Impact of nurse-initiated education on HeartScore in patients with hypertension: a randomised trial.

BACKGROUND: People with hypertension experience significant damage to major organs due to insufficient management of cardiovascular risk factors. AIMS: To assess the impact of nurse-led educational interventions on the total cardiovascular risk among people with hypertension. METHOD: the study was an interventional randomised study. The sample (n=92) was randomly assigned to the either the control or intervention group. The HeartScore tool was used to assess patients' total cardiovascular risk between December 2017 and March 2018. FINDINGS: 56.6% of the control group and 55.4% of the intervention group were women, with a mean age of 64.4 years and 66.2 years respectively (P>0.05). Total cholesterol reduced in both groups; however, improvement was greater in the intervention group (P<0.05). Total cardiovascular risk fell in the intervention group from 4.75 to 4.33 (P>0.05), while the control group saw an increase in risk from 10.03 to 12.65 (P=0.035). CONCLUSION: Nurse-led educational interventions should be incorporated in the usual care of patients with hypertension, in order to achieve the best management of the condition.

Scales for assessing medication adherence in patients with hypertension.

BACKGROUND: the choice of the appropriate tool for assessing level of medication adherence is a significant barrier in scientific research. AIMS: to translate into Greek and test the reliability of the Hill-Bone and A-14 scales among patients with hypertension. Also, to compare patients' responses in the Hill-Bone scale, A-14 scale and Morisky Medication Adherence Scale (MMAS). METHODS: data collection occurred between February 2016 and March 2016 at a general hospital in Athens, Greece. The sample consisted of hypertensive patients (n=34) and non-hypertensive patients (n=34). FINDINGS: the coefficient alpha in hypertensive patients was 0.76 for Hill-Bone, 0.64 for MMAS and 0.91 for the A-14 scale. In non-hypertensive patients, the Cronbach's alpha for MMAS was 0.81 and 0.78 for A-14. A statistically significant difference was found among the mean scores of the scales, whereas strong correlation was found only between two pairs of questions with similar meaning. CONCLUSION: all tools are appropriate to assess the level of medication adherence in Greek hypertensive patients. However, careful translation of the scales is essential since items with the same meaning could be understudied in a different way.

Psychological Disorders and Quality of Life Among Patients With Chronic Viral Hepatitis: A Single-Center Cross-Sectional Study With Pair-Matched Healthy Controls.

Recent research evidence has shown that patients with chronic viral hepatitis develop symptoms of anxiety and/or depression, which has a strong impact on their health-related quality of life. This study aimed to assess the levels of anxiety, depression, and health-related quality of life among patients with chronic hepatitis B or C in Greece. It was a cross-sectional study among 111 patients with chronic viral hepatitis, evaluated at a tertiary General Hospital of Athens from March to September of 2014. Anxiety, depression, and health-related quality of life were assessed by the use of specially designed questionnaires. For the comparison between patients' population and general population, a pair-matched population of 111 healthy participants was recruited. Mean age of patients was 44.85 years (SD = 14.4). Fifty-nine patients were infected by hepatitis B virus and 52 by hepatitis C virus. Levels of anxiety and depression were higher among patients than among controls and the overall health-related quality of life was poorer (p < .001). Female gender and liver parenchyma damage were associated with higher levels of anxiety (p < .05). Certain demographic, socioeconomic, and clinical-serological factors were related with higher levels of depression. Poorer health-related quality of life was reported by patients with liver cirrhosis and alanine aminotransferase of 40 IU/L or more. Patients with chronic viral hepatitis demonstrate psychological and physical impairment, especially those with advance liver disease and/or active viral activity.

The level of anxiety, depression and quality of life among patients with heart failure in Greece.

