Implementing a system to evaluate quality assurance in rehabilitation in Greece.

BACKGROUND: Use of a widely accepted quality assurance tool is an essential procedure of effective and result-oriented quality management in the rehabilitation sector, and generally in health care and social services, but is still lacking in Greece. OBJECTIVE: This study aims to explore to what extent a Quality Assurance System in Rehabilitation (QASR) in the Greek setting could respond to the needs for quality evaluation of the facilities for people with a disability and to discuss possibilities of its use in rehabilitation organizations, sites and hospitals. METHODS: The European Quality in Social Services (EQUASS) Assurance self-assessment questionnaire was officially translated and used as the basis for the new tool, which consisted of 110 questions in 11 sections on development and 6 questions on its evaluation. This tool was tested in 15 specialized centers. RESULTS: The study received a high (93.75%) response rate. Overall score ranged from 11% to one perfect 100%; 53.3% of the facilities fell short of the preset qualification standards, while 4 (26.7%) were qualified for level-1 accreditation. Evaluation of the QASR questionnaire for the function of the rehabilitation facilities for the disabled was extremely positive. CONCLUSIONS: The EQUASS assurance-based Greek QASR has received proper attention in its first implementation and it was shown promising to assess the needs of sites that would like to improve their services. The next steps are to establish its validity and reliability so that it can significantly emerge as the standard system for guiding policy in the rehabilitation sector in Greece

Pathways and targets in hepatocellular carcinoma

Expert Rev. Anticancer Ther. 12(10), 1347-1357 (2012) The incidence of hepatocellular carcinoma (HCC) has been rising in several western low-incidence areas over the past decade. The purpose of this review was to summarize the current knowledge on the ‘state of the art’ management of HCC focusing on targeted systemic therapies. The information for this review was compiled by searching the PubMed and MEDLINE databases for articles published until 1 June 2012. Cytotoxic chemotherapy has failed to affect outcome of HCC. Treatment with sorafenib is associated with survival gain in HCC but the responses are not durable. In addition, sorafenib is associated with substantial dermatologic and gastrointestinal toxicity. In this review, the authors summarize molecular targets and signal transduction pathways in HCC and provide an update of published and ongoing studies. Many targeted agents against angiogenesis, Ras/Raf/MAPK, EGF receptor, PI3K/AKT/mTOR, HGF/Met and IGF/IGF receptor are being tested in clinical trials

Towards a standard-based open data ecosystem: analysis of DCAT-AP use at national and European level

In Europe, an open government data ecosystem is being developed. This ecosystem is implemented using various technologies and platforms. In fact, the use of a common metadata standard for describing datasets and open data portals, i.e., the DCAT-AP specification, appears as the lingua franca that connects an, otherwise, fragmented environment. In this context, the standard-based consolidation of open data promotes the subsidiarity principle, allowing open data portal owners to choose platforms and internal representations based on their specific requirements. However, the portal owners must provide an export with DCAT-AP compliant metadata about the dataset they store. In this paper we provide a detailed study of how the DCAT-AP specification is used in practice, both at the national and the European level. Consequently, we also identify issues, challenges, and opportunities for improvements that can be used as input for the next revision cycle of the standard. Essentially, our goal is to contribute towards the enrichment of a growing and promising European open data ecosystem

Impact of renal sympathetic denervation on cardiac magnetic resonance-derived cardiac indices in hypertensive patients - A meta-analysis

