Professional quality of life, psychological well-being, and work engagement of healthcare professionals in two Greek hospitals during COVID-19: A cross-sectional study.

BACKGROUND: During the COVID-19 pandemic, the mental health of healthcare professionals has emerged as an issue of great concern. OBJECTIVE: To investigate the levels of professional quality of life, psychological well-being, and work engagement among healthcare professionals in two Greek hospitals during the COVID-19 pandemic. METHODS: A cross-sectional study was conducted in December 2021 in two public hospitals in Greece. To assess the levels of professional quality of life, psychological well-being, and work engagement, respondents completed the Professional Quality of Life Scale Version 5 (ProQOL-V), the Psychological Well-being (PWB) scale, and the Utrecht Work Engagement Scale (UWES-17). RESULTS: A total of 150 questionnaires were distributed, and 102 were returned (response rate: 68%). It was found that as burnout levels increased, the levels of work engagement decreased (rho = -0.36, p-value <  0.01). Higher levels of compassion satisfaction were associated with higher work engagement (rho = 0.48, p-value <  0.01). Multivariable analysis revealed that healthcare personnel's contact with patients or service users exposed to or who have experienced traumatic events was associated with less positive relationships with others (and, consequently, lower levels of psychological well-being) (p-value = 0.035). CONCLUSIONS: Healthcare professionals in the two public hospitals in Greece, experienced moderate levels of compassion satisfaction, burnout, and secondary traumatic stress during the COVID-19 pandemic. Their psychological well-being was also found to be moderate, and their levels of work engagement were moderate to high. Supporting the physical and psychological well-being of healthcare professionals is essential for their ability to provide high-quality care in times of crisis, such as during the COVID-19 pandemic.

Pertinence of Salt-Related Knowledge and Reported Behaviour on Salt Intake in Adults: A Cross-Sectional Study.

The association between salt-related knowledge, attitude, behaviour (KAB) and actual salt consumption in Greek adults is uncertain. This study investigates the correlation between salt intake, gauged by 24-h urinary sodium excretion, with salt-related KAB. It further explores how socio-demographic factors influence these behaviors. Salt consumption was evaluated using a 24-h urinary sodium test, and compared to self-reported KAB data. Knowledge and behavior scores related to salt were computed. An overall cohort-adjusted model examined the relationship between daily salt consumption, knowledge and behavior scores, and certain covariates. Through the stratification by the cohort random effect, two models were established (Cohort I Adults; Cohort II Students) examining the same relationships of the overall cohort model. 463 Greek adults participated. The average salt intake was 9.54 g/day, nearly double the WHO recommendation. Significant differences in knowledge scores were noted based on sex, age, education, and BMI. A trend suggesting lower discretionary salt use with increased salt intake was observed (p = 0.06). However, comprehensive analysis revealed no direct correlation between salt intake and either knowledge (p = 0.562) or behavior scores (p = 0.210). The results emphasize the need for food product reforms by industry stakeholders and accelerated efforts towards reducing salt intake.

Dispensing of antibiotics without prescription in the metropolitan area of Athens, Greece, in 2021-Can new legislation change old habits?

Objective: To assess the effect of new legislation on the dispensing of antimicrobials without prescription from pharmacies in Greece. Design: In-person survey. Setting: The study included 110 pharmacies in the greater Athens Metropolitan area. Methods: Volunteer collaborators visited 110 pharmacies in the greater Athens Metropolitan area in December 2021 and January 2022. They asked for either ciprofloxacin or amoxicillin-clavulanate acid (6:5 ratio) without providing a prescription, without simulating symptoms, and without offering justification or insisting. Fluoroquinolones have additional dispensing restrictions in Greece. Results were compared to a 2008 study. In 2020, legislation allowed the dispensing of antibiotics from pharmacies only with an electronic prescription, overriding the 1973 forbidding the dispensing of all medications without prescriptions. Results: All pharmacists refused to dispense ciprofloxacin without a prescription. Only 1 pharmacy dispensed amoxicillin-clavulanate without a prescription. Compared to the 2008 study, dispensing of amoxicillin-clavulanate without a prescription dropped from 100% in 2008 to 1% in 2021 and dispensing ciprofloxacin without a prescription dropped from 53% in 2008 to 0% in 2021. Conclusions: A new and enforced law that requires electronic prescribing led to a dramatic reduction of antibiotic dispensing without prescription compared to 12 years ago. Similar initiatives could help solve the problem of antibiotic consumption and resistance in Greece and elsewhere.

