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130 σ.Εθνικό Μετσόβιο Πολυτεχνείο--Μεταπτυχιακή Εργασία. Διεπιστημονικό-Διατμηματικό Πρόγραμμα Μεταπτυχιακών Σπουδών (Δ.Π.Μ.Σ.) “Γεωπληροφορική”Από τα παλιά χρόνια οι εκκλησίες όριζαν τις γειτονιές αφού όλες οι υπηρεσίες και δραστηριότητες χωροθετούνταν γύρω από αυτές τόνιζοντας έτσι τη σημασία τους για τον άνθρωπο. Ακόμα και σήμερα με την επέκταση του αστικού ιστού η ανέγερση του ναού σε μια καινούρια περιοχή λαμβάνει ύψιστη σημασία από τον πολεοδόμο. Λαμβάνοντας αυτά υπόψη, έγινε αφορμή για την αξιολόγηση της υφιστάμενης χωροθέτησης εκκλησιών ανά ενορία στην ευρύτερη περιφέρεια της Μητρόπολης Λεμεσού και Επισκοπής Αμαθούντος. Στόχος της εργασίας αυτής είναι η ίδρυση μεθοδολογίας με τον συνδυασμό τεχνικών χωρικής ανάλυσης και τη χρήση των ΓΣΠ η οποία θα είναι σε θέση να κάνει αξιολόγηση χωροθέτησης λειτουργιών και δραστηριοτήτων. Παράλληλα η εργασία θέτει ως στόχο την δημιουργία διαδικτυακής χαρτογραφικής πλατφόρμας όπου θα γίνει δημοσίευση των πρωτογενών δεδομένων και αποτελεσμάτων της χωρικής ανάλυσης για ελεύθερη χρήση.Since the past the temples set the neighborhoods since all services and activities allocated around them stressing their importance for the people. Even today with the extension of urban web the construction of a temple in a new region receives uppermost importance from the city planner. Taking into consideration these, it became the reason for the evaluation of the existing arrangement of churches per parish in the wider region of Metropolis of Limassol and Bishopric of Amathountos. Objective of this thesis is the foundation of a methodology with the combination of techniques of spatial analysis and the use of GIS which will make evaluations of the arrangement of operations and activities. At the same time the thesis places as objective the creation of an internet cartographic platform where the primary data and results of spatial analysis will be published online for free use.Νικόλαος Μάμα

The efficiency of the public dental services (PDS) in Cyprus and selected determinants

Background: Currently there is a dual system of oral healthcare delivery in Cyprus: the public dental system (PDS) run by the Government and the private system provided by private dental practitioners. Although 83% of the population is entitled to free treatment by the PDS only 10% of the population make use of them. As Cyprus faces now the challenges of the introduction of a new health care system and rising healthcare costs in general, surveys that examine, among other things, the efficiency of the PDS become very important as tools to make important cost savings. The aims of this study are to assess trends regarding the number of visits and the age distribution of patients using PDS from 2004 to 2007, to measure the technical efficiency of the PDS and to investigate various factors that may affect it. Methods: Non-parametric Data Envelopment Analysis (DEA) was employed to assess technical efficiency. Two separate cases were examined. Efficiency was calculated, firstly using as inputs the wages and the working hours of the personnel, and secondly the working hours of the personnel and the cost of the materials. As outputs, in both cases, the treatment offered (divided into primary, secondary and tertiary care) and the numbers of visits were used. In the second stage Tobit analysis was used to explore various predictors of efficiency (time per patient, location, age of dentists, age of patients and age of assistants). Results: The study showed that whilst there was an increase in the number of patients using the PDS from 2004 to 2007, only a small proportion of the population (10%) make use of them. Women, middle and older aged patients, make more use of the PDS. Regarding efficiency, there were large differences between the units. The average Technical Efficiency score was 68% in the first model and 81% in the second. Urban areas and low time per patient are predictors of increased efficiency. Conclusion: The results suggest that many of the rural PDS are underperforming. Given that the option of shutting them down is undesirable, measures should be taken to reduce inputs (e. g. by reducing the personnel’s working hours) and to increase outputs (remove barriers, make PDS more accessible and increase the number of patients)

