Andreas Tsounis

Assessment of patient satisfaction of the quality of health care provided by outpatient services of an oncology hospital.

Aim: The purpose of this research is to investigate the patient’s satisfaction (patient’s satisfaction) with medical services provided in Outpatients’ Departments of a Greek Anti-Cancer Hospital in morning and afternoon clinics. The assessment of patients and identification of factors that contribute to their satisfaction will highlight the organizational and operational problems of outpatient department and assist in finding solutions to upgrade the quality of services provided. Material and Methodology: For the collection of data, a questionnaire with closed answers in a five-point scale ‘Likert’ scale was used. The questions were related to demographics, social data users, and the overall service process in the outpatient Hospital. The sample consisted of 100 patients (RR: 76%) who visited the outpatient clinic in the morning or afternoon over a month long period of time. Results: The results of our research showed that cancer patients reported a high satisfaction rate with the health services provided in outpatient department of Anti-Cancer Hospital. The highest reported levels of satisfaction were related to working with medical staff because of the special relationship of trust that patients develop with their physician. Some problems were noted during the morning shift by patients. Patients reported frustration over long waiting times to get an appointment, last minute appointments, lack of flexibility when making appointments and long waiting times before being examined by a doctor. No statistically significant relationship was found between overall satisfaction with demographics’ and other factors, although the grading services seem to be affected by the health status of patients, education and sex. Conclusion: The problems that were identified leading to less patient satisfaction were the long waiting periods to get an appointment, last minute appointments, non-flexibility in making appointments and long waiting times to be examined by the doctor. Administration should increase its efforts to upgrade the quality of health care provided to oncology patients by taking all the necessary measures.

The impact of occupational stress on nurses’ caring behaviors and their health related quality of life

BackgroundNursing is perceived as a strenuous job. Although past research has documented that stress influences nurses’ health in association with quality of life, the relation between stress and caring behaviors remains relatively unexamined, especially in the Greek working environment, where it is the first time that this specific issue is being studied. The aim was to investigate and explore the correlation amidst occupational stress, caring behaviors and their quality of life in association to health.MethodsA correlational study of nurses (N = 246) who worked at public and private units was conducted in 2013 in Greece. The variables were operationalized using three research instruments: (1) the Expanded Nursing Stress Scale (ENSS), (2) the Health Survey SF-12 and (3) the Caring Behaviors Inventory (CBI). Univariate and multivariate analyses were performed.ResultsContact with death, patients and their families, conflicts with supervisors and uncertainty about the therapeutic effect caused significantly higher stress among participants. A significant negative correlation was observed amidst total stress and the four dimensions of CBI. Certain stress factors were significant and independent predictors of each CBI dimension. Conflicts with co-workers was revealed as an independent predicting factor for affirmation of human presence, professional knowledge and skills and patient respectfulness dimensions, conflicts with doctors for respect for patient, while conflicts with supervisors and uncertainty concerning treatment dimensions were an independent predictor for positive connectedness. Finally, discrimination stress factor was revealed as an independent predictor of quality of life related to physical health, while stress resulting from conflicts with supervisors was independently associated with mental health.ConclusionOccupational stress affects nurses’ health-related quality of life negatively, while it can also be considered as an influence on patient outcomes.

Austerity and its consequences on cancer screening in Greece

1 Control measures of prescribing and laboratory exams performance exam. Offi cial Journal of the Hellenic Republic Series B. http://www.ygeianet.gr/box/cal/44823.pdf (accessed Sept 30, 2014). 2 Dimitrakaki C, Boulamatsis D, Mariolis A, Kontodimopoulos N, Niakas D, Tountas Y. Use of cancer screening services in Greece and associated social factors: results from the nation-wide Hellas Health I survey. Eur J Cancer Prev 2009; 18: 248–57. 3 Organisation for Economic Co-operation and Development. Health at a glance 2013: OECD indicators. Paris: Organisation for Economic Co-operation and Development Publishing, 2013. 4 Hellenic Ministry of Health. National Anticancer Action Plan 2011–2015. http://www.anticancer. gov.gr (accessed Sept 30, 2014). 5 Anttila A, Ronco G, Cliff ord G, Bray F, Hakama M, Arbyn M. Cervical cancer screening programmes and policies in 18 European countries. Br J Cancer 2004; 91: 935–41. 6 Hellenic Statistical Authority. Estimated population by sex and 5-year age groups on 1st January (years 2001–2013). http://www. statistics.gr/portal/page/portal/ESYE/ PAGEthemes?p_param=A1605&r_ param=SPO18&y_param=2012_00&mytabs=0 (accessed Sept 30, 2014). the prevailing guidelines. The regulation does not mention the need for hormonal therapy. And the statement that any operation that changes gender-linked traits shall be done in synchronisation with or subsequent to gonadectomy is medically questionable. Third, the present regulation does not specify penalties for possible violations, which could encourage violation. In view of these fl aws in the present regulation, future regulations on sex reassignment surgery should be aimed at health promotion rather than mere management, and more humane and meticulous thinking.

