S P E C I A L P A P E R Patient Safety and Healthcare Quality

Abstract Introduction: Due to a variety of circumstances and world-wide research findings, patient safety and quality care during hospitalization have emerged as major issues. Patient safety deficits may burden health systems as well as allocated resources. The international community has examined several proposals covering general and systemic aspects in order to improve patient safety; several long-term programs and strategies have also been implemented promoting the participation of health-related agents, and also government agencies and non-governmental organizations. Aim: Those factors that have negative correlations with patient safety and quality healthcare were determined; WHO and EU programs as well as the Greek health policy were also reviewed. Method: Local and international literature was reviewed, including EU and WHO official publications, by using the appropriate keywords. Conclusions: International cooperation on patient safety is necessary in order to improve hospitalization and healthcare quality standards. Such incentives depend heavily on establishing worldwide viable and effective health programs and planning. These improvements also require further steps on safe work procedures, environment safety, hazard management, infection control, safe use of equipment and medication, and sufficient healthcare staff

Diabetic Patients are often Sub-Optimally Aware about their Disease and its Treatment

Background: Diabetes mellitus (DM) represents a continuously growing worldwide threat with major financial impact on the healthcare systems. The importance of tight glycaemic control in patients with DM type II is well established and is most effectively accomplished with the proper cooperation of both the treating physicians aswell as the treated subjects.Aims: The aim of our study was to evaluate the level of awareness of patients with DM type II about the various aspects of DM, including the nature of the disease, its precipitating factors and complications, as well as its treatment.Methodology: The patients were asked to complete anonymously a questionnaire concerning their knowledge about diabetes, its basic pathophysiology and complications, the treatment options and possible side-effects. Data were analyzed using STATA statistical software (Version 9.0).Results: Eighty patients were on oral hypoglycaemic agents (OHA), 34 on insulin while 4 were under a hybrid treatment. Among patients on OHA, 40 patients (50%) were taking a combination of them. 13.4% of the sample was aware of what DM stands for, 84.9% did not know the type of DM they were suffering from, while (85.7%) considered that obesity plays a major role in the pathogenesis of DM. Concerning the therapy of DM, only 54.83% of the patients were aware of the brand names of their antidiabetic medication, 88.2% did not know theirway of action, while 60.5% did not know the possible side effects. The majority of the sample, 60.5%, assumed that blood glucose should be measured only before meals.Conclusions: The knowledge of the subjects visiting the center for the first time was found to be inadequate. This is probably due to inadequate information, non-availability of educational material and improper guidance

The Importance of the Early Sending to the Nephrology Team within the Health Promotion

Introduction: The kidney disease is a common situation, it is accompanied by a significantmorbidity/mortality and despite the development of substitution renal functions methods (SRFM) and transplantation, the prognosis is unfavorable.Aim: The aim of the present review is the assessment of the necessity for sending to theNephrology Team (NT) in the early stage of RF.Results: Lately, it has been documented that the timely sending to the NT, can significantlyimprove the survival of patient with kidney disease. On the contrary, the delayed sending has asa result not only the non timely measure uptake for the delay of the loss of renal function, butalso the later therapy for the uremic complications.According to Eadington (1996) the sending is considered as a delayed, when the provision ofhealthcare services could be improved with the timely contact with the Nephrology Services.Both in Europe and North America, the delayed sending comes up to the 30-40% of people whoare inducted in dialysis.The benefit from the early sending to the NT, it is important and consists of the regimens forthe delay of the kidney disease development,, timely information for the patient about theSRFM, timely vascular preparation or other kind of accessibility, non-urgent dialysis initiation,patients’ training, lower financial cost, less hospitalization days, transplantation preparation andlower mortality.Conclusions: Optimal sending is the timely sending since it makes possible the diagnosis, thedelay of the development of KD and the prevention of the complications. Furthermore, givestime for the appropriate medical and psychological preparation of the patient and the initiation ofdialysis in the appropriate time.The measures which should be adopted include the improvement training and communication ofhealthcare workers and services interference, as well as the enactment of guidelines