PURPOSE: The assessment of the level of anxiety, depression and quality of life among patients with heart failure. METHODS: It was an observational study. The populations were 231 patients with heart failure who were hospitalized in cardiology departments of 2 general hospitals in Athens, from September 1, 2010 through January 31, 2012. We used the "Minnesota Living with Heart Failure Questionnaire - MLHFQ" to evaluate patients' quality of life and the " State-Trait Anxiety Inventory - STAI" and the "Maastricht Questionnaire - MQ" to evaluate the level of stress and depression, respectively. RESULTS: The mean age of patients was 66.1±10.1years. The quality of life was poor, since the average score in MLHFQ was 65.4±20.6. Also, patients revealed high levels of both trait and state anxiety (mean score in STAI was 54.5±9.4 and 52.8±8.5 respectively) and depression (mean score in MQ was 34.3±8.4). Factors associated with poor quality of life and high levels of anxiety and depression were older age, low level of education, unemployment, poor economic situation, multiple hospitalizations (> 4 times) and heart failure stages III and IV in NYHA (p<0.001 in all cases). CONCLUSION: Patients with heart failure present severe symptoms of anxiety and depression and poor quality of life. Assessing those patients for these symptoms and providing holistic health care by a multidisciplinary team, will lead to the prevention and early treatment not only of physical but also of the psychosocial manifestations of the disease.

Effects of work environment on patient and nurse outcomes.

BACKGROUND: Several parameters of the nurse's work environment lead to fewer patient complications and lower nurse burnout. The aim of this systematic review was the analysis of research data related to the effect of nurses' work environments on outcomes for both patients and nurses. METHODS: Medline was searched by using keywords: 'working conditions', 'work environment', 'nurses', 'nursing staff', 'patients', 'outcomes'. RESULTS: In total, 10 studies were included, of which 4 were cross-sectional and the remaining were descriptive correlational studies. Patients who were hospitalised in units with good work environments for the nurses were more satisfied with the nursing care than the patients in units with poor work environments. Nurses who perceived their work environment to be good experienced higher job satisfaction and lower rates of burnout syndrome. CONCLUSIONS: A good work environment constitutes a determinant factor for high care quality and, at the same time, relates to improved outcomes for the nurses.

Translation and validation of the Greek version of the hypertension knowledge-level scale.

AIMS AND OBJECTIVES: To translate and validate a Greek version of the Hypertension Knowledge-Level Scale. BACKGROUND: The major barrier in the management of hypertension is the lack of adherence to medications and lifestyle adjustments. Patients' knowledge of the nature of hypertension and cardiovascular risk factors is a significant factor affecting individuals' adherence. However, few instruments have been developed to assess patients' knowledge level and no one has been translated into Greek. DESIGN: This study used a case control study design. METHODS: Data collection for this research occurred between February 7, 2013 and March 10, 2013. The sample included both hypertensives and non-hypertensives. Participants simultaneously completed the version of the Hypertension Knowledge-Level Scale. A total of 68 individuals completed the questionnaire. RESULTS: Coefficient alpha was 0·66 for hypertensives and 0·79 for non-hypertensives. The difference for the mean scores in the entire scale between the two samples was statistically significant. In addition, significant differences were observed in many sub-dimensions and no correlation was found between level, knowledge and age, gender and education level. CONCLUSIONS: Findings provide support for the validity of the Greek version of the Hypertension Knowledge-Level Scale. RELEVANCE TO CLINICAL PRACTICE: The translation and validation of an instrument evaluating the level of knowledge of hypertension contribute to assessing the provided educational intervention. Low knowledge level should lead to the development of new methods of education, therefore nurses will have the opportunity to amplify their role in patients' education and develop relationships based on honesty and respect.

The Development and Testing of the Hippocratic Heart Failure Self-Care Scale.

BACKGROUND: The adoption of self-care behaviors among patients with congestive heart failure (CHF) is essential for the management of their health condition. However, there is a lack of tools for estimating self-care in CHF patients. We aim to develop and validate the Greek version of the Hippocratic heart failure self-care scale (HHFSCS). METHODS: The scale includes 22 items which are reviewed by a committee of experts. Individuals indicate the frequency at which they follow each self-behavior on a five-point Likert scale. Adult patients with CHF (n = 250) from a General Hospital in Athens participated in the study from June 2020 to March 2021. Reliability coefficients and an explanatory factor analysis (EFA), using a Varimax rotation and the principal component method, were used to assess the psychometric measurements. RESULTS: The Cronbach's alpha coefficient of the HHFSCS was 0.807. The exploratory factor analysis identified two domains that accounted for 88.44% of the variance in the scale items; however, each sub-scale could not be used as an independent scale. Finally, the test-retest showed a significant and strong correlation (r = 0.973, p < 0.001). CONCLUSIONS: The HHFSCS is a reliable and valid tool for assessing self-behaviors in CHF patients. Health professionals can use it in their clinical practice to improve the management of a patient's health conditions.

