculoskeletal pain and can be a challenge to healthcare providers to diagnose and treat. In view of the variability of sciatica symptoms, a great range of patient reported outcome measures (PROMs) and performance-based measures (PBOs) have been developed for its assessment and management, with however, often poor or controversial results in their reliability and discriminative ability. Accurate diagnosis of sciatica is crucial to ensure appropriate intervention is given. However, to date there is no gold standard to diagnose sciatica. There has been no systematic review conducted to compare the diagnostic validity of assessment tools of sciatica.
OBJECTIVE: To evaluate the diagnostic value of tools (PROMs and PBOs) used to assess patients presenting with sciatica.
METHODS: This review informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Protocols. PubMed, Science Direct, Cochrane Library, CINAHL, MEDLINE, EMBASE, key journals and grey literature searched rigorously to find diagnostic accuracy studies investigating patient with sciatica. Two independent reviewers conducted the search, extracted the data and assessed risk of bias for included studies using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. The overall quality of included studies evaluated using Grading of Recommendations, Assessment, Development and Evaluation guidelines.
RESULTS: From 8347 studies, 11 studies were included. Nine studies out of the 11 were at risk of bias. Very low level evidence supports the use of dermatomal patterns and low level evidence supports the use of 7 tools (neurological examination, Βragard test, S-LANSS, ID Pain, PDQ, S-DN4, SQST) for diagnosing sciatica. Moderate level evidence supports a cluster of eight signs (age, duration of disease, paroxysmal pain, pain worse in leg than back, typical dermatomal distribution, worse on coughing/sneezing/straining, finger to floor distance and paresis), twenty items of patient history, self-reported items (pain below knee, which pain worst, numbness pins and needles), question «worsening of pain during sneezing coughing and straining» and Slump test for diagnosing sciatica. Also, moderate level evidence supports the use of the StEP tool for diagnosing lumbar radicular pain, demonstrating high sensitivity (92%) and specificity (97%) values. SLR showed moderate level evidence in one study and high level evidence in another study in diagnosing sciatica with sensitivity 63.46% and specificity 45.88%.
CONCLUSIONS: Overall low-moderate level evidence supports the diagnostic utility of the tools examined in this review in diagnosing sciatica. The weak evidence base is largely due to methodological flaws and indirectness regarding applicability of the included studies. The most promising diagnostic tools include a cluster of 8 patient history/clinical examination signs, the StEP tool and the SLR test. From these results it is easily understood that history taking has a major role as assessment tool of sciatica in clinical practice. Low risk of bias and high level of evidence diagnostic utility studies are needed, in order for stronger recommendations to be mad
Acute Postoperative Changes in Body Composition and Muscle Function Among Patients with Pancreatic Cancer Undergoing Pancreaticoduodenectomy
Full text linkAim: To observe changes in the nutritional status of patients during the acute postoperativedays following pancreaticoduodenectomy and to evaluate their influence onpostoperative complications.Methods: Nutritional status was assessed in 72 patients on the preoperative day beforesurgery and postoperative days (PD) 3 and 8, included measurements of bodycomposition by bioimpedance impedance analysis, biochemical values and musclefunction by maximum handgrip strength (HGS). The presence of postoperative complicationswas collected over 30 post operative days. Changes at PD were calculatedfor all variables. Non-parametric statistics were used and results are given as median(25th–75th quartiles).Results : Significant changes occurred on PD 3 in body weight +2.3 (0.8–3.6) kg, totalbody water +2.8 (1.1–5.9) l, extracellular water +2.5 (1.2–3.7) l, intracellular water+1.1 (-0.4–1.9) l, phase angle -1.0 (-1.2 to -0.7)°, C-reactive protein +58.0 (36.0–100.8)mg/l, serum albumin -12 (-16.5 to -10.0) g/l, and HGS -4.8 (-7.3 to -3.0) kg. Higher butno significant changes were observed at PD 3 in patients with postoperative complications(n=28) compared to those without (n=44). The hospital stay was longer inpatients with complications (12.5 days, p=0.005).Conclusion: Changes in body composition, biochemical values and muscle functionwere observed during the first 8 PDs. Changes at PD 3 did not influence significantlythe outcomes, but trends in body fluids and phase angle were found among patientswith postoperative complications
Best Practices for Radiographers During the COVID-19 Pandemic