Study of the compliance of diabetic patients with their treatment

The aim of this thesis is to evaluate and study the compliance level of patients with diabetes mellitus with regard to their treatment and other factors that burden the disease.Methodology: The tools used in the study were the Demographics Medical History and Other Data Questionnaire (DMHODQ) (pilot study: Cronbach a 0.81), the Life Events Scale, the Morisky Medication Adherence Scale (MMAS-8) and the Diabetes Quality of Life, DQOL Brief Clinical Inventory – Greek Version (pilot study: Cronbach a 0.95). The evaluation of inflammation included control of pro-inflammatory cytokines (IL6, IL10, TNF-α). 613 patients with diabetes in the area of Korinthos, Greece participated in the randomized sampling study (November 2014 - July 2015), 100 of whom participated in blood sampling and chemical selection molecules laboratory measurements were performed. The data were analyzed with the SPSS 22.0.Results: The majority of participants were male (54.8%), with an average age of 70.70 ± 13.49 years, of low educational attainment (basic education 83.6%) and 19.5% residing in an urban area. 89.4% recorded values above the normal weight and the median HbA1c in the sample was 7.1±0.8 mg/dl. Regarding the presence of concurrent diseases, the prevalence of hypertension, coronary artery disease and dyslipidaemia has become the dominant combination. Almost all participants (99.2%) were insured and the monthly cost of medication was 21.2€±16.5€. All respondents reported low or moderate compliance with prescription medication. The mean cytokine values found in the sample patients were IL6 2,108±1,108 pg/ml, IL-10 0,89±0,13 pg/ml and TNF-α 4.12±0.88 pg/ml. Women showed higher rates of diabetes (10.1 ± 7.6 vs 8.9 ± 6.7, p 6 years than those who have suffered from it for 1-5 years showed lower compliance with their medication (2.5±0.5 vs 2.7±0.5, p= 0.001) and enjoyed worse quality of life (40.1±11.2 vs 37.5±9.1, p=0.002). The factors found to affect the patient's health-related quality of life were age, place of residence, IL-6, IL-10 and TNF-α levels, the diagnosis years, HbA1c, smoking patterns, the number of medications, the likelihood of their health being affected in the near future, the attitudes of patients towards their diabetes and their health, medication and treatment, recession and the beliefs that patients hold about their treatment.Conclusions: The results of this study are consistent with the international literature and provide new knowledge due to its novelty (correlation of diabetes, inflammation and quality of life). This research project can contribute, as an epidemiological study, to Health Education and Promotion of Primary Health Care.Σκοπός της παρούσας μελέτης είναι η αξιολόγηση και η μελέτη του επιπέδου συμμόρφωσης των ασθενών με Σακχαρώδη Διαβήτη σε σχέση με την θεραπευτική τους αγωγή και άλλους παράγοντες που επιβαρύνουν τη νόσο.Μεθοδολογία: Τα εργαλεία που χρησιμοποιήθηκαν στη μελέτη ήταν το Ερωτηματολόγιο Δημογραφικών Πληροφοριών, Ιατρικού Ιστορικού και λοιπών στοιχείων (Demographics, Medical History and Other Data Questionnaire, DMHODQ) (πιλοτική μελέτη: Cronbach a 0,81), η Κλίμακα Συμβάντων (Life Events Scale) του τελευταίου έτους, η Κλίμακα Συμμόρφωσης με τη Φαρμακευτική Θεραπεία (Morisky Medication Adherence Scale, MMAS-8) και η Κλίμακα μέτρησης της Σχετιζόμενης με το Διαβήτη Ποιότητας Ζωής (Diabetes Quality of Life, DQOL Brief Clinical Inventory – Greek Version) (πιλοτική μελέτη: Cronbach a 0.95). Η αξιολόγηση της φλεγμονής περιελάμβανε τον έλεγχο προφλεγμονωδών κυτοκινών (IL6, IL10, TNF-a). 