Αξιολόγηση γνώσεων και στάσεων φοιτητών Νοσηλευτικής για την ανακουφιστική φροντίδα

Εισαγωγή: Η αποτελεσματική διαχείριση των αναγκών των ασθενών με χρόνια νοσήματα και των οικογενειών τους απαιτεί από τους νοσηλευτές κατάλληλες γνώσεις, δεξιότητες και πεποιθήσεις οι οποίες θα ξεκινούν από τη βασική τους εκπαίδευση. Σκοπός: H διερεύνηση των βασικών γνώσεων και στάσεων των φοιτητών Νοσηλευτικής για την Ανακουφιστική Φροντίδα (ΑΦ) και της σχέσης των δημογραφικών χαρακτηριστικών και προηγούμενων προσωπικών εμπειριών που τις επιδρούν σε αυτές. Δείγμα: 90 φοιτητές 2ου , 3ου και 4ου έτους του τμήματος Νοσηλευτικής ΕΚΠΑ. Μέθοδος: Το ερωτηματολόγιο PCQN χρησιμοποιήθηκε για τη μέτρηση της γνώσης και το FATCOD για τη μέτρηση της στάσης. Αποτελέσματα: Η συνολική μέση βαθμολογία για τις γνώσεις στην ΑΦ ήταν 8,32/20 και για τη στάση για τη φροντίδα ασθενών στο τέλος της ζωής 112/150. Οι 4ετεις φοιτητές είχαν περισσότερες γνώσεις και θετικότερη στάση σε σχέση με τους 2ετεις και 3ετεις φοιτητές. Οι φοιτητές του 2ου έτους είχαν κατά 23,5 μονάδες χαμηλότερη βαθμολογία δηλαδή λιγότερες γνώσεις σε σύγκριση με του 4ετείς. Η παρακολούθηση σεμιναρίων ή διαλέξεων με θέμα την ΑΦ και η εμπειρία τους με ασθενή που πέθανε κατά τη διάρκεια της κλινικής άσκησης συσχετίστηκαν με αυξημένες γνώσεις. Οι γυναίκες και οι έγγαμοι παρουσίασαν θετικότερη στάση για τη φροντίδα των ασθενών στο τέλος της ζωής. Όσοι ανέφεραν ότι διδάχθηκαν για τη φροντίδα ασθενών που πεθαίνουν στο πλαίσιο του προγράμματος σπουδών φάνηκε να έχουν περισσότερες γνώσεις για την ΑΦ και θετικότερη στάση προς τη φροντίδα των ασθενών που πεθαίνουν. Τέλος όσο περισσότερες γνώσεις για την ΑΦ είχαν οι φοιτητές τόσο θετικότερη ήταν η στάση τους για τη φροντίδα ασθενών στο τέλος της ζωής τους. Συμπεράσματα: Το γεγονός ότι οι 4ετείς φοιτητές είχαν περισσότερες γνώσεις για την ΑΦ και θετικότερη στάση προς τους ανθρώπους που πεθαίνουν από τους 3ετείς και 2ετείς φοιτητές πιθανά να σχετίζεται με τη διδασκαλία του μαθήματος ΑΦ. Ωστόσο χρήζει περαιτέρω μελέτη σε μεγαλύτερο δείγμα, και αναζήτηση και άλλων παραγόντων που πιθανά θα αυξήσουν το επίπεδο των γνώσεων που εκτιμήθηκαν ως ανεπαρκές καθώς και θα βελτιώσουν τη στάση.Introduction: Effective management needs of patients with chronic illnesses and their families requires of nurses appropriate knowledge, skills and beliefs which will start from the basic education. Purpose: Investigate the knowledge and attitudes of nursing students for Palliative Care (PC) and the relationship between demographic characteristics and previous personal experience to affect them. Sample: 90 students of 2nd, 3rd and 4th year of the Athens University Nursing Department. Method: The PCQN questionnaire was used to measure the knowledge and FATCOD for measuring attitudes. Results: The total mean score for knowledge in PC was 8,32/20 and for the attitude to take care of patients at the end of life 112/150. The 4th year students had more knowledge and more positive attitude towards 2nd and 3rd year students. The students of the second year was 23.5 points lower rating that is less knowledge than the 4th year.The attending seminars or lectures on the PC and experience with patient died during clinical practice associated with increased knowledge. Women and married showed a positive attitude to take care of patients at the end of life. Those who reported that they were taught to care for dying patients as part of the curriculum seemed to have more knowledge on PC and positive attitude towards caring for dying patients. Finally as more knowledge on the PC had students were more positive their attitude to patient care at the end of their lives. Conclusions: The fact that 4th year students had more knowledge on PC and positive attitude towards people who die from 3rd and 2nd year students possibly related to teaching the course PC. But needs further study in larger sample, and search other factors that will likely increase the level of knowledge assessed as inadequate and improve posture