Patient Knowledge, Medication Adherence, and Influencing Factors: A Cross-Sectional Study among Hypertensive Patients in Greece.

This study aimed to investigate the knowledge of patients with hypertension about their condition, adherence to antihypertensive medication, and the factors influencing it. A cross-sectional study was conducted in two cardiology outpatient clinics of two tertiary hospitals, in Greece. The study included 188 patients diagnosed with hypertension. The patients' knowledge about their disease and adherence to medication were assessed by using the HK-LS and A-14 scales, respectively. Patients had sufficient knowledge levels about their disease, but significantly low levels of adherence to medication. Patients with higher knowledge levels were more adherent to medications [r(188) = 0.885, p < 0.001]. By using multivariate analysis, higher age (p = 0.018), residence in a more populous area (p = 0.041), more years with the disease (p = 0.012), and a lower number of medications (p = 0.03) were associated with higher levels of knowledge. Conversely, younger age (p = 0.036), lower educational levels (p = 0.048), fewer years with the disease (p = 0.001), and a higher number of medications (p = 0.003) were associated with lower adherence to medication. The Greek patients' hypertension knowledge was sufficient; however, adherence to medication was significantly low. Healthcare managers could utilize our findings to design targeted interventions for improving adherence to medication for these patients.

Health-related quality of life of patients with severe heart failure. A cross-sectional multicentre study.

BACKGROUND: Heart failure is a serious chronic syndrome that is accompanied by significant physical and psychological burdens, resulting in poor quality of life. AIM: To assess the quality of life of patients with severe heart failure and its correlation with patient demographic, socio-economic and clinical characteristics. METHOD: We studied 199 patients with heart failure who were hospitalized in the Cardiology Department of three general hospitals of Greece during a 1-year period. Demographic and socio-economic data were obtained using a short questionnaire, while clinical data were obtained from medical record review. The assessment of the patients' quality of life was performed using Minnesota Life with Heart Failure Questionnaire (MLWHFQ). FINDINGS: The mean MLWHFQ score was 62.7 (±20.3). Significantly lower quality of life was found in patients with diabetes mellitus (Coefficient beta (ß)=11.4; 95% Confidence Interval (CI), 5.2-17.5), hypertension (ß=10.3; CI, 1.4-19.1), chronic renal failure (ß=13.9; CI, 5.9-21.9), chronic respiratory failure (ß=11.2; CI, 4.7-17.7), cancer (ß=12.3; CI, 2.3-22.4), psychiatric disease (ß=10.5; CI, 0.6-20.4) and those patients who were classified in New York Heart Association class IV (ß=10.6, CI=4.1-17.0). CONCLUSIONS: The average score of the MLWHFQ was high, and this reflects the poor quality of life of patients. Higher scores in specific patient groups show the negative influence of these factors in quality of life. The holistic care of patients with heart failure by a multidisciplinary team of healthcare professionals could improve their quality of life.

The Development and Validation of the "Hippocratic Hypertension Self-Care Scale".

BACKGROUND: The adoption of self-care behaviors among patients with arterial hypertension (AH) plays an important role in the management of their health condition. However, a lack of scales assessing self-care is observed. We aimed to develop and validate the Hippocratic hypertension self-care scale. METHODS: From a pool of questions derived from a literature review, 18 items were included in the scale and reviewed by a committee of experts. Participants indicated the frequency at which they followed the self-behavior prescribed in each statement on a five-point Likert scale. Data were collected between April 2019 and December 2019. RESULTS: A total of 202 consecutive adult patients with AH were enrolled in the study. The internal consistency of the scale was found to be 0.807, using Cronbach's alpha coefficient. An exploratory factor analysis identified two domains that accounted for 92.94% of the variance in the scale items; however, each sub-scale could not be used as an independent scale. Finally, the test-retest of the scale showed a significant strong correlation (r = 0.0095, p < 0.001). CONCLUSION: This analysis indicates that the scale is reliable and valid for assessing self-care behaviors in patients with AH. It is suggested that health professionals use it in their clinical practice to improve the management of AH.

The Early Mobilization of Patients on Extracorporeal Membrane Oxygenation: A Systematic Review.