613 διαβητικοί ασθενείς του Νομού Κορινθίας συμμετείχαν στη μελέτη με τυχαία δειγματοληψία (Νοέμβριος 2014 - Ιούλιος 2015), εκ των οποίων οι 100 διαβητικοί ασθενείς συμμετείχαν στην αιμοληψία και πραγματοποιήθηκαν οι εργαστηριακές μετρήσεις των χημικών μορίων επιλογής. Τα δεδομένα αναλύθηκαν με το στατιστικό πακέτο SPSS 22.0Αποτελέσματα: Η πλειοψηφία των συμμετεχόντων ήταν άνδρες (54,8%), με μέση ηλικία 70,70±13,49 έτη, χαμηλό μορφωτικό επίπεδο χαμηλό (βασική εκπαίδευση 83,6%) και το 19,5% κατοικούσε σε αστική περιοχή. Το 89,4% κατέγραψε τιμές άνω του φυσιολογικού βάρους και η μέση τιμή γλυκοζυλιωμένης αιμοσφαιρίνης (HbA1c) του δείγματος ήταν 7,1±0,8 mg/dl. Αναφορικά με τη ύπαρξη συνοδών νόσων, κυρίαρχος συνδυασμός αναδείχθηκε η συνύπαρξη υπέρτασης, στεφανιαίας νόσου και δυσλιπιδαιμίας. Σχεδόν όλοι οι συμμετέχοντες (99,2%) ήταν ασφαλισμένοι και το μηνιαίο κόστος της φαρμακευτικής αγωγής ήταν 21,2€±16,5€. Το σύνολο των ερωτηθέντων ανέφεραν χαμηλή ή μέτρια συμμόρφωση με τη συνταγογραφημένη φαρμακευτική αγωγή. Οι μέσες τιμές των κυτοκινών που βρέθηκαν στους ασθενείς του δείγματος ήταν IL6 2,108±1,108 pg/ml, IL-10 0,89±0,13 pg/ml και TNF-a 4,12±0,88 pg/ml.Οι γυναίκες εμφάνισαν υψηλότερα ποσοστά διαβήτη (10,1±7,6 vs 8,9±6,7, p<0,05), ελάμβαναν για θεραπεία συνδυασμό όλων των μεθόδων (16,6% vs 12,2%, p<0,05), ένιωθαν περισσότερο ικανοποιημένες από τη ρύθμιση του διαβήτη τους (3,6±0,8 vs 3,3±0,8, p<0,05) και είχαν υψηλότερα επίπεδα συμμόρφωσης σε σχέση με τους άντρες (2,8±1,3 vs 3,6±1,8, p<0,05). Οι ασθενείς που έμεναν σε αστικές περιοχές είχαν χαμηλότερα επίπεδα IL-6 (p=0,004), λιγότερα έτη διάγνωσης (p=0,001) και παρακολούθησης (p=0,001), χαμηλότερη τιμή γλυκοζυλιωμένης (p=0,001), έκαναν πιο συχνά αιματολογικό έλεγχο (p=0,001), η ζωή τους επηρεάζεται λιγότερο από το διαβήτη (p=0,001), αισθάνονται λιγότερο ανασφαλείς για το μέλλον σε σχέση με τη θεραπευτική αγωγή που ακολουθούν (p=0,001), έχουν χαμηλότερη συμμόρφωση με τη φαρμακευτική θεραπεία (p=0,001) και καλύτερη ποιότητα ζωής (p=0,001). Οι ασθενείς που έπασχαν από διαβήτη περισσότερο από 6 έτη σε σχέση με όσους έπασχαν 1-5 έτη, έχουν χαμηλότερη συμμόρφωση με τη φαρμακευτική τους θεραπεία (2,5±0,5 vs 2,7±0,5, p=0,001) και χειρότερη ποιότητα ζωής (40,1±11,2 vs 37,5±9,1, p=0,002). Οι παράγοντες που βρέθηκαν ότι επηρεάζουν τη σχετιζόμενη με την υγεία ποιότητα ζωής των ασθενών ήταν η ηλικία, ο τόπος διαμονής, τα επίπεδα IL-6, IL-10 και TNF-a, τα έτη που οι ασθενείς έχουν διαγνωσθεί με διαβήτη, η τιμή της γλυκοζιωμένης αιμοσφαιρίνης, τα έτη καπνίσματος, ο αριθμός των φαρμακευτικών σκευασμάτων που λαμβάνουν οι ασθενείς, η πιθανότητα να επηρεαστεί η υγεία τους στο εγγύς μέλλον, οι στάσεις των ασθενών απέναντι στο διαβήτη και την υγεία τους, οι στάσεις των ασθενών απέναντι στη φαρμακευτική και θεραπευτική αγωγή, οι στάσεις των ασθενών απέναντι στην οικονομική κρίση και οι πεποιθήσεις των ασθενών σχετικά με την θεραπευτική τους αγωγή.Συμπεράσματα: Τα αποτελέσματα της μελέτης μας συμφωνούν με τον κύριο όγκο των μελετών της διαθέσιμης διεθνούς βιβλιογραφίας και προσδίδουν νέα γνώση, λόγω του πρωτότυπου της (συσχέτιση σακχαρώδη διαβήτη, φλεγμονής και ποιότητας ζωής). Το συγκεκριμένο ερευνητικό έργο μπορεί να συμβάλλει, ως επιδημιολογική μελέτη, στην Αγωγή και Προαγωγή της Υγείας και την Πρωτοβάθμια Φροντίδα Υγείας