Ενισχυμένες ανισότητες Hölder και αντίστροφες Hölder για Gaussian τυχαία διανύσματα

Βασικός στόχος αυτής της εργασίας είναι να παρουσιάσουμε αποτελέσματα των Chen, Δαφνή και Παούρη τα οποία δίνουν αλγεβρικά κριτήρια που εξασφαλίζουν ενισχυμένες ανισότητες Hölder και αντίστροφες Hölder για γινόμενα συναρτήσεων Gaussian τυχαίων διανυσμάτων με αυθαίρετη δομή συνδιακυμάνσεων. Θα δούμε επίσης ότι αυτές οι ανισότητες γενικεύουν κλασικά αποτελέσματα όπως η ανισότητα Prékopa-Leindler, η ανισότητα Brascamp-Lieb καθώς και η αντίστροφή της ανισότητα του Barthe, και θα μελετήσσουμε τη γεωμετρία των επιλέξιμων εκθετών αυτών των ανισοτήτων. Τέλος θα δούμε πώς αυτές οι ανισότητες μπορούν να χρησιμοποιηθούν για να αποδειχθεί η ανισότητα του Ehrhard. Πιο συγκεκριμένα στην εργασία: • Στο 3ο κεφάλαιο παρουσιάζουμε δύο αποδείξεις των Δαφνή, Παούρη και Chen για ενισχυμένες ανισότητες Hölder και αντίστροφες Hölder η πρώτη γίνεται με χρήση της Gaussian ολοκλήρωσης κατά μέρη, ενώ η δεύτερη με χρήση της ημιομάδας Ornstein-Uhlenbeck. •Στο 4ο κεφάλαιο μελετάμε διασυνδέσεις του βασικού Θεωρήματος με γνωστές ανισότητες. Στη συνέχεια θα μελετήσουμε κάποιες γεωμετρικές ιδιότητες των επιλέξιμων εκθετών του βασικού Θεωρήματος, ακόμα θα δείξουμε ότι γενικεύει την Gaussian υπερσυσταλτότητα και την αντίστροφη μορφή της. •Στο 5ο κεφάλαιο θα παρουσιάσουμε το λήμμα του Barthe καθώς και την απόδειξη που αυτός έδωσε, ακόμα παρουσιάζουμε πώς αυτό το Λήμμα μπορεί να γενικευτεί από το Θεώρημα των Δαφνή, Παούρη και Chen. • Στο 6ο κεφάλαιο αποδεικνύουμε μια ακριβή ανισότητα για τις Gaussian ροπές λογαριθμικά κοίλων ή λογαριθμικά κυρτών συναρτήσεων και στη συνέχεια αποδεικνύουμε ένα αποτέλεσμα ευστάθειας για τη λογαριθμική ανισότητα Sobolev. • Στο 7ο κεφάλαιο παρουσιάζουμε μία απόδειξη για την ανισότητα του Ehrhad που οφείλεται στους Παούρη και Neeman, οι οποίοι κατασκευάζουν μια ποσότητα που είναι μονότονη κατά μήκος της ημιομάδας Ornstein-Uhlenbeck.The main goal of this thesis is to present results of Chen, Dafnis and Paouris which provide algebraic criteria that ensure improved Hölder and inverse Hölder inequalities for products of functions of Gaussian random vectors with arbitrary covariance structure. We will also see that these inequalities generalize classical results such as the Prékopa- Leindler inequality, the Brascamp-Lieb inequality and its inverse Barthe inequality, and we will study the geometry of eligible exponents for these inequalities. Finally, we will see how one can use these inequalities to prove the Ehrhard-Borell inequality. More specifically at thesis: • In the 3rd chapter we present two proofs by Dafni, Paouris and Chen for enhanced Hölder and inverse Hölder inequalities, the first is done using Gaussian integration by parts, while the second is using the Ornstein-Uhlenbeck semigroup. • In the 4th chapter we study interconnections of the basic Theorem with known inequalities. Next we will study some geometrical properties of selectable exponents of the Basic Theorem, we will also show that it generalizes Gaussian hypercontractibility and its inverse form. •In the 5th chapter we will present Barthe's Lemma as well as the proof he gave, we also present how this Lemma can be generalized from the Theorem of Dafni, Paouris and Chen. • In chapter 6 we prove an exact inequality for the Gaussian moments of logarithmically concave or logarithmically convex functions and then prove a stability result for the logarithmic Sobolev inequality. • In chapter 7 we present a proof of Ehrhad's inequality due to Paouris and Neeman, who construct a quantity that is monotonic along the Ornstein-Uhlenbeck semigroup