Motivation among physicians in Greek public health-care sector.

Aims: The aim of this study is to examine the issue of motivation of physicians employed at Greek public hospitals. Methodology: Through the review of relevant literature, an attempt to examine the trends in this issue in Greek public health care sector has been made. Various electronic databases were searched by the authors and through systematic selection 41 scientific articles, studies and electronic sources were identified, that this literature review is based on. The selection was based in two different criteria : for the theoretical background of the issue of motivation, articles and books that considered to be fundamental for the formulation of the subsequent theories were selected, while for the relevant to the main research question literature (motivation in Greek physicians) the most recent data were selected. Results: Motivation of doctors is a highly complex issue that presents an intense differentiation compared with other aspects of staff handling. According to the literature, financial incentives cannot by themselves motivate physicians. On the contrary, the development and utilization of incentives that are associated with achievement of goals, possibility of professional development and recognition in the workplace, appears more effective. Review Article British Journal of Medicine & Medical Research, 4(5): 1094-1105, 2014 1095 Conclusion: Proper diagnosis of the needs of the doctors in the hospital and the selection of appropriate techniques, as these arise through various theories of motivation, can help in the efficiency and efficacy of health care services. Especially in a time of prolonged economic downturn, while the health needs of the population are increased and budgetary constraints compound the difficulties of their effective coverage, searching for administration models that will be able to take full advantage of material and human resources are inevitably in the spotlight of our interest.

Burnout among nurses working in social welfare centers for the disabled

BackgroundIn the healthcare sector, we often come across the burnout syndrome. It is an occupational syndrome which causes, physical and emotional exhaustion. More information is needed on the dangers of burnout and how often it occurs in healthcare. The purpose of this study was to investigate burnout and factors associated with the syndrome among nurses working with people that are mentally challenged.MethodsA cross-sectional survey was conducted, among 180 nurses working in public health centers for the disabled in multiple regions of Greece. A self-administered questionnaire with questions about socio-demographic and work-related characteristics was used, as well as the Maslach Burnout Inventory (MBI) for burnout assessment. Univariate and multivariate analyzes were performed.ResultsThe burnout dimensions of emotional exhaustion (Mean = 31.36) and depersonalization (Mean = 11.27) were at high levels while personal accomplishment was at low levels (Mean = 44.02). Female nurses had a higher personal accomplishment score (Mean = 44.82, p = 0.047) than men (Mean = 42.10, p = 0.047). Marital status, daily routine and relationships with supervisors were significantly related with emotional exhaustion and personal accomplishment and professional experience with higher levels of emotional exhaustion and depersonalization. Reason for professional selection was an independent predictor for depersonalization and personal accomplishment, with those that have selected the nursing profession randomly or because of the fear of unemployment having higher scores. Moderate relationships with colleagues was an independent predictor for all burnout dimensions.ConclusionsNurses working in services for people with intellectual disabilities in Greece show increased burnout levels. Burnout can be prevented by offering more opportunities for professional advancement and education, new ways to provide supervisor support, provide incentives for nurses to initiate or participate in innovative programs. Specific training on conflict resolution, collaboration, reinforcement and stress coping techniques must be implemented.

Pathogenesis and treatment of post-operative cognitive dysfunction.

