The first positive evidence that training improves triage decisions in Greece: evidence from emergency nurses at an Academic Tertiary Care Emergency Department.

BACKGROUND Triage refers to the process of patient prioritisation in the emergency department (ED). This is based on the severity of the patient's illness and is performed by emergency nurses (ENs). This has a pivotal role in ensuring patient safety and in ensuring that the ED operates smoothly - so continuous and accurate training are essential. As Emergency Nursing has been formally established in Greece since 2019, it is of the uppermost importance that all Greek ENs should be trained in the use of a standardised triage system. The present study aimed to evaluate the effect of triage training of ENs in the use of the Swiss Triage System (STS) after an intervention of one week. METHODS The effect of triage training was studied experimentally by comparing performance before and one week after training. A sample of thirty-six ENs from the University Department of Emergency Medicine at AHEPA University Hospital took part. The role of training in triage by the STS was assessed by completing the same self-administered questionnaire before and after a 45-minute e-learning program (presentation video of STS but with simulation scenarios) which was available during the period of a week. The post-training test was taken 2 weeks later, after the training process. RESULTS The most promising finding was that there was a significant improvement in the number of correct answers after the training in triage (p<0.001). A significant improvement was also detected (p<0.001) in the questions that tested vigilance in providing safe health services by ENs, whereas there was no significant association between the number of correct answers and years of emergency experience or level of education, - either before or after the intervention. CONCLUSIONS Triage training seems to successfully improve effective and efficient triage. To the best of our knowledge, this is the first study that has demonstrated that triage training has a significant positive impact on triage performance by ENs in Greece. It is planned to support these findings by real time studies in an ED

The effects of sevoflurane on pulmonary hypertension in sepsis

Introduction: Severe sepsis is a major healthcare problem. Aim of the study: The aim of this experimental study was to investigate and elucidate the influence of sevoflurane on pulmonary and systemic circulation in a porcine model of sepsis. Material and Methods: Thirty two female pigs were randomized into four groups. In Group A, animals remained anaesthetized and received no further therapeutic interventions. In Group B, sevoflurane was administered to the animals via the AnaConDa device. In Group C, sepsis was induced by the intravenous administration of 250μg/kg BW lipopolysaccharide (LPS) from Escheria coli, serotype 111:B4. Finally, in Group D, after the administration of LPS, sevoflurane was delivered to the animals via the AnaConDa system. Evaluation of hemodynamic, respiratory and other parameters of the animals was performed at eight phases during the three hours of the study. PASW 18.0 (SPSS Inc., Chicago, IL) was used for data analysis. All p-values less than 0.05 were considered statistically significant. Results: LPS injection increased in a statistically significant manner pulmonary pressures and resistances in Groups C and D, which remained elevated in Group C during the whole study period. On the contrary, in Group D after sevoflurane administration, they exhibited step-by-step reduction and reached the normal values. Systemic arterial pressures decreased in a similar way in Groups C and D after LPS injection. There were no significant differences in Groups A and B. Conclusion: The results of our study demonstrate that subanesthetic administration of sevoflurane improves pulmonary haemodynamics in sepsis without causing any negative systemic effects. However, the possible positive results of this experimental study merit further investigation.Εισαγωγή: Η σοβαρή σήψη αποτελεί ένα σημαντικό παγκόσμιο πρόβλημα υγείας. Σκοπός: Σκοπός αυτής της μελέτης ήταν η διερεύνηση της επίδρασης του sevoflurane στην πνευμονική και συστηματική κυκλοφορία σε ένα πειραματικό μοντέλο σήψης σε χοίρους. Υλικό και Μέθοδος: Τριάντα δύο θηλυκοί χοίροι τυχαιοποιήθηκαν σε τέσσερις ομάδες. Στην Ομάδα Α τα πειραματόζωα παρέμειναν υπό συνθήκες γενικής αναισθησίας και δεν έγινε καμία άλλη παρέμβαση. Στην Ομάδα Β χορηγήθηκε sevoflurane με τη βοήθεια της συσκευής AnaConDa. Στην Ομάδα Γ προκλήθηκε σήψη με την ενδοφλέβια έγχυση 250μg/kg ΒΣ λιποπολυσακχαρίτη (LPS) από Eschericia Coli με ορότυπο 111:B4. Τέλος, στην Ομάδα Δ μετά την πρόκληση της σήψης χορηγήθηκε sevoflurane με τη βοήθεια της συσκευής AnaConDa. Αξιολογήθηκαν αιμοδυναμικές, αναπνευστικές και άλλες παράμετροι σε οκτώ φάσεις κατά τη διάρκεια των τριών συνολικά ωρών του πειράματος. Για την ανάλυση των δεδομένων χρησιμοποιήθηκε το πακέτο PASW 18.0 (SPSS Inc., Chicago, IL). Τιμές p<0,05 θεωρήθηκαν στατιστικά σημαντικές. Αποτελέσματα: Η έγχυση LPS προκάλεσε στατιστικά σημαντική αύξηση των πνευμονικών πιέσεων και αντιστάσεων στις ομάδες Γ και Δ. Μάλιστα, αυτές παρέμειναν σταθερά αυξημένες στην ομάδα Γ καθόλη τη διάρκεια του πειράματος, ενώ στην ομάδα Δ, μετά τη χορήγηση sevoflurane, άρχισαν σταδιακά να μειώνονται και να προσεγγίζουν τη βασική μέτρηση. Οι συστηματικές πιέσεις και αντιστάσεις μειώθηκαν με παρόμοιο τρόπο στις ομάδες Γ και Δ, μετά την έγχυση LPS. Στις ομάδες Α και Β δε διαπιστώθηκαν ιδιαίτερες μεταβολές. Συμπέρασμα: Τα αποτελέσματα της μελέτης μας καταδεικνύουν ότι η υποαναισθητική χορήγηση sevoflurane βελτιώνει την πνευμονική κυκλοφορία σε συνθήκες σήψης, χωρίς να έχει αρνητικές συστηματικές επιδράσεις. Βέβαια, είναι απαραίτητη περαιτέρω διερεύνηση, ώστε να επιβεβαιωθούν τα θετικά αποτελέσματα αυτής της πειραματικής μελέτης

Variant-Related Differences in Laboratory Biomarkers among Patients Affected with Alpha, Delta and Omicron: A Retrospective Whole Viral Genome Sequencing and Hospital-Setting Cohort Study

During the COVID-19 pandemic, different SARS-CoV-2 variants of concern (VOC) with specific characteristics have emerged and spread worldwide. At the same time, clinicians routinely evaluate the results of certain blood tests upon patient admission as well as during hospitalization to assess disease severity and the overall patient status. In the present study, we searched for significant cell blood count and biomarker differences among patients affected with the Alpha, Delta and Omicron VOCs at admission. Data from 330 patients were retrieved regarding age, gender, VOC, cell blood count results (WBC, Neut%, Lymph%, Ig%, PLT), common biomarkers (D-dimers, urea, creatinine, SGOT, SGPT, CRP, IL-6, suPAR), ICU admission and death. Statistical analyses were performed using ANOVA, the Kruskal–Wallis test, two-way ANOVA, Chi-square, T-test, the Mann–Whitney test and logistic regression was performed where appropriate using SPSS v.28 and STATA 14. Age and VOC were significantly associated with hospitalization, whereas significant differences among VOC groups were found for WBC, PLT, Neut%, IL-6, creatinine, CRP, D-dimers and suPAR. Our analyses showed that throughout the current pandemic, not only the SARS-CoV-2 VOCs but also the laboratory parameters that are used to evaluate the patient’s status at admission are subject to changes