Undergraduate nursing students' knowledge about palliative care and attitudes towards end-of-life care: a three-cohort, cross-sectional survey.

Background: Ensuring adequate knowledge about palliative care and positive attitudes towards death and dying are crucial educational aspects when preparing undergraduate nursing students to respond effectively to the complexities of care for people affected by a progressive, life-limiting illness. In undergraduate nursing education in Greece, the level of students' attained knowledge and developed attitudes towards palliative and end-of-life care remain unknown. Purpose: To investigate undergraduate nursing students' knowledge about palliative care and attitudes towards death and end-of-life care, and explore demographic and academic factors as potential moderators of student knowledge and attitudes. Methods: We conducted a descriptive, cross-sectional, questionnaire-based survey. We recruited 2nd, 3rd and 4th year undergraduate nursing students from the country's two University Faculties. Participants completed a demographic form, the Palliative Care Quiz for Nursing (PCQN), and the Frommelt Attitudes Towards Care of the Dying (FATCOD) questionnaire. Results: The final sample was 529 students (response rate = 87.6%). Mean total PCQN scores revealed low levels of knowledge. Knowledge about pain/symptom management and psychosocial/spiritual care was insufficient. Mean total FATCOD scores indicated positive, liberal and supportive attitudes towards end-of-life care, with 60% of respondents keen to care for a dying person and their family. We noted less positive attitudes mainly in relation to student comfort with the care of a dying person and his/her imminent death. Academic parameters (year of study) and student demographic characteristics (older age) were the most significant moderators of both knowledge and attitudes. Greater knowledge about palliative care was a relatively weak, yet significant, predictor of more liberal attitudes towards care of the dying. Conclusion: Our findings suggest that structured courses in palliative care can be a core part of undergraduate nursing education. Specific attention could be given to such areas patient-health professional communication, misconceptions and biases towards death and dying, and comfort in caring for the dying in order to prepare student nurses to psychologically deal with the sensitive and challenging process of death and dying

Confronting Pharmaceutical Products Selection Criteria: A comparative survey of consumers in Greece, France and Bulgaria

Purpose: The survey at hand explores the factors describing the consumers’ profile in the pharmaceutical markets of three European nations Design/methodology/approach: A primary research was carried out using questionnaires with a sample of citizens (pharmacy customers) in the capital of each nation and aiming to to determine the criteria motivating the customer/patient to purchase particular pharmaceutical preparations and the ultimate goal is to get an objective picture of the buying behavior of Greek, French and Bulgarian consumers Findings: Behavioral motives appear to be affected by health scientists, price, advertising, alternative available options and “public opinion”. Moreover, it appears that customers differ from one nation to the other but also between themselves, both with respect to their choices, as well as their special mode of action. Such individuality mainly results from the different levels of education and basic income of each pharmaceutical products consumer. Comparative study reveals that Frenchmen, Greeks and Bulgarians tend to agree in some common behavioral trends, yet substantially differ in issues of major importance. Research limitations/implications: Any research on the quantitative measurement of perceptions has inherent limitations as it rests on the subjective views and attitudes of the respondents. Additionally, some obstacles emerged in the course of the survey and in regard to the filling-out of the questionnaires in all three countries, thus account must be taken of the following limitations when interpreting the findings: (1) lack of detailed knowledge of the legislative framework for the supply of pharmaceutical products in Bulgaria and France; (2) rapid changes in external factors (legal-political-social) in the case of Greece; (3) inability of personal contact with every respondent in order to get a first-hand view of their “pharmaceutical behavior” and education, and (4) time and resources limitations dictated that the survey be carried out with respect to a very limited and small sample compared to the total population of Athens, Paris and Sofia. Originality/value: This research effort was motivated by former researches relating to the consumers of pharmaceutical products, the knowledge gap that was created with respect to this issue during the years of the financial and more general crisis and the continuous changes in the health system of Greece. The idea for a comparative survey then rested on the practical and substantial comparison of consumers from Greece and those from the two other nations. It was simultaneously reinforced by the fact that no other similar research effort (for Greece-France-Bulgaria) has been published in recent years