Cognitive disorders common in the post-operative period, are the post-operative delirium (POD) and the post-operative cognitive dysfunction (POCD). The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not mention POCD as a separate disease entity, and thus little is known about the pathogenesis of this disorder. The aim of this study was to review, detect and highlight the most important data cited, regarding pathogenesis mechanisms and treatment of the post-operative cognitive dysfunction (POCD). The study was carried out from March 2015 to June 2015. Literature review was achieved by searching a number of bibliographic databases including PubMed, Google Scholar and SCOPUS, surveying published articles from 1955 to 2014. As far as the selection criteria, the material consists of scientific articles published mainly over the last fifteen years, while material published before 2000 was selected because it was considered to be important. This review showed that deficits are observed in one or more discrete areas of the patient’s mental state, such as attention, concentration, memory, psychomotor speed and more. This condition is usually developed over a period of more than a week or month after surgery and is more common in elderly patients. Mechanisms that have been proposed to explain this phenomenon are hyperventilation, hypotension, cerebral microemboli and inflammatory mechanisms. Its differential diagnosis will be made mainly from delirium. POCD treatment will first include the exclusion of any other serious diseases that can cause organic psychosyndrome and then focus on the actual symptoms.

Social capital and job satisfaction among substance abuse treatment employees

BackgroundJob satisfaction is an important predictor for management and clinical ratios. Although it is accepted that is affected by many aspects, the influence of social capital remains to be determined. The main purpose of the article is to examine the relationship between job satisfaction and individual social capital for employees offering services in the treatment of addiction.MethodsA cross-sectional study was conducted on 239 employees from 14 therapeutic programs at KETEA (Therapy Center for Dependent Individuals in Greece) (KETHEA). A revised Greek Version of the Social Capital Questionnaire (SCQ-G) for the individual social capital measurement, and of the Job Satisfaction Survey (JSS) for the job satisfaction measurement, were used.ResultsIndividual Social Capital ranged in medium levels. We observed a significant positive association between social capital and its’ different aspects and gender, age, place of residence and working experience. Men, older employees, those who lived in smaller places, and those working more years, reached higher levels of individual social capital. Concerning overall job satisfaction most of the participants were ambivalent (61.5%), while 21.8% were satisfied and 16.7% were dissatisfied. Concerning its separate aspects, 77% were least satisfied with pay, 69.9% were least satisfied with advancement opportunities, 60.3% were least satisfied with fringe benefits, 85.8% were most satisfied with the nature of their work, 80.8% with their relationship with colleagues, and 77.8% were satisfied with supervision. Total Job Satisfaction was positively associated with place of residence and monthly salary. A significant positive correlation between social capital and job satisfaction was also observed.ConclusionsEarly evidence suggests that social capital is associated with job satisfaction of employees providing services in the treatment of substance abuse. Further research, regarding social capital on job satisfaction, is suggested. We need to design and implement individual and organizational interventions for the empowerment of Social Capital.

Depression and Anxiety in Greek Male Veterans After Retirement

INTRODUCTION Retirement is a turning point in human life, resulting in changes to physical and mental health status. The aim of this study was to examine the factors that are related with depression and anxiety symptoms in Greek male veterans after retirement. MATERIALS AND METHODS A total of 502 veterans participated in a cross-sectional study. Beck Depression Inventory for depression assessment and Spielberger Trait Anxiety Inventory for anxiety assessment were used. The Ethics Committee of the Technological Educational Institution of Thessaly granted permission for conducting the research, and informed consent was obtained from all the participants. Questionnaires were filled in electronically using a platform that was made for the specific research. Mean values, standard deviations, Student t test, nonparametric cluster analysis of variance, Pearsons and Spearmans coefficients, and linear regression were conducted, using the Statistical Program for Social Services version 19.0. RESULTS Severe depression was found in 3.8% of veterans with a mean score of 6.78, whereas 23.2% displayed mild-to-moderate symptoms of depression. Mean score of state anxiety was found to be 36.55 and of trait anxiety 33.60. Veterans who were discharged because of stressful working conditions, those who have a high body mass index, consume regularly alcohol, smoke and were not satisfied by changes in their everyday life after retirement had significantly more symptoms of depression and anxiety, although those who retired because of family problems had significantly more symptoms of depression. Multivariate linear regression analyses indicated that dissatisfaction related to lifestyle changes had statistically significant effect on symptoms of depression and anxiety, and stressful working conditions as a leading cause for retirement had statistically significant effect on depression. Finally, according to linear regression analyses results, those who were satisfied with their professional evolution had 1.80 times lower score in depression scale. CONCLUSION The sense of satisfaction derived from fulfilling work-related expectations when finishing a career, with changes in everyday life, and smoking and alcohol reduction, may contribute to a better adjustment during the retirement period. To our knowledge, this was the first study examining depression and anxiety levels in Greek veterans, and the sample size was large, covering a randomly chosen veteran population. On the other, it was a convenient sample, although the study results could not focus on direct-term effects of retirement (up to 3 years of retirement from active service). Primitive data may be used for research directions in the future.

