Long-Term Outpatient Care and Rehospitalizations in Patients after Cardiac Electrotherapy Device Implantation.

Background and Objectives: Cardiovascular implantable electronic device (CIED) treatment is widely used in modern cardiology. Indications for this type of treatment are increasing. However, a significant proportion of CIED implantation patients require subsequent hospitalization for cardiovascular reasons. Older age and the associated complex clinical picture necessitate multidisciplinary outpatient specialist care for these patients. The aim of this study was to analyze the reasons for subsequent hospitalizations in the cardiology department and the impact of outpatient specialty care on these hospitalizations. To the best of our knowledge, there are no such studies in the available literature. Materials and Methods: This study was conducted on a population of patients treated with CIED. Reasons for subsequent hospitalizations were divided into clinically and statistically valid groups according to the main diagnosis. Using an electronic database, causes of hospitalization were determined based on this diagnosis. Using data on consultations at outpatient specialty clinics, a logistic regression model was created for the probability of subsequent hospitalization for cardiovascular causes according to the specialty of the clinic. Results: The 9-year follow-up included a population of 2071 patients treated with CIED. During the follow-up period, 508 patients (approximately 24.5%) required subsequent hospitalization for cardiovascular reasons. The most common leading causes were heart failure, atrial fibrillation, and coronary artery disease. The need for consultation at outpatient specialty clinics increased the likelihood of hospitalization. Moreover, the need to consult patients in nephrology outpatient, pulmonary disease outpatient, and orthopedic outpatient clinics was the most significant. Conclusions: The use of electronic implantable cardiovascular devices is a very important part of therapy in modern cardiology. The methods for their use are constantly being improved. However, they represent only one stage of cardiac treatment. After CIED procedures, patients require further care in both inpatient and outpatient specialty care settings. In this paper, we outline the reasons for subsequent hospitalizations and the importance of outpatient specialty care in this context. Effective organization of care after CIED procedures may be important in reducing the most expensive component of this care, that is, inpatient treatment.

Long-Term, Single-Centre Observation of Patients with Cardiac Implantable Electronic Devices.

Background and Objectives: Electrotherapy is a valuable treatment method for patients with heart rhythm disturbances. There are very few observations of long-term patients treated with these techniques. There is a particular lack of this type of study conducted in Eastern European countries. The aim of this single-centre analysis was to evaluate the long-term survival (from 2010 to 2018) of patients treated with electrotherapy devices, taking into account clinical factors facilitating the prognosis of these patients. Materials and Methods: The patients (N = 2071) subsequently included in the study were subjected to the implementation or replacement of cardiac pacemakers. The medical records of all the patients were analysed. Data concerning death, made available by the State Systems Department of the Ministry of Administration and Digitization, were used. Results: The patients with VVI pacemakers had the worst prognosis after the replacement of the devices. Male patients had a worse prognosis, regardless of the kind of device implanted. Advanced atrioventricular conduction disturbances, chronic kidney disease, and hypothyroidism with reduced left ventricular ejection fraction were among the most significant coexisting diseases. Conclusions: The long-term prognosis of patients under different forms of electrotherapy remains poor. Despite the more straightforward technique, a single-chamber device (VVI/AAI) or generator replacement leads to the worst prognosis. The complexity of the clinical picture that stems from coexisting diseases and advanced age is of the utmost importance.

Reporting adverse events: Greek doctor and nurse attitudes.

PURPOSE: The purpose of this paper is to elicit Greek doctors' and nurses' views about adverse event reporting. DESIGN/METHODOLOGY/APPROACH: This is an exploratory study using an adverse events questionnaire administered to 209 doctors and 214 nurses in 14 major Athens universities and tertiary hospitals. FINDINGS: The paper finds that Greek doctors and nurses prefer a strictly confidential or conditionally confidential reporting scheme. Most doctors favoured disclosing department identity, while a nursing majority argued that it should remain unknown. When asked about the person's professional affiliation that, under a confidential scheme, receives reports and gives feedback, most doctors and nurses preferred the receiver to belong to their profession. Most medical personnel preferred the mandatory model or the discretionary model with a set of guidelines exemplifying adverse event types, while a nurse majority preferred the discretionary with a set of guidelines exemplifying adverse events. PRACTICAL IMPLICATIONS: It is necessary to establish a strictly confidential, non-punitive reporting scheme that supports learning and knowledge and one that is separate from any disciplinary scheme. ORIGINALITY/VALUE: The study indicates that culture, legal and patient complaint systems do not affect healthcare professional notions with respect to reporting adverse events.