Practices and educational needs of Hellenic Police Officers in providing first aid/cardiopulmonary resuscitation: A cross-sectional survey.

BACKGROUND: It is well known that police officers (POs) are expected to be the first responders in emergency cases requiring First Aid (FA) such as cardiac arrest. OBJECTIVE: Description of practices and educational needs of Hellenic POs in providing FA/Cardiopulmonary Resuscitation (CPR) in case of medical emergencies and description of the equipment of professional FA kit. METHODS: An anonymous cross-sectional survey was conducted from January 1, 2016, to December 31, 2017, using a self-administered questionnaire designed to serve the purposes of this particular survey. The instrument consisted of 53 questions (multiple choice and open-ended questions) administered in a convenience sample of 700 POs of the Attica prefecture. RESULTS: A sample of 520 POs (constables and lieutenants) completed the questionnaire (response rate = 74.28%). Among the participants, 248 (47.7 %) declared that they had provided FA/CPR in the past, while among those declaring that they had never provided FA/PCR (n = 248), 153 (61.7%) said that they had experienced FA/CPR needs, but did not know what they had to do. Moreover, only 18.1% (94/520) of the POs answered that they have FA equipment in their professional equipment, which mainly includes bandages (54/94, 57.4%), while 29.7% of POs provided answers about their educational needs (313 in total) declared that they would like to be educated in bleeding control. CONCLUSION: There is a need to educate and train Greek POs in first aid and CPR in an organized and mandatory way in order to meet emergency needs.

[Evaluation tools of the characteristics of attention deficit and hyperactivity disorder (ADHD) in children and adolescents: A literature review].

Attention deficit hyperactivity disorder (ADHD) is one of the most commonly occurring developmental disorders of childhood, which can often be present after adulthood. The main symptoms of ADHD are distraction, impulsiveness, and hyperactivity, which are common in childhood, and for this reason, the diagnosis is usually delayed. At the same time, in several cases, the problems caused by ADHD (such as behavioral and social adjustment problems and problems in school performance) are considered as results of other co-existing situations (such as family problems, environmental change, and developmental pathologies). For this reason, ADHD often remains undiagnosed or misdiagnosed and even when it is accurately diagnosed, a comprehensive model of a combination of therapeutic approaches that are required to treat it, is not always applied. Today, there are a plethora of tests used to assess specific deficits presented by both children and adolescents with ADHD. The purpose of this literature review was to present tools and tests used in the evaluation of children and adolescents with ADHD. Search was performed on PubMed until February 20, 2021, without time limit for the publication of scientific papers. Studies were excluded if they were not published in English language, were conducted on animals and were case studies, editorials, and letters to the editor. Of the scientific papers retrieved, 15 were included in the systematic review. Some of the specialized tests used in the evaluation of children and adolescents with ADHD are the Children's Color Trails Test (CCTT), the Test of Variables of Attention (TOVA), the Continuous Performance Test (CPT), the Conner's' Parent Rating Scale (CPRS), the Child Behavior Checklist (CBCL), the Visual and Auditory Continuous Performance Testing (IVA-CPT), the Visual Analog Scale (VAS), the 30-item Semi-Structured Interview with Parents (CAPA- RAD), the Controlled Oral Word Association Test (COWAT), the Conners' Teacher Rating Scale (CTRS). In conclusion, there are a number of evaluation tools that can be used to evaluate specific deficits presented by children and adolescents with ADHD, as well as to evaluate the course of treatment, but also to distinguish children and adolescents with ADHD from those with other types of cognitive and learning disorders.

Potential benefit from the implementation of the Kaiser Permanente neonatal early-onset sepsis calculator on clinical management of neonates with presumed sepsis.