Patients on extracorporeal membrane oxygenation (ECMO) often require prolonged periods of bed rest owing to the severity of their illness. Care is also required to maintain the position and integrity of the ECMO cannula. However, they experience a range of effects due to prolonged bed rest. This systematic review examined the possible effects of the early mobilization in patients on ECMO. The database PUBMED was searched by using appropriate keywords: "rehabilitation", "mobilization", "ECMO" and "extracorporeal membrane oxygenation". The selection criteria for the article search were the following: (a) studies published in the last five years, (b) descriptive studies, (c) randomized studies, (d) published in the English language and (e) studies in adults. A total of 259 studies were found, 8 of which were finally selected. Most of the studies showed that early intensive physical rehabilitation related to a decrease in in-hospital stay and a reduction in the duration of mechanical ventilation and doses of vasopressors. In addition, improvements in the functional status and rate of mortality were observed along with a reduction in health care costs. Exercise training should be a fundamental part of the management of patients on ECMO.

Development and Validation of the CVP Score: A Cross-Sectional Study in Greece.

Although central venous pressure (CVP) is among the most frequent estimated hemodynamic parameters in the critically ill setting, extremely little is known on how intensive care unit (ICU) nurses use this index in their decision-making process. The purpose of the study was to develop a new questionnaire for accessing how ICU nurses use CVP measurements to address patients' hemodynamics investigating its validity and reliability. A cross-sectional study was conducted among 120 ICU nurses from four ICUs of Greece. Based on a comprehensive literature review and the evaluation by a panel of five experts, a new questionnaire, named "CVP Score", was created, having eight items. The construct validity and the reliability of the questionnaire were examined. Half of the study participants (51.7%) worked at a specialized ICU, and they had a mean [±Standard Deviation (SD)] ICU experience of 13(±7.1) years. The estimated construct validity of the newly developed tool was acceptable, while the internal consistency reliability as measured by Cronbach alpha was excellent (0.901). CVP Score had acceptable test-retest reliability (r = 0.996, p < 0.001) and split-half reliability (0.855). The CVP score is a valid and reliable instrument for measuring how critical care nurses use CVP measurements in their decision-making process.

3D Digital Printing in Healthcare: Technologies, Applications and Health Issues.

3D Printing has a wide range of technologies and applications used in healthcare. In this work, a thorough literature review, concerning the last decade, was conducted in major bibliographic databases. The aim is to report the main applications and materials used in healthcare. In addition, this work tries to identify possible health issues due to particles emissions made by the 3D printing materials.

Knowledge and Perceptions of Undergraduate and Postgraduate Nursing Students About the Use of 3D Digital Printing in Healthcare.

3D printing is applicable in various fields. The purpose of this study was to explore the knowledge and perceptions of undergraduate and postgraduate nursing students in relation to the use of 3D printing. A questionnaire was developed including questions about demographics, the students' knowledge about, and the student's attitude towards the 3D printing technology. Descriptive statistics and correlations were examined. The average knowledge score was 2.6 out of 6 and the perception score was 7.7 out of 10. Only gender was found to be related with 3D printing knowledge. Gender, age, and educational level were related with students' attitude towards 3D printing.

Determinants of Health Promotion Behaviors among Family Caregivers of Stroke Survivors.

PURPOSE: To record the health promotion behaviors of family caregivers of stroke survivors, as well as potential determinants that could affect these behaviors. METHODS: A cross-sectional study was carried out through home visits in the Attica region using the convenience sampling method. The studied population included 109 survivors who had suffered a stroke and experienced functional problems, and their 109 primary caregivers, who were family members, lived in the same house and were fully responsible for their care. The dependent variables were the caregivers' health promotion behaviors, while the independent variables were the survivors and caregivers' demographic characteristics, survivors' functional capacity, depression, social support and changes in caregivers' lives from caring. RESULTS: Better health promotional behaviors were associated with the following: patient having advanced age and a high level of functionality, caregivers assessing their own state of health as "good", greater social support, a higher educational level and a higher income level. In addition, more hours of patient care were associated with a less healthy lifestyle for caregivers. CONCLUSIONS: Promoting the health of family caregivers of stroke survivors is crucial for both survivors and caregivers. For this reason, it is of great importance to detect factors that affect the health promotion behaviors of caregivers in order to carry out appropriate interventions and improve their quality of life.

