Petros Galanis

Biliary stenting alone versus biliary stenting plus sphincterotomy for the treatment of post-laparoscopic cholecystectomy biliary leaks: a prospective randomized study.

Objective Although various endoscopic techniques have been proved effective in treating post-cholecystectomy biliary leaks, the choice of the best method remains controversial. The aim of this prospective study was to compare the efficacy and safety of biliary stenting alone with biliary stenting plus sphincterotomy for the treatment of post-cholecystectomy biliary leaks. Methods Patients with post-laparoscopic cholecystectomy leaks were randomized into two groups. The first group included 24 patients who were treated with a 7 Fr biliary stent alone, and the second group included 28 patients who underwent an endoscopic sphincterotomy followed by insertion of a 10 Fr biliary stent. Results Endoscopic therapy was successful in all patients (100%). Clinical improvement was observed after 2–6 days. Patients remained hospitalized for 4–12 days. Stents were removed after 6.7 (6–8) weeks. The overall complication rate was 4.16% for the first group and 10.71% for the second (P=0.615). No complications were recorded during the follow-up period. Conclusions Endoscopic therapy of biliary leaks with a small-diameter biliary stent alone is as effective and safe as endoscopic sphincterotomy followed by insertion of a large-diameter stent.

Endoscopic variceal ligation vs. propranolol for prevention of first variceal bleeding : a randomized controlled trial

Objectives Data in the literature regarding the role of endoscopic variceal ligation for the prevention of first variceal bleeding in cirrhotic patients are controversial. To further explore this issue we have compared ligation and propranolol treatment in a prospective randomized study. Methods Sixty patients with cirrhosis and oesophageal varices with no history but at high risk of bleeding were randomized to ligation treatment (30 patients) or propranolol (30 patients). Patients were followed for approximately 27.5 months. Results Variceal obliteration was achieved in 28 patients (93.3%) after 3±1 sessions. The mean daily dose of propranolol was 60.3±13.3 mg. Two patients (6.7%) in the ligation group and nine patients (30%) in the propranolol group developed variceal bleeding (P=0.043). The actuarial risks of variceal bleeding at 2 years were 6.7% and 25%, respectively. On multivariate analysis, propranolol treatment and grade III varices turned out to be predictive factors for the risk of variceal bleeding. Mortality was not different between the two groups. There were no serious complications due to ligation. Propranolol treatment was discontinued in four patients because of side effects. Conclusions Variceal ligation is a safe and more effective method than propranolol treatment for the prevention of first variceal bleeding in cirrhotic patients with high-risk varices.

Informal payments for maternity health services in public hospitals in Greece.

BACKGROUND Private health expenditure for consuming maternity health services has been identified as an issue within public hospitals. AIM To estimate level of private health expenditure, in the form of informal payments, for maternal services in public hospitals in Greece. METHODS The study population consisted of 160 women who had recently given birth in three provincial general hospitals and one general hospital in Athens. A three-part questionnaire was developed in order to collect financial information regarding the use of public obstetrics services in Greece. RESULTS The mean age of respondents was 29.5 (±5.6) years. There was a high rate of informal payments with 74.4% of women involved in informal transactions. Mean total private payments were €1549 (±992), representing 7.9% of the mean annual per capita income in Greece. Mean informal payment was €848 (±714). For 56.3% of the respondents, it was at the obstetricians request, on top of formal payment of €701 (±1351). Total informal payments were higher for women who gave birth in Athens (p<0.001), for Greek women compared to non Greek (p<0.001) and for deliveries that were conducted by womens personal obstetrician (p=0.001). CONCLUSION There is a large black economy in the field of obstetric services, as 74.4% of women who used public maternity services had to pay under-the-table payments corresponding approximately to the net salary of an intern physician. There is a need for the state to adopt innovative strategies and mechanisms in order to reduce informal payments for obstetric services in the public sector.

Capsule Endoscopy in the Investigation of Patients with Portal Hypertension and Anemia

INTRODUCTION Data on small bowel abnormalities in patients with portal hypertension (PHT) are limited. Bleeding from the gastrointestinal tract and anemia are common complications in these patients. Capsule endoscopy (CE) was used to evaluate small bowel (SB) pathology in patients with PHT and anemia, and possible associations with various parameters were examined. METHODS Thirty-five patients with PHT referred for CE investigation of the SB for anemia were prospectively enrolled in the study, as well as 70 age- and sex-matched control patients with anemia, normal liver function and no evidence of PHT who underwent CE. RESULTS Findings compatible with portal hypertensive enteropathy (PHE) were detected in 65.7% of the patients and in 15.7% of the controls chi2=26.641, P=0.000). Abnormalities in PHT patients included varices in 25.7%, diffuse changes of mucosa with inflammatory-like appearance in 42.9%, and angiodysplasias and/or spider angiomas in 22.9% of cases. The presence of PHE was significantly associated only with the presence of severe portal hypertensive gastropathy, while the presence of SB varices alone was significantly associated with the presence of severe portal hypertensive gastropathy, larger esophageal varices and the presence of colonic varices. CONCLUSIONS Varices, diffuse changes of mucosa with inflammatory-like appearance, and angiodysplasias and/or spider angiomas are detected more often in patients with PHT than in controls, and probably constitute the endoscopic characteristics of PHE. CE of the SB added a significant number of likely important findings to those detected by conventional endoscopic techniques for the clinical management of patients with PHT and anemia.