To assess the potential benefit from the implementation of the Kaiser Permanente early-onset sepsis calculator (EOS-C), in terms of antibiotic use and requested laboratory tests, in a network of neonatal intensive care units (NICUs) in Greece, and to determine the incidence of early-onset sepsis (EOS) in Greek NICUs, a prospective surveillance study was conducted in 7 NICUs between April 2018 and June 2019. Data were collected for all newborns ≥ 34 weeks' gestation receiving empiric antibiotic therapy within the first 3 days of life. The number of live births and positive blood or cerebrospinal fluid cultures within the first 3 days of life were used for calculation of EOS incidence. Evaluation of possible impact of implementing the calculator was done by comparing the clinicians' recorded management to the calculator's suggested course of action. The unit-specific incidence of culture-proven EOS ranged between 0 and 2.99/1000 live births. The weighted incidence rate for all 7 units was 1.8/1000 live births. Management of EOS guided by the calculator could lead to a reduction of empiric antibiotic initiation up to 100% for the group of "well-appearing" neonates and 86% for "equivocal," lowering exposure to antibiotics by 4.2 and 3.8 days per neonate, respectively. Laboratory tests for blood cultures drawn could be reduced by up to 100% and 68%, respectively. Sensitivity of the EOS-C in identifying neonates with positive blood cultures was high.Conclusion: Management strategies based on the Kaiser Permanente neonatal sepsis calculator may significantly reduce antibiotic exposure, invasive diagnostic procedures, and hospitalizations in late preterm and term neonates. What is Known: • Neonates are frequently exposed to antibiotics for presumed EOS. • The Kaiser Permanente sepsis calculator can reduce antibiotic exposure in neonates.. What is New: • EOS calculator can be an effective antibiotic stewardship tool in a high prescribing country and can reduce invasive diagnostic procedures and mother-baby separation. • Incidence of EOS in Greece is higher compared to other European countries.

Πρόληψη της μικροβιακής αντοχής και προώθηση της ορθολογικής χρήσης αντιμικροβιακών ουσιών στα νοσοκομεία στην Ελλάδα : EVIPNet σύνοψη ερευνητικών δεδομένων, Νούμερο 10

Η παρούσα έκθεση αποτελεί την πρώτη σύνοψη ερευνητικών δεδομένων (Evidence Policy Brief-EBP) που συντάσσεται στην Ελλάδα στο πλαίσιο του World Health Organization (WHO) Evidence-Ιnformed Policy Network (EVIPNet) Europe. Αναπτύχθηκε από τον Εθνικό Οργανισμό Δημόσιας Υγείας (ΕΟΔΥ), τον Οργανισμό Διασφάλισης Ποιότητας στην Υγεία Α.Ε. (ΟΔΙΠΥ) και το Κέντρο Κλινικής Επιδημιολογίας και Έκβασης Νοσημάτων (CLEO). Αυτό το EBP αποτελεί ένα εργαλείο δράσης βασισμένο σε ερευνητικά δεδομένα και έχει ως σκοπό την αντιμετώπιση των ακόλουθων σημαντικών προβλημάτων που αφορούν την παρεχόμενη φροντίδα υγείας: α. τα υψηλότερα από τον μέσο όρο της Ευρωπαϊκης Ένωσης ποσοστά μικροβιακής αντοχής (ΜΑ) των νοσοκομειακών παθογόνων, β. τον υψηλό επιπολασμό των λοιμώξεων που σχετίζονται με την φροντίδα υγείας (Healthcare Associated Infections-HAIs), και γ. την υψηλή κατανάλωση προωθημένων αντιμικροβιακών παραγόντων στα νοσοκομεία. Η ομάδα εργασίας καθόρισε το σκοπό της συστηματικής βιβλιογραφικής ανασκόπηση, διενήργησε την κριτική αξιολόγηση και τον έλεγχο των επιλεγμένων επιστημονικών άρθρων και πραγματοποίησε σειρά συναντήσεων με βασικούς συναρμόδιους φορείς στον τομέα της νοσοκομειακής περίθαλψης και της διοίκησης μονάδων υγείας. Τα δεδομένα, οι πληροφορίες και οι γνώσεις που προέκυψαν κατά τη βιβλιογραφική ανασκόπηση, χρησιμοποιήθηκαν για τη διαμόρφωση τριών προσεγγίσεων, οι οποίες μπορούν να εφαρμοστούν μεμονωμένα ή σε συνδυασμό για την αντιμετώπιση της αυξανόμενης ΜΑ και της υψηλής επίπτωσης των λοιμώξεων που σχετίζονται με την φροντίδα υγείας, στα ελληνικάνοσοκομεία. Οι προτεινόμενες προσεγγίσεις αφορούν: (1) τη δημιουργία ενός διασυνδεδεμένου ηλεκτρονικού συστήματος επιτήρησης της μικροβιακής αντοχής στα νοσοκομεία, (2) την εφαρμογή προγραμμάτων επιμελητείας (ορθολογικής χρήσης) αντιμικροβιακών και πρόληψης & ελέγχου λοιμώξεων σε όλα τα νοσοκομεία και (3) την εφαρμογή εκπαιδευτικών προγραμμάτων για τους επαγγελματίες υγείας σχετικά με την ορθολογική χρήση αντιμικροβιακών και τον έλεγχο των λοιμώξεων στο νοσοκομειακό περιβάλλον.