Patient Safety and Healthcare Quality

Introduction: Due to a variety of circumstances and world-wide research findings, patient safety andquality care during hospitalization have emerged as major issues. Patient safety deficits may burdenhealth systems as well as allocated resources. The international community has examined severalproposals covering general and systemic aspects in order to improve patient safety; several long-termprograms and strategies have also been implemented promoting the participation of health-relatedagents, and also government agencies and non-governmental organizations.Aim: Those factors that have negative correlations with patient safety and quality healthcare weredetermined; WHO and EU programs as well as the Greek health policy were also reviewed.Method: Local and international literature was reviewed, including EU and WHO official publications,by using the appropriate keywords.Conclusions: International cooperation on patient safety is necessary in order to improvehospitalization and healthcare quality standards. Such incentives depend heavily on establishing worldwideviable and effective health programs and planning. These improvements also require further stepson safe work procedures, environment safety, hazard management, infection control, safe use ofequipment and medication, and sufficient healthcare staff

Measuring the reliability and validity of the Greek edition of the Diabetes Quality of Life Brief Clinical Inventory

Background: The present study focuses on studying the validity and reliability of the Greek edition of DQOL-BCI. DQOL-BCI includes 15 questions-elements that are evaluated on a 5- grade scale like Likert and two general form-shapes. Methods: The translation process was conducted in conformity with the guidelines of EuroQol group. A non-random sample of 65 people-patients diagnosed with diabetes I and II was selected. The questionnaire that was used to collect the data was the translated version of DQOL-BCI, and included the demographic characteristics of the interviewees. The content validity of DQOL-BCI was re-examined from a team of five experts (expert panel) for qualitative and quantitative performance. The completion of the questionnaire was done via a personal interview. Results: The sample consisted of 58 people (35 men and 23 women, 59.9 ± 10.9 years). The translation of the questionnaire was found appropriate in accordance to the peculiarities of the Greek language and culture. The largest deviation of values is observed in QOL1 (1.71) in comparison to QOL6 (2.98). The difference between the standard deviations is close to 0.6. The statistics results of the tests showed satisfactory content validity and high construct validity, while the high values for Cronbach alpha index (0.95) reveal high reliability and internal consistency. Conclusions: The Greek version of DQOL-BCI has acceptable psychometric properties and appears to demonstrate high internal reliability and satisfactory construct validity, which allows its use as an important tool in evaluating the quality of life of diabetic patients in relation to their health