The presence of obesity paradox in Greek patients with chronic heart failure.

PURPOSE: To investigate the effect of body mass index (BMI) values on 1- and 2-year mortality rates in patients with chronic heart failure (HF). PATIENTS AND METHODS: We conducted a retrospective cohort study of 112 patients with confirmed HF who visited the HF outpatient unit of a tertiary hospital of Athens, Greece, during a 5-month period (December 2012 - April 2013). These patients were assigned to four groups based on their BMI category. Data collection was carried out through a review of the medical patient records and the filling in of a structured questionnaire, including information on the demographic and clinical patient variables. Additionally, 1- and 2-year patient mortality was recorded. The statistical significance was two-tailed, and p-values of less than 0.05 were considered significant. The statistical analysis was performed with Mann-Whitney U test, χ2 test, and Student's t-test using the SPSS software (IBM SPSS 21.0 for Windows). RESULTS: Obese patients had significantly lower 1-year (13% vs 34.6%, p=0.039) and 2-year (4% vs 21.4%, p=0.022) mortality rates compared with those with normal BMI values. Additionally, we found clinically and not statistically significant lower mortality in overweight and obese patients, when compared with normal BMI and overweight patients, respectively. CONCLUSION: Obesity paradox seems to be present in our study, translating to significantly lower long-term mortality rates of obese patients compared to those with normal BMI. The significantly higher left ventricular ejection fraction and hematocrit levels among obese HF patients could justify our study findings. Further research is needed due to the inherent weaknesses of BMI and the other study limitations.

Perioperative neutrophil to lymphocyte ratio as a predictor of poor cardiac surgery patient outcomes.

PURPOSE: The purpose of the present study was to investigate the association between the perioperative neutrophil to lymphocyte ratio (NLR) and cardiac surgery patient outcomes. PATIENTS AND METHODS: A retrospective cohort study of 145 patients who underwent cardiac surgery in a tertiary hospital of Athens, Greece, from January to March 2015, was conducted. By using a structured short questionnaire, this study reviewed the electronic hospital database and the medical and nursing patient records for data collection purposes. The statistical significance was two-tailed, and p-values <0.05 were considered significant. The statistical analysis was performed with Mann-Whitney U test and Spearman's correlation coefficient, by using the Statistical Package for Social Sciences software (IBM SPSS 21.0 for Windows). RESULTS: The increased preoperative levels of NLR were associated with significantly higher mortality, both in-hospital (p=0.001) and 30-day (p=0.002), prolonged postoperative hospital length of stay (LOS), both in the cardiac intensive care unit (ICU) (p=0.002), and in-hospital (p=0.018), and likewise with delayed tracheal extubation (p≤0.001). Furthermore, patients with elevated NLR during the second postoperative day had significantly higher in-hospital mortality (p=0.018), increased incidence of pneumonia (p=0.022), higher probability of readmission to the ICU (p=0.002), prolonged ICU LOS (p≤0.001), and delayed tracheal extubation (p≤0.001). CONCLUSION: Increased perioperative NLR seems to be associated with significantly higher mortality and morbidity in cardiac surgery patients. At the same time, NLR is a significant and inexpensive biomarker for the early identification of patients at high risk for complications. In addition, NLR levels could lead clinicians to perform measures for the optimal therapeutic patient approach.

HBeAg negative serological status and low viral replication levels characterize chronic hepatitis B virus-infected women at reproductive age in Greece: a one-year prospective single center study.