Preventing antimicrobial resistance and promoting appropriate antimicrobial use in inpatient health care in Greece: EVIPNet evidence brief for policy, number 10

The present Evidence Brief for Policy (EBP) drawn up in Greece within the framework of the WHO European Evidence-informed Policy Network was prepared by the National Public Health Organization, the Center for Clinical Epidemiology & Outcomes Research (CLEO), The Agency for Quality Assurance in Health S.A. and the WHO Country Office in Greece. This EBP was produced as a research-derived actionable tool, with a view to addressing the following pressing problems in hospital healthcare: a. the higher-than-EU-average rates of antimicrobial resistance (AMR) in hospital-acquired pathogens, b. the high prevalence of healthcare associated infections (HAIs), and c. the high consumption of advanced antimicrobials in hospitals. The working group defined the scope of the literature research, conducted a critical appraisal and review of the selected evidence, and carried out a series of meetings with key stakeholders in the field of clinical healthcare and health administration. The derived data, information and insights were used for the formulation of three options, that may be implemented in isolation or in conjunction to address the rising AMR and high incidence of HAIs in Greek hospitals. The proposed options pertain to: (1) Establishing an interconnected electronic AMR surveillance system in hospitals; (2) Establishing antimicrobial stewardship and IPC programmes in all hospitals; and (3) Implementing post-graduate educational programs for healthcare workers on prudent antimicrobial use and infection control in the hospital setting.

Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A "Low-Hanging Fruit" Approach.

Antibiotics are commonly prescribed in Neonatal Intensive Care Units (NICU), where stewardship interventions are challenging. Lowering antibiotic consumption is desperately needed in Greece, a country with high antibiotic resistance rates. We sought to assess the effectiveness of a low-cost and -resource intervention to reduce antibiotic use in Greek NICUs implementing a "low-hanging fruit" approach. A prospective quasi-experimental study was conducted in 15/17 public NICUs in Greece (9/2016-06/2019). The intervention selected was discontinuation of antibiotics within 5 days for neonates with gestational age ≥ 37 weeks, no documented signs or symptoms of sepsis, CRP ≤ 10 mg/L and negative cultures within 3 days of antibiotic initiation. Impact was evaluated by the percentage of discontinued regimens by day 5, length of therapy (LOT) and stay. Trends of antibiotic consumption were assessed with days of therapy (DOT) per 1000 patient-days. Overall, there was a 9% increase (p = 0.003) of antibiotic discontinuation in ≤5 days. In total, 7/13 (53.8%) units showed a ≥10% increase. Overall, 615 days on antibiotics per 1000 patients were saved. Interrupted time-series analysis established a declining trend in DOT/1000 patient-days relative to the pre-intervention trend (p = 0.002); a monthly decrease rate of 28.96 DOT/1000 patient-days (p = 0.001, 95%CI [-45.33, -12.60]). The intervention had no impact on antibiotic choice. Antibiotic use was successfully reduced in Greek NICUs using a "low-hanging fruit" approach. In resource-limited settings, similar targeted stewardship interventions can be applied.

Willingness of Greek general population to get a COVID-19 vaccine.