Investigation of anxiety and depression in patients with chronic diseases

The health of an individual depends on both his/her physical and psychological condition. In recent years it has been observed that chronic patients have frequently an affected psycho-emotional state. The purpose of this study is to investigate anxiety and depression in patients with chronic diseases and the correlation of the results with daily physical activity levels and individual health levels, as well comorbidity. This study included patients with chronic diseases that were treated in a local general hospital or were visiting often outpatient clinics of the same hospital due to their condition. The sample in this particular study included 204 patients; 118 of them were women and 86 men. From the total sample that participated in our research, 118 (57.8%) were females and the majority of the participants were secondary/basic education graduates (67%), married (71%), living in urban areas (53%). Hypertension was the most frequent chronic disease in our sample, followed by hypercholesterolemia and diabetes mellitus. Comparing the occurrence of depression and anxiety symptoms in both questionnaires in relation to the expected frequency in the general population, significant levels of depression and anxiety symptoms were recorded. Taking into consideration the findings of this research, anxiety and depression symptoms can have profound effects regarding the control of chronic diseases, the patients’ quality of life and their general health

Investigation of depression in Greek patients with diabetic peripheral neuropathy

Background: Considerable studies directly connect the complications in diabetic patients, and especially peripheral neuropathy, with the emergence of depression. Neuropathetic pain may deteriorate the general health status of the diabetic patient and glycaemic regulation. Purpose: The purpose of this study was to investigate the appearance and degree of diabetic peripheral neuropathy and its correlation with depression, with other parameters of the disease and also duration. Methods: 57 diabetic patients participated with diagnosed diabetic peripheral neuropathy (male n=27, female n= 30, mean of age 72.7±6.35 years). The first part of Michigan Neuropathy Screening Instrument and the Zung Depression Rating Scale were used as tools for our study. Data was analysed with the SPSS 18.0 statistic program. Results: 57.9% of the patients were overweight, 35.1% were obese and only 7% were within normal weight range. The BMI findings between the two genders indicate that male participants are more often obese than females. Women surpassed men in the category of overweight patients (p<0.05). The score based on MNSI was high and between 3 to 12 (mean average of 8.19±2.60 with 8 as intermediate rate). Almost 60% of patients had severe neuropathy, only 2 were found with mild symptoms and the rest had moderate neuropathtic symptoms, based on the score summary from the questionnaire. Investigating in detail the relation of diabetic neuropathy and depression, it derives that a high degree of diabetic neuropathy is related with high score of depression [F(3.160)=9.821, p=0.001]. Moderate and severe neuropathy was found with almost the same levels of depression. Conclusions: The correlation between diabetic neuropathy and depression is confirmed, while a very high depression rate was found in patients with severe neuropathy. The issue needs further study by using common instruments to obtain comparative results from the scientific community

O R I G I N A L P A P E R . . Diabetic Patients are often Sub-Optimally Aware about their Disease and its Treatment

Abstract Background: Diabetes mellitus (DM) represents a continuously growing worldwide threat with major financial impact on the healthcare systems. The importance of tight glycaemic control in patients with DM type II is well established and is most effectively accomplished with the proper cooperation of both the treating physicians as well as the treated subjects. Aims: The aim of our study was to evaluate the level of awareness of patients with DM type II about the various aspects of DM, including the nature of the disease, its precipitating factors and complications, as well as its treatment. Methodology: The patients were asked to complete anonymously a questionnaire concerning their knowledge about diabetes, its basic pathophysiology and complications, the treatment options and possible side-effects. Data were analyzed using STATA statistical software (Version 9.0). Results: Eighty patients were on oral hypoglycaemic agents (OHA), 34 on insulin while 4 were under a hybrid treatment. Among patients on OHA, 40 patients (50%) were taking a combination of them. 13,4% of the sample was aware of what DM stands for, 84,9% did not know the type of DM they were suffering from, while (85,7%) considered that obesity plays a major role in the pathogenesis of DM. Concerning the therapy of DM, only 54,83% of the patients were aware of the brand names of their antidiabetic medication, 88,2% did not know their way of action, while 60,5% did not know the possible side effects. The majority of the sample, 60,5%, assumed that blood glucose should be measured only before meals. Conclusions: The knowledge of the subjects visiting the center for the first time was found to be inadequate. This is probably due to inadequate information, non-availability of educational material and improper guidance