Comparison of two schemes of small bowel preparation for capsule endoscopy with polyethylene glycol: a prospective, randomized single-blind study.

Objective Small bowel preparation for capsule endoscopy remains controversial. This study was conducted to compare the efficacy of 2 and 4 l of polyethylene glycol. Methods One hundred and one patients (group A) received 2 l and 100 (group B) received 4 l in a prospective, randomized single-blind trial. To objectively evaluate enteric preparation, a cleansing coefficient was calculated for each patient. Results The two groups were found comparable regarding age, sex, body mass index, and reason for referral. In 82 patients of group A and in 76 of group B, examination of small bowel was completed (P=0.40). Gastric emptying time and small bowel transit time were found comparable in both groups. Cleansing coefficients, for small bowel as a whole or for proximal or distal separately, were similar among the two groups. However, the cleansing coefficient of the proximal bowel was significantly higher than that of the distal, independently of preparation (group A: P<0.001, group B: P<0.001). Small bowel preparation was related only with the age of the patients and gastric emptying time; the younger the patient or the shorter the gastric emptying time, the higher the cleansing coefficient. Pathological findings were found in 43 (42.6%) patients of group A and in 37 (37.0%) patients of group B (P=0.42). A final positive diagnosis was established in 33 (32.7%) patients of group A and in 29 (29.0%) of group B (P=0.57). Conclusion The two schemes were equal regarding enteric cleansing and completion of the procedure. Therefore, 2 l seems to be an adequate preparation for capsule endoscopy.

Evaluation of four time-saving methods of reading capsule endoscopy videos.

Objective Review of wireless capsule endoscopy recordings is time consuming. The aim of this study was to evaluate four time-saving methods offered with Rapid Software. Methods A total of 100 wireless capsule endoscopy videos with abnormal findings were evaluated using five different ways of viewing: (a) manual mode at a speed of 10 frames per second (fps), (b) manual mode at a speed of 20 fps, (c) manual mode with a simultaneous display of two images at a speed of 20 fps, (d) automatic mode at a speed of 10 fps, and (e) quickview mode at a speed of 3 fps. Then, we calculated the concordance of abnormal findings between each one of the four time-saving methods using method A. Results The mean reading time with time-saving methods was significantly shorter than with method A (method A: 59.8 min, method B: 30 min, method C: 30.2 min, method D: 32.2 min, method E: 16.3 min). The agreement in finding abnormal lesions between method A and the four evaluated methods was excellent and almost perfect (&kgr;>0.8), except for quickview in recognizing polyps. Diagnostic miss rate was 1% for method D, 2% for B and C, and 12% for E. No tumors and cases of celiac or Crohn’s disease were lost by all four methods. Conclusion We conclude that manual mode/20 fps, the simultaneous projection of two images/20 fps, and automatic mode/10 fps have minimal diagnostic miss rates and can safely replace slower modes in clinical practice. The quickview mode is a safe diagnostic tool only when larger or diffuse lesions are suspected, such as Crohn’s or celiac disease.

Risk factors for prolonged stay in cardiac surgery intensive care units.

AIMS AND OBJECTIVES To identify the factors that might affect the length of stay in the intensive care unit (ICU-LOS) among cardiac surgery patients. BACKGROUND ICU-LOS forms an important factor for assessing the effectiveness of the provided nursing care. A number of factors can be accused for increasing patient hospitalization. The nursing workload (NWL), among others, was found to play a significant role as it is closely associated with the quality of care. DESIGN An observational cohort study among 313 consecutive patients who were admitted to the cardiac surgery intensive care unit of a general, tertiary hospital of Athens, Greece from November 2008 to November 2009. METHODS Data collection was performed by using a short questionnaire (for basic demographic information) and two instruments, the Nursing Activities Score (NAS) and the logistic EuroSCORE, for assessing the NWL and the perioperative risk for each patient respectively. RESULTS ICU-LOS of more than 2 days increased with age and was more common among females (p < 0.001 and p = 0.02, respectively). Multivariate logistic regression analysis revealed a positive association between increased perioperative risk and the increased ICU-LOS [odd ratio (OR) 1.9, 95% confidence interval (CI) 1.0-3.5, p = 0.04], while patients with a first day NAS of more than 61.6% had an almost 5.2 times greater probability to stay in the cardiac surgery unit for more than 2 days (OR 5.2, 95% CI 3.0-8.8, p < 0.001). CONCLUSIONS Increased level of NWL and patient perioperative risk are closely associated with increased ICU-LOS. RELEVANCE TO CLINICAL PRACTICE The correlation between patient perioperative risk and ICU-LOS encourages the early identification of high-risk patients for prolonged hospitalization. Furthermore, the relationship between NWL and ICU-LOS allows the early identification of these patients with the use of an independent nursing tool.