BACKGROUND: Epidemiological data indicate that a large part of population needs to be vaccinated to achieve herd immunity. Hence, it is of high importance for public health officials to know whether people are going to get vaccinated for COVID-19. The objective of the present study was to examine the willingness of adult residents in Greece to receive a COVID-19 vaccine. METHODS: A cross-sectional was survey conducted among the adult general population of Greece between April 28, 2020 to May 03, 2020 (last week of lockdown), using a mixed methodology for data collection: Computer Assisted Telephone Interviewing (CATI) and Computer Assisted web Interviewing (CAWI). Using a sample size calculator, the target sample size was found to be around 1000 respondents. To ensure a nationally representative sample of the urban/rural population according to the Greek census 2011, a proportionate stratified by region systematic sampling procedure was used to recruit particpants. Data collection was guided through a structured questionnaire. Regarding willingness to COVID-19 vaccination, participants were asked to answer the following question: "If there was a vaccine available for the novel coronavirus, would you do it?" RESULTS: Of 1004 respondents only 57.7% stated that they are going to get vaccinated for COVID-19. Respondents aged > 65 years old, those who either themselves or a member of their household belonged to a vulnerable group, those believing that the COVID-19 virus was not developed in laboratories by humans, those believing that coronavirus is far more contagious and lethal compared to the H1N1 virus, and those believing that next waves are coming were statistically significantly more likely to be willing to get a COVID-19 vaccine. Higher knowledge score regarding symptoms, transmission routes and prevention and control measures against COVID-19 was significantly associated with higher willingness of respondents to get vaccinated. CONCLUSION: A significant proportion of individuals in the general population are unwilling to receive a COVID-19 vaccine, stressing the need for public health officials to take immediate awareness-raising measures.

Perioperative antimicrobial prophylaxis in adult patients: The first multicenter clinical practice audit with intervention in Greek surgical departments.

OBJECTIVE: To audit clinical practice and implement an intervention to promote appropriate use of perioperative antimicrobial prophylaxis (PAP). DESIGN: Prospective multicenter before-and-after study. SETTING: This study was conducted in 7 surgical departments of 3 major Greek hospitals. METHODS: Active PAP surveillance in adults undergoing elective surgical procedures was performed before and after implementation of a multimodal intervention. The surveillance monitored use of appropriate antimicrobial agent according to international and local guidelines, appropriate timing and duration of PAP, overall compliance with all 3 parameters and the occurrence of surgical site infections (SSIs). The intervention included education, audit, and feedback. RESULTS: Overall, 1,447 patients were included: 768 before and 679 after intervention. Overall compliance increased from 28.2% to 43.9% (P = .001). Use of antimicrobial agents compliant to international guidelines increased from 89.6% to 96.3% (P = .001). In 4 of 7 departments, compliance with appropriate timing was already >90%; an increase from 44.3% to 73% (P = .001) and from 20.4% to 60% (P = .001), respectively, was achieved in 2 other departments, whereas a decrease from 64.1% to 10.9% (P = .001) was observed in 1 department. All but one department achieved a shorter PAP duration, and most achieved duration of ~2 days. SSIs significantly decreased from 6.9% to 4% (P = .026). After the intervention, it was 2.3 times more likely for appropriate antimicrobial use, 14.7 times more likely to administer an antimicrobial for the appropriate duration and 5.3 times more likely to administer an overall appropriate PAP. CONCLUSION: An intervention based on education, audit, and feedback can significantly contribute to improvement of appropriate PAP administration; further improvement in duration is needed.

Prevalence, incidence, length of stay and cost of healthcare-acquired pressure ulcers in pediatric populations: A systematic review and meta-analysis.