Factors impeding nurses from reporting adverse events.

AIM: To explore the reasons why Greek nurses are reluctant to report adverse events. BACKGROUND: This study provides an understanding of why nurses fail to report adverse events so that we can introduce systems and develop cultures, which make this easier. METHODS: An exploratory study using the Adverse Events Questionnaire, which was administered to 214 nurses in 14 major Athens hospitals, comprising university as well as tertiary hospitals. RESULTS: Five main reasons for not reporting were identified. They include the fear of the press, the licensing board, the difficulty in handling an adverse event, confidence about bringing up adverse events and the complaints by patients. Moreover, clustering variables into homogeneous sets, three latent variables were extracted. They include procedures, culture and dishonour, social control, workload and tradition. CONCLUSION: Nurses' impeding factors for bringing up adverse events may be projected not only by cultural aspects such as professional, national and organizational cultures but also by healthcare practice structural issues such as safety systems, rules and procedures, and relevant acts and regulations. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management should change management rules and establish systems so that nurses work in a blame-free culture, which examines system factors as causes of error rather than individuals.

The Greek Nurses' job satisfaction scale: development and psychometric assessment.

The growing literature relating to job satisfaction among nurses concludes that more research is required to understand the organizational, professional, and personal variables that improve nurse satisfaction and retention. This study developed and psychometrically tested a nurse satisfaction questionnaire, suitable for the nurses' working conditions in Greece. A cross-sectional survey, in Greek, was conducted in three public hospitals. Two-hundred and twenty-five Greek nurses evaluated the psychometric properties of the Greek Nurses' Job Satisfaction Scale (GNJSS). The 18-item questionnaire showed a high degree of internal consistency (Cronbach's alpha = 0.907) and revealed four factors that are consistent with the predetermined subscales and the conceptual base of the GNJSS. The factors, which explain 62.420% of variance, are associated with interaction and recognition, leadership style and organizational policies, self-growth and responsibility, and remuneration and work itself. Although it would be useful to carry out further analyses to assess time-based properties of reliability, the GNJSS questionnaire is a reliable and valid instrument to assess nurses' job satisfaction.

Factors that prevent physicians reporting adverse events.

PURPOSE: The purpose of this paper is to explore the reasons why Greek doctors are reluctant to report adverse events. DESIGN/METHODOLOGY/APPROACH: The paper is an exploratory study using the adverse events questionnaire, administered to 209 doctors in 14 major Athens hospitals, comprising university as well as tertiary. FINDINGS: The questionnaire showed a high degree of internal consistency (Cronbach's alpha 0.84), which revealed a four-factor solution, explaining 67.4 per cent of the variance. Three dominant reasons for not reporting, with which almost or more than 50 per cent of doctors strongly or slightly agreed, were identified as no tradition for bringing up adverse events and a belief that bringing up adverse events will not lead to any improvement and workload. RESEARCH LIMITATIONS/IMPLICATIONS: Factors that dissuade doctors from bringing up adverse events may be projected not only by cultural aspects such as professional, national and organisational cultures but also by healthcare structural issues such as safety systems, rules and procedures, and relevant acts and regulations. The study has several noteworthy limitations. First, doctors' response was poor, which might conceal sample bias problems. Second, the present study identified four factors but the fourth factor was not well defined. ORIGINALITY/VALUE: The study provides an understanding why physicians fail to report adverse events so that systems can be introduced and cultures developed, which make this easier.