Background: Renal sympathetic denervation (RDN) is a safe device-based option for the treatment of hypertension although current guidelines do not recommend its use in routine clinical practice. In this meta-analysis, we investigated the effects of RDN in cardiac magnetic resonance (CMR)-derived cardiac indices. Methods: This meta-analysis was performed in accordance with the PRISMA statement. A comprehensive systematic search of MEDLINE database and Cochrane library through to January 2021 was performed. The inclusion criteria were studies that enrolled patients undergoing RDN in whom CMR data were provided for left ventricular end-diastolic volume indexed to body surface area (BSA) (LVEDVI), left ventricular end-systolic volume indexed (LVESVI), left ventricular mass indexed (LVMI), and left ventricular ejection fraction (LVEF) pre and post RDN. A random effects model was used for the analyses. Results: Our search strategy revealed 9 studies that were finally included in the meta-analysis (n = 300 patients, mean age: 60 years old, males: 59%). Compared to control group, RDN patients showed significantly lower values in the attained volumes (LVEDVI:-6.70 ml/m(2), p = 0.01; LVESVI:-3.63 ml/m(2), p = 0.006). Moreover, RDN group achieved a statistically significant higher attained LVEF (3.49%, p = 0.01). A non-significant difference was found in the attained LVMI between RDN and control groups (-2.59 g/m(2), p = 0.39). Compared to pre-RDN values, RDN reduces significantly the LVMI, the LVEDVI, and the LVESVI while a non-significant change of LVEF was found. Conclusions: In conclusion, the current study demonstrates the potential beneficial role of RDN in CMRderived cardiac indices that reflect adverse remodeling. However, large, randomized studies are needed to elucidate the role of RDN in cardiac remodeling in hypertension, heart failure, and other clinical settings. (C) 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved

Serum levels of retinol-binding protein-4 are associated with the presence and severity of coronary artery disease

Background: The interplay between the novel adipokine retinol-binding protein-4 (RBP4) and coronary artery disease (CAD) is still obscure. We investigated the relationship between RBP4 levels and the presence and severity of angiographically proven CAD and determined its possible role in acute myocardial infarction (AMI). Methods: 305 individuals with angiographically proven CAD (CAD-patients), were classified into 2 subgroups: 1) acute myocardial infarction (AMI, n = 141), and 2) stable angina (SA, n = 164). Ninety-one age-and sex-matched individuals without CAD, but with at least 2 classical cardiovascular risk factors, served as controls (non-CAD group). RBP4 serum levels were measured at hospital admission and were analyzed in relation to the coronary severity stenosis, assessed by the Gensini-score and the number of coronary narrowed vessels. Other clinical parameters, including insulin levels, HOMA-IR, hsCRP, glycaemic and lipid profile, and left-ventricular ejection fraction were also assessed. Results: Serum RBP4 levels were significantly elevated in patients with CAD compared to non-CAD patients (39.29 +/- 11.72 mg/L vs. 24.83 +/- 11.27 mg/L, p < 0.001). We did not observe a significant difference in RBP4 levels between AMI and SA subgroups (p = 0.734). Logistic regression analysis revealed an independent association of CAD presence with serum RBP4 (beta = 0.163, p = 0.006), and hsCRP (beta = 0.122, p = 0.022) levels, in the whole study group. Among variables, hsCRP (beta = 0.220), HDL (beta = -0.150), and RBP4 (beta = 0.297), correlated in both univariate and multivariate analysis with CAD severity (R-2 = 0.422, p < 0.001). Similarly, RBP4 concentrations increased with the number of coronary narrowed vessels (p < 0.05). Conclusion: Patients with CAD, both SA and AMI, showed elevated RBP4 serum levels. Notably, increased RBP4 concentration seemed to independently correlate with CAD severity, but no with AMI

Quality assessment systems in rehabilitation services for people with a disability in Greece: A critical review

Background: Despite international interest on quality assessment systems (QAS) and their importance in health care accreditation, implementation of a Rehabilitation Services Quality Measurement System still remains a neglected subject in Greece. Objective: To identify appropriate tools for researchers and policy makers to assess the quality of rehabilitation services in Greece, within the current active debate on national health care reform. Methods: A critical review methodology was undertaken, using a systematic approach, aiming to identify the most appropriate tools in the field. Multi-step strategy was followed to gather relevant data, including bibliographical database, internet and hand searches. Results: Twenty-two studies, articles and documents were identified as meeting all inclusion criteria, representing four QAS, compared according to appropriateness, efficiency, and feasibility for general use. The European Quality in Social Services (EQUASS) was evaluated as meeting all of the desired features, such as proper certification, objective measuring, equality, education and training, established guidelines and person-centered approach. Conclusions: EQUASS initiative, developed according to European standards and implemented in resource-limited settings, was recognized as the most adaptive and appropriate system for Greek rehabilitation settings. Health policy makers are urged to take findings into consideration in establishing an integrated, quality-assured rehabilitation system throughout the country. (C) 2013 Elsevier Inc. All rights reserved