BACKGROUND: Pressure ulcers are a major problem for national healthcare systems since they frequently occur in hospitalized patients, negatively affecting patients' quality of life and extending duration of hospitalization. OBJECTIVE: To systematically review the available evidence regarding the incidence, prevalence, attributable length of stay and cost of hospital-acquired pressure ulcers in pediatric populations. DESIGN: A systematic review and meta-analysis. METHODS: A systematic search (March 15, 2020) was conducted in PubMed, Scopus, and ProQuest databases. Cross-sectional and cohort studies of neonates and children aged <21 years old were eligible for inclusion when full text was available in English and data for at least one of the following criteria was provided: incidence, prevalence, attributable length of stay or healthcare cost due to hospital-acquired pressure ulcers. Study quality was evaluated using the Joanna Briggs Institute Critical Appraisal Tools. Random effects models were used to synthesize data. Heterogeneity and publication bias were evaluated. RESULTS: From the 1055 studies appeared in literature search, 21 studies were included in the systematic review and 19 were included in the meta-analysis. The overall prevalence ranged from 0.47% to 31.2% and cumulative incidence ranged from 3.7% to 27%. The pooled prevalence was estimated at 7.0% (95% confidence interval (CI): 4.3%-10.4%) and the pooled cumulative incidence at 14.9% (95% CI: 7.7%-23.9%). The pooled prevalence among neonates was 27.0% (95% CI: 22.1%-33.1%) among children aged less than 1 year old was 19.2% (95% CI: 9.4%-31.3%) and among children older than 1 year was 12.3% (95% CI: 2.3%-27.9%). The cumulative incidence of hospital-acquired pressure ulcers in neonates was 9.8% (95% CI: 2.9%-19.8%) and in children aged <1 year old was 11.3% (95% CI: 4.4%-20.7%), while no data was available to estimate this figure for children older than 1 year. The attributable length of stay ranged from 0.9 to 14.1 days and the attributable cost ranged from $894.69 to $98,730.24 (United States dollars; value of a dollar in 2020) per patient with hospital-acquired pressure ulcers. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: The results of this meta-analysis indicate that hospital-acquired pressure ulcers occur frequently in pediatric populations with a great variation across different age groups. Moreover, although limited data are available, it seems that hospital-acquired pressure ulcers have significant economic implications for the healthcare systems since they prolong patients' hospitalization stay; these findings further highlight the need for implementation of patient-based prevention strategies. SYSTEMATIC REVIEW REGISTRATION NUMBER: Not registered Tweetable abstract: Hospital-acquired pressure ulcers occur frequently in pediatric populations, prolonging their hospitalization and increasing the healthcare cost.

Length of stay, cost, and mortality of healthcare-acquired bloodstream infections in children and neonates: A systematic review and meta-analysis.

OBJECTIVE: To estimate the attributable mortality, length of stay (LOS), and healthcare cost of pediatric and neonatal healthcare-acquired bloodstream infections (HA-BSIs). DESIGN: A systematic review and meta-analysis. METHODS: A systematic search (January 2000-September 2018) was conducted in PubMed, Cochrane, and CINAHL databases. Reference lists of selected articles were screened to identify additional studies. Case-control or cohort studies were eligible for inclusion when full text was available in English and data for at least 1 of the following criteria were provided: attributable or excess LOS, healthcare cost, or mortality rate due to HA-BSI. Study quality was evaluated using the Critical Appraisal Skills Programme Tool (CASP). Study selection and quality assessment were conducted by 2 independent researchers, and a third researcher was consulted to resolve any disagreements. Fixed- or random-effect models, as appropriate, were used to synthesize data. Heterogeneity and publication bias were evaluated. RESULTS: In total, 21 studies were included in the systematic review and 13 studies were included in the meta-analysis. Attributable mean LOS ranged between 4 and 27.8 days; healthcare cost ranged between $1,642.16 and $160,804 (2019 USD) per patient with HA-BSI; and mortality rate ranged between 1.43% and 24%. The pooled mean attributable hospital LOS was 16.91 days (95% confidence interval [CI], 13.70-20.11) and the pooled attributable mortality rate was 8% (95% CI, 6-9). A meta-analysis was not conducted for cost due to lack of eligible studies. CONCLUSIONS: Pediatric HA-BSIs have a significant impact on mortality, LOS, and healthcare cost, further highlighting the need for implementation of HA-BSI prevention strategies.

Evidence of sympathetic innervation and α1-adrenergic receptors of the long head of the biceps brachii tendon.