Risk Factors for the Development of Post-Operative Cognitive Dysfunction

BACKGROUND Many studies have shown that a large number of patients undergoing surgery show a measurable cognitive deterioration after surgery, while many of them still show cognitive deficits even three months later an operation. These specific cognitive deficits in which there is a temporal association between surgery and mental disorders are defined as postoperative impairment of cognitive function. Among cognitive disorders occurring during the postoperative period, the post-operative cognitive dysfunction (POCD) is less studied. AIM Risk factors concerning POCD will be overviewed in order to be considered as a measure of prevention of POCD. METHOD A literature search using combined keywords was undertaken on bibliographic databases including PubMed, Google Scholar and Scopus and through systematic selection 72 scientific articles were identified. Concerning the selection criteria, the material of this study consists of sources published mainly over the last fifteen years, while some articles that published before 2000 were selected because they were considered to be important. RESULTS These disorders frequently occur in patients of advanced age. It is obvious that as the population of humanity ages, many older people are likely to develop health problems that require surgery and therefore a large number of people are likely to develop post-operative cognitive disorders. For the appearance of POCD, as for other mental disorders (e.g. delirium), several factors are implicated. According to the findings, except the advanced age, genetic polymorphism, idiosyncratic condition, the presence of metabolic syndrome and neurological diseases, the type of anaesthesia and surgical operation and sleep disturbance are among the most important risk factors.

Comparison of Quality of Life before and after pancreaticoduodenectomy: a prospective study

Background Pancreatic cancer is an aggressive malignancy, and surgical resection is the only therapeutic option with pancreaticoduodenectomy being considered the standard of care. It is essential to take into account the patients’ Quality of Life after the resection, in order to make more informed decisions about treatment options. Objective The aim of the study was to determine perceived Quality of Life levels among patients who undergo pancreaticoduodenectomy, in a period of six months after surgery. Methods This prospective study was conducted on all patients (n=40) who underwent pancreaticoduodenectomy in Attikon University General Hospital in Athens, Greece, from January 2013 to June 2015. The Quality of Life was assessed by use of EORTC QLQ-C30 and EORTC QOL-PAN26 questionnaires at four phases: First, after admission at the hospital preoperatively, and then one month, three months, and six months postoperatively. Repeated measurements analysis of variance (ANOVA) was used in order to evaluate changes in Quality of Life measures during the follow-up (postoperative) period. Data analysis was conducted using SPSS version 19. A p-value of less than or equal to 0.05 was set as the level of significance. Results The study revealed a mixed image. Except for the nausea and vomiting scale, where indeed a symptom increase is initially reported and then gradually decreases below preoperative levels by 6 months, scoring in many symptom scales worsens postoperatively. From first to fourth assessment, fatigue (Mean from 23.61 to 38.72, p=0.005) and financial difficulties scoring (Mean from 5.98 to 42.42, p<0.001) consistently worsen. Functionality scales scoring also tends to get worse between first and fourth assessment, with statistically significant changes for physical (p<0.001), role (p<0.001) and social functioning (p<0.001). However, a slight improvement can be noted in many scales from third to fourth assessment, as in diarrhea (Mean from 32.38 to 29.29), pancreatic pain (Mean from 17.71 to 2.34), global health status (Mean from 50.48 to 52.53) and social functioning (Mean from 43.81 to 48.48) scales. Conclusions Quality of Life levels among patients who undergo pancreaticoduodenectomy are getting worse following surgery. However, the longitudinal study of these changes may improve patients’ postoperative life by formulating evidence-based interventions concerning symptoms treatment and psychological and social support.