Full text linkRadiographers or Radiological Technologists (RTs) as health professionals are calledupon to stand up to the circumstances and to modify practical applications to dealwith suspected and confirmed cases of Corona Virus Disease 19 (COVID-19). Theyperform chest X-ray examinations and Computed Tomography scans, which are keytools for diagnosing and monitoring patients with Severe Acute Respiratory SyndromeCoronavirus 2 (SARS-CoV-2). They are also an integral part of the departments ofMagnetic Resonance Imaging, Nuclear Medicine, Radiotherapy, Mammography, Orthopantomography- Cephalometric, Bone Density Measurement, and InterventionalRadiology – Hemodynamic. The purpose of this article is to provide RTs guidancethroughout the scope of their work and to keep the Hospital community informed.They are required to fully adhere to personal protective equipment (PPE) practices,such as the use of gloves, high-protection mask, special clothing, eye and feet protection.They should maintain safety distance and come into as little contact as possiblewith the patients. It is necessary to thoroughly disinfect and use protection for all theirwork components, stable or not. There should be separated spaces, in the presencesuspicious and confirmed cases, as well as the rational distribution of staff in theirworkstations and their continuous training and briefing. RTs are present in mediumand high-risk zones. As they are potential virus carriers in hospital units, PPE mustbe applied and strictly monitored. Moreover, workplaces should adapt to the currentprecautionary measures to ensure personal and occupational safety
Acute Kidney Injury in Patients with COVID – 19 Infection: Α Tertiary Referral Hospital Experience
Full text linkThe emersion of the new coronavirus SARS COV 2 (Severe Acute Respiratory SyndromeCoronavirus 2) was rapidly characterized as a pandemic by WHO. The majormanifestation of the virus is respiratory distress; however, the involvement of other organsshould not be overlooked. The kidney is one of the most important target organsof the specific virus with acute kidney injury (AKI) described in 5-36% of COVIDpositive patients and an average 25% within the severely ill.Purp ose: The purpose of this study was to consider the incidence of AKI in patientswith COVID 19 in our cohort and to better understand risk factors associated withAKI. Further, we wanted to investigate the impact of AKI on survival and in hospitalmortality.Methods: Patients admitted to Evagelismos General Hospital with confirmed COVID-19 infection from 11th March until 22th May were investigated. Patients 18 yearsold as well as transplanted patients were excluded from this study. AKI was definedaccording to the AKI criteria.Results : From 99 patients with COVID-19 infection, AKI occurred in 41 (41.4%).A total of 44 patients (44.4%) were admitted to Intensive Care Unit (ICU) and 31 ofthem (70.5%) developed AKI. Of the 44 patients with AKI, 16 (39%) required renalreplacement therapy. Hospital mortality, in total, was 16.2% (37% among patientswith AKI versus 0.02% among those without AKI, p=0.000).Conclusion: AKI was common among patients hospitalized with COVID 19. AKIwas associated with older age, clinical severity and existing CKD
Mental Health and Healthcare Facilities: The Case of the Oral Maxillofacial Practice
Full text linkAIM: The aim of the study is to analyze and understand the deeper causes that leadindividuals suffering from mental illnesses to fear pain and especially pain causedduring the dental examination, repair or extraction of teeth.METHOD: A qualitative research was conducted with semi- structured interviews in«Evagelismos» Hospital in Athens, Greece. Participants were patients suffering frommental illness who had several problems with their mouth and teeth. 17 interviewswere conducted with participants who visited the hospital in order to visit the dentistand maxillofacial department. Interviews were analyzed by thematic analysis and themain topics were the Satisfaction of participants with hospital services, Doctor-patientcommunication, the trust in doctors, the Physical and oral hygiene of mentally ill patientsand the medication use.RESULTS: Participants were mostly satisfied with the healthcare services offered bythe physicians of the hospital and the equipment of the hospital. Almost all of theinterviewed participants reported trusting the physicians and followed their instructions.About 60% of the participants took care of their teeth daily. About 45% of theparticipants reported experiencing increasing stress levels during the dental examination.The analysis of the interviews revealed particularly useful information for understandingthe deeper causes, triggering difficult psychological conditions as well asanxiety in mentally ill individuals when faced with health problems and oral hygiene.CONCLUSION: The results showed that the majority of patients were satisfied by theservices they received. A further investigation is needed to record the factors that affectsignificantly in the upgrading of service quality