BACKGROUND: The primary purpose of this study was to investigate the sympathetic innervation of the long head of the biceps brachii tendon LHB via immunohistochemical staining for protein S-100 and neuropeptide Y (NPY) in patients with complex proximal humerus fractures, in individuals with chronic biceps tendinosis in the setting of large rotator cuff tears (RC), and in cadaveric samples with no previously reported shoulder pathology. METHODS: We investigated the presence of sympathetic innervation and α1-adrenergic receptors of the long head of the biceps brachii tendon (LHB) in patients with complex proximal humerus fractures and individuals with chronic biceps tendinosis in the setting of large rotator cuff tears (RC). The correlation of morphological features with immunohistochemical evidence of neural element presence was also investigated. Forty-one LHB tendon specimens were examined. Seventeen were harvested from patients who underwent hemiarthroplasty for proximal humerus fractures, 14 were from individuals with biceps tendinosis in the context of a large RC tear, and ten were from cadaveric controls with no previous shoulder pathology. Histologic examination was performed using hematoxylin and eosin. Immunohistochemistry was used to detect the expression of the protein S-100, neuropeptide Y, and α1-adrenergic receptors, as well as to characterize the potential neural differentiation of tendon cells. RESULTS: A strong correlation between the expression of NPY/S-100, α1-adrenergic/S-100, and α1-adrenergic/NPY was found. The LHB tendon has sympathetic innervation and α1-adrenergic receptors in acute and chronic pathological conditions. CONCLUSION: Our results provide useful guidance on the management of tendinosis and the handling of the LHB in hemiarthroplasties for fractures.

The results of the three-month co-operation between a German and a Greek surgical team in a role II military hospital in Afghanistan.

BACKGROUND AND AIM: There are a lot of unique challenges for the military medical personnel assigned to Afghanistan. We evaluate the results of the co-operation between a German and a Greek surgical team during a 3-month period in a role II hospital. MATERIALS AND METHODS: Patients who were admitted to the role II German hospital of Kunduz were evaluated. We reviewed the type of diseases, mechanism and location of injuries, management, types of surgical procedures, blood supply, and outcome. RESULTS: The data included 792 ISAF patients, 18 NGOs patients, and 296 local patients. Out of them, 71.6% of the patients were ISAF personnel; 51 patients underwent a surgical operation; 35 of them were operated in an emergency base. Fifty-five surgical procedures were performed. In 22 (43.1%) of these patients, orthopedic procedures were performed, while in the rest 29 (56.9%) patients the operations were of general surgery interest. Gunshot injuries were the main mechanism of injury for locals, whereas ISAF personnel were usually presented with injuries after IEDs and rocket attacks. A total number of 11 patients were transferred to role III military hospitals for further treatment within 24 hours. CONCLUSIONS: The co-operation between surgical teams from different countries, when appropriately trained, staffed, and equipped, can be highly effective in a combat environment.

A comparison between the Airtraq and Macintosh laryngoscopes for routine airway management by experienced anesthesiologists: a randomized clinical trial.

BACKGROUND: The Airtraq Optical Laryngoscope is a new type of laryngoscope that provides a direct view of the glottis without alignment of the mouth, pharynx and trachea. Data show that it has advantages over the Macintosh laryngoscope. OBJECTIVE: The aim of this study was to compare the use of the Airtraq laryngo-scope versus the No. 3 Macintosh blade for routine airway management in terms of intubation time, complications during and after laryngoscopy, and ease of use. METHODS: In this single-center, randomized, clinical trial, 63 patients scheduled for elective operation were randomly allocated to two groups. Thirty-five patients were intubated with the Airtraq laryngoscope and 28 with the traditional Macintosh laryngoscope. All intubations were performed by experienced anesthesiologists who had a similar level of experience with the Airtraq laryngoscope. The time needed for intubation, any assistance required, complications during and after laryngoscopy and intubation, and the number of unsuccessful intubation attempts were documented and compared between the groups. RESULTS: Intubation with the Macintosh laryngoscope was quicker (mean+/-standard deviation: 23.7+/-5.9 seconds) than with the Airtraq laryngoscope (29.6+/-8.5 seconds). Although the difference (5.9 seconds) was statistically significant (p<0.05), it was not clinically significant. The anesthesiologists who used the Airtraq laryngo-scope less frequently required assistance (p<0.05) to place the endotracheal tube. No differences were found regarding complications during and after laryngoscopy and intubation. There were no differences in any of the outcomes in patients with Mallampati class > 2. CONCLUSION: The Airtraq laryngoscope is easier to use but it does not have any significant advantages compared with the Macintosh laryngoscope for routine airway management. More studies are needed to evaluate its use in patients with a difficult airway, and in emergency procedures.