Fluid challenges in intensive care: the FENICE study A global inception cohort study

Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC.This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC.2213 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during an FC was 500 ml (500-1000). The median time was 24 min (40-60 min), and the median rate of FC was 1000 [500-1333] ml/h. The main indication for FC was hypotension in 1211 (59 %, CI 57-61 %). In 43 % (CI 41-45 %) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36 %, CI 34-37 %). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22 %, CI 20-24 %). No safety variable for the FC was used in 72 % (CI 70-74 %) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response.The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Thermodynamic and kinetic phenomena in the enzymatic conversion of acetophenone to 1-(R)-phenylethanol in a continuous gas/solid reactor

Nowadays, the Gas/Solid Biocatalytic Systems gain continuously ground within the area of the Non-Conventional Biocatalysis. In order to use the gas/solid catalysis for analytical and synthetical purposes, the respective process has to be understood in detail. Therefore, the construction and characterization of a continuous gas/solid reactor was here demonstrated. The overlaying thermodynamic and kinetic phenomena taking place during the reduction of acetophenone to 1-(R)-phenylethanol with the concomitant oxidation of 2-propanol to acetone catalyzed by deposited wild type LBADH were described. The operation of the reactor set-up was validated and the achievement of thermodynamic control was proven. At the validated system, the mass transfer along the packed bed was investigated and axial dispersion of the reacting compounds along the packed-bed was predicted. Nevertheless, the dispersion over the packed-bed was overlaid by a pronounced adsorption of acetophenone, reaching up to 6 mgacetophenone/mgprotein. The role of water was investigated through adsorption studies and was proven to be central, influencing and interconnecting the separately studied phenomena. The hydration of the deposited enzyme was described by a BET-like isotherm. It was shown that the presence of sucrose in the enzyme preparation is significant for water activities exceeding 0.5 and reaches a factor of 2 with respect to bead mass at a water activity of 0.9. Significant hysteresis during water desorption was identified, resulting in up to 0.6 mgwater/mgprotein for lyophilized enzyme and up to 10 mgwater/mgprotein for deposited enzyme preparation. The minimal water activity at which measurable conversion at the reactor was achieved was shown to be between 0.2 and 0.25, corresponding to approximately 5 mgwater/mgprotein of adsorbed water, whereas further increase of the water activity of the reaction mixture led to an almost exponential increase of the conversion. A kinetic study was performed, under strictly reaction rate limiting conditions that demonstrated a first order kinetic pattern with respect to acetophenone (vmax/KM=0.0046 µmol/min/IU) and a Michaelis-Menten pattern with respect to 2-propanol (vmax=0.0046 µmol/min/IU and KM=0.105). The stability of the deposited wild type LBADH without sucrose was investigated under standard operating conditions and the significant role of water activity was underlined. The purification state of the enzyme prior to deposition and the handling of the deposited enzyme preparation were highlighted as decisive factors for the operational stability. A comparative study of the operational stability of the wild type LBADH and the G37D NADH-dependent mutant demonstrated that the prediction of enzyme properties from data obtained in solution is not straightforward. The enantioselectivity of the enzyme in the studied reaction system was also investigated. The acetophenone conversion was performed with high enantioselectivity in the gas/solid reactor, yielding enantiomeric excess values approaching 99.5 %, at all commonly used operating conditions. The most significant parameter influencing the enantioselectivity was found to be the water activity of the reaction mixture. Throughout the overall project the performance of the reactor set-up as well as of the deposited enzyme preparation was tested and challenged. Several weaknesses of the immobilization method of choice were revealed: pronounced diffusional limitation at high specific activities of deposited enzyme preparation with sucrose, leaching of the enzyme from its support at higher humidity levels, effect of the enzyme preparation handling on the measurement reproducibility and others. Those effects suggested the choice of a stronger, probably covalent immobilization method in the future and/or use of porous carriers