AIM: To evaluate the seroprevalence of hepatitis B surface antigen (HBsAg) in 13 581 women at reproductive age and the hepatitis B e antigen (HBeAg)/anti-HBe status as well as serum hepatitis B virus (HBV)-DNA levels in a subgroup of HBsAg(+) pregnant women at labor in Greece. METHODS: Serological markers were detected using enzyme immunoassays. Serum HBV-DNA was determined by a sensitive quantitative PCR assay. Statistical analysis of data was based on parametric methodology. RESULTS: Overall, 1.156% of women were HBsAg(+) and the majority of them (71.3%) were Albanian. The prevalence of HBsAg was 5.1% in Albanian women, 4.2% in Asian women and 1.14% in women from Eastern European countries. The prevalence of HBsAg in African (0.36%) and Greek women (0.29%) was very low. Only 4.45% of HBsAg(+) women were also HBeAg(+) whereas the vast majority of them were HBeAg(-)/anti-HBe(+). Undetectable levels of viremia (<200 copies/mL) were observed in 32.26% of pregnant women at labor and 29.03% exhibited extremely low levels of viral replication (<400 copies/mL). Only two pregnant women exhibited extremely high serum HBV-DNA levels (>10 000 000 copies/mL), whereas 32.26% exhibited HBV-DNA levels between 1 500 and 40 000 copies/mL. CONCLUSION: The overall prevalence of HBsAg is relatively low among women at reproductive age in Greece but is higher enough among specific populations. The HBeAg(-)/anti-HBe(+) serological status and the extremely low or even undetectable viral replicative status in the majority of HBsAg(+) women of our study population, suggest that only a small proportion of HBsAg(+) women in Greece exhibit a high risk for vertical transmission of the infection.

Serological profile of HBV infection and liver histopathology among injecting drug users with chronic HCV infection in Greece.

BACKGROUND: The aim of this study was to evaluate the serological status of HBV infection and liver histology in chronic HCV-infected injecting drug users (IDUs) and to correlate them with the possible time of infection and the principal HCV genotype. METHODS: Some 130 prior IDUs with chronic HCV infection were consecutively evaluated for the serological status of HBV infection. Fifty-eight (44.62%) reported intravenous drug use beginning before 1992 (group A) and 72 (55.38%) after 1992 (group B). HCV genotyping was available in 86 patients (PCR). Liver biopsy was performed in 48 patients (Ishak scoring system). There was no available data about alcohol consumption in the study population. Statistical analysis was based on the t-test and the chi(2) test (p<0.05). RESULTS: Some 82.8% of group A patients had previous HBV infection, whereas only 22.2% of group B patients did (p<0.001). Among group A patients, 10.3% were HBV-seronegative whereas 61.1% of group B patients were (p<0.001). Only 3.4% of group A patients were HBV-vaccinated compared to 16.7% in group B (p=0.016). HCV genotype was not associated with HBV serological status. No significant differences were detected in age, sex, possible time of infection, HBV serological status, or HCV genotype among those with higher vs. lower total grading scores. Seventy-five percent of patients had mild or no detectable fibrosis unrelated to the possible period of infection, the HBV serological status, and the HCV genotype. CONCLUSIONS: The serological profile of HBV infection is changing among Greek chronic HCV-infected IDUs, while the percentages of successfully HBV-vaccinated IDUs are relatively low. Severe liver disease is an uncommon finding in these patients, irrespective of the possible time of infection, the HBV serological status, and the HCV genotype.

Translation and validation of the Greek "Minnesota Living with Heart Failure" questionnaire.

INTRODUCTION: The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is an important measurement instrument for assessing the health-related quality of life (HRQOL) among heart failure patients. The purpose of this study was to translate and validate the MLHFQ in the Greek language. METHODS: Three hundred forty-four consecutive adult patients from three General Hospitals, two in Athens and one in another part of the country, who were diagnosed with chronic heart failure, and 347 healthy controls were enrolled in the study from March 2009 to March 2010. The questionnaire instrument was translated from English, back-translated, and reviewed by a committee of experts. The psychometric measurements that were performed included reliability coefficients and Explanatory Factor Analysis (EFA), using a Varimax rotation and Principal Components Method. In a further step, confirmatory analysis (CFA)--known as structural equation modeling--of the principal components was conducted. RESULTS: The internal consistency of the Greek MLHFQ version was found to be 0.97, using Cronbach's alpha coefficient. An exploratory factor analysis identified two domains that accounted for 72.5% of the variance of MLHFQ items; the area under the ROC curve was calculated at 0.942 and the logistic estimate for the threshold score of 24.50 provided the model with 95.1% sensitivity and 99.8% specificity. Additionally, the CFA demonstrated that the two-factor model offered a very good fit to our data. CONCLUSIONS: Our data indicate that the Greek MLHFQ is a reliable and valid tool for assessing HRQOL among patients with heart failure. Health professionals can use it in their clinical practice to improve their evaluation of these patients.