Conflict management in public hospitals: the Cyprus case

BACKGROUND Conflict among health-care personnel has been identified as an issue within health-care settings around the world. AIM To investigate the existence and management of conflict among health-care personnel in public hospitals in Cyprus; to assess the factors leading to conflict among staff members; to evaluate the consequences of conflict arising; and to consider the management strategies. METHODS A self-administered questionnaire was completed by a random sample of 1037 health-care professionals in all (seven) state-run hospitals in Cyprus in 2008. RESULTS Mean age of respondents was 41 years, and 75% were female. Sixty-four per cent of respondents reported that they had never been informed about conflict management strategies, with physicians being the least informed as the relative percentage was 79.8% (χ(2) = 33, P < 0.001). Sixty per cent of health-care professionals reported conflict at work with other health-care personnel one to five times per week, and 37% of the respondents stated that they devote 90 min (mean value) from work during their shift in conflict resolution, meaning that managing conflicts may absorb 19% of working time daily. The majority of respondents agreed that organizational problems and communication gaps were the main issues creating conflict. Avoidance and collaboration were the preferable strategies for conflict resolution, used by 36.6% and 37.5% of the respondents, respectively. CONCLUSION   Better communication, fair management practices and clear job descriptions and expectations may be needed in order to facilitate change and reverse the negative atmosphere that exists. Further education in conflict management for physicians, nurses and their managers may also be needed.

Factors associated with abnormal eating attitudes among Greek adolescents.

OBJECTIVE To estimate the prevalence of abnormal eating attitudes among Greek adolescents and identify possible risk factors associated with these attitudes. DESIGN Cross-sectional, school-based study. SETTING Six randomly selected schools in Patras, southern Greece. PARTICIPANTS The study population consisted of 540 Greek students aged 13-18 years, and the response rate was 97%. MAIN OUTCOME MEASURE The dependent variable was scores on the Eating Attitudes Test-26, with scores > or = 20 indicating abnormal eating attitudes. ANALYSIS Bivariate analysis included independent Student t test, chi-square test, and Fishers exact test. Multivariate logistic regression analysis was applied for the identification of the predictive factors, which were associated independently with abnormal eating attitudes. A 2-sided P value of less than .05 was considered statistically significant. RESULTS The prevalence of abnormal eating attitudes was 16.7%. Multivariate logistic regression analysis demonstrated that females, urban residents, and those with a body mass index outside normal range, a perception of being overweight, body dissatisfaction, and a family member on a diet were independently related to abnormal eating attitudes. CONCLUSIONS AND IMPLICATIONS The results indicate that a proportion of Greek adolescents report abnormal eating attitudes and suggest that multiple factors contribute to the development of these attitudes. These findings are useful for further research into this topic and would be valuable in designing preventive interventions.

Public health services knowledge and utilization among immigrants in Greece: a cross-sectional study

BackgroundDuring the 90s, Greece has been transformed to a host country for immigrants mostly from the Balkans and Eastern European Countries, who currently constitute approximately 9% of the total population. Despite the increasing number of the immigrants, little is known about their health status and their accessibility to healthcare services. This study aimed to explore the perceived barriers to access and utilization of healthcare services by immigrants in Greece.MethodsA pilot cross-sectional study was conducted from January to April 2012 in Athens, Greece. The study population consisted of 191 immigrants who were living in Greece for less than 10 years. We developed a questionnaire that included information about sociodemographic characteristics, health status, public health services knowledge and utilization and difficulties in health services access. Statistical analysis included Pearson’s ×2 test, ×2 test for trend, Student’s t-test, analysis of variance and Pearson’s correlation coefficient.ResultsOnly 20.4% of the participants reported that they had a good/very good degree of knowledge about public health services in Greece. A considerable percentage (62.3%) of the participants needed at least once to use health services but they could not afford it, during the last year, while 49.7% used public health services in the last 12 months in Greece. Among the most important problems were long waiting times in hospitals, difficulties in communication with health professionals and high cost of health care. Increased ability to speak Greek was associated with increased health services knowledge (p<0.001). Increased family monthly income was also associated with less difficulties in accessing health services (p<0.001).ConclusionsThe empowerment and facilitation of health care access for immigrants in Greece is necessary. Depending on the needs of the migrant population, simple measures such as comprehensive information regarding the available health services and the terms for accessibility is an important step towards enabling better access to needed services.