Primary Care Doctors’ Assessment of and Preferences on Their Remuneration

Despite numerous studies on primary care doctors’ remuneration and their job satisfaction, few of them have quantified their views and preferences on certain types of remuneration. This study aimed at reporting these views and preferences on behalf of Greek doctors employed at public primary care. We applied a 13-item questionnaire to a random sample of 212 doctors at National Health Service health centers and their satellite clinics. The results showed that most doctors deem their salary lower than work produced and lower than that of private sector colleagues. Younger respondents highlighted that salary favors dual employment and claim of informal fees from patients. Older respondents underlined the negative impact of salary on productivity and quality of services. Both incentives to work at border areas and choose general practice were deemed unsatisfactory by the vast majority of doctors. Most participants desire a combination of per capita fee with fee-for-service; however, 3 clusters with distinct preferences were formed: general practitioners (GPs) of higher medical grades, GPs of the lowest medical grade, residents and rural doctors. Across them, a descending tolerance to salary-free schemes was observed. Greek primary care doctors are dissatisfied with the current remuneration scheme, maybe more than in the past, but notably the younger doctors are not intended to leave it. However, Greek policy makers should experiment in capitation for more tolerable to risk GPs and introduce pay-for-performance to achieve enhanced access and quality. These interventions should be combined with others in primary care’s new structure in an effort to converge with international standards

Comorbidity burden in patients undergoing left atrial appendage closure

Objective To estimate the risk of in-hospital complications after left atrial appendage closure (LAAC) in relationship with comorbidity burden.Methods Cohort-based observational study using the US National Inpatient Sample database, 1 October 2015 to 31 December 2017. The main outcome of interest was the occurrence of in-hospital major adverse events (MAE) defined as the composite of bleeding complications, acute kidney injury, vascular complications, cardiac complications and postprocedural stroke. Comorbidity burden and thromboembolic risk were assessed by the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Score (ECS) and CHA2DS2-VASc score. MAE were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. The associations of comorbidity with in-hospital MAE were evaluated using logistic regression models.Results A total of 3294 hospitalisations were identified, among these, the mean age was 75.7±8.2 years, 60% were male and 86% whites. The mean CHA2DS2-VASc score was 4.3±1.5 and 29.5% of the patients had previous stroke or transient ischaemic attack. The mean CCI and ECS were 2.2±1.9 and 9.7±5.8, respectively. The overall composite rate of in-hospital MAE after LAAC was 4.6%. Females and non-whites had about 1.5 higher odds of in-hospital AEs as well participants with higher CCI (adjusted OR (aOR): 1.19, 95% CI: 1.13 to 1.24, p<0.001), ECS (aOR: 1.06, 95% CI: 1.05 to 1.08, p<0.001) and CHA2DS2-VASc score (aOR: 1.08, 95% CI: 1.02 to 1.15, p=0.01) were significantly associated with in-hospital MAE.Conclusion In this large cohort of LAAC patients, the majority of them had significant comorbidity burden. In-hospital MAE occurred in 4.6% and female patients, non-whites and those with higher burden of comorbidities were at higher risk of in-hospital MAE after LAAC

Readmissions After Left Atrial Appendage Closure in Patients with Previous Ischemic Stroke or Transient Ischemic Attack

BackgroundWe examined the frequency and risk factors associated with readmissions after left atrial appendage closure (LAAC) in patients with and without previous ischemic stroke/transient ischemic attack (TIA). MethodsHospitalizations for LAAC were identified from the US NRD 2016-2018. The primary outcome was the first unplanned readmission after LAAC, with readmission times stratified into 0 to 30 days and 31 to 180 days. Patients were stratified based on the history of previous stroke/TIA. ResultsOf 12,901 discharges after LAAC, 28% had previous stroke/TIA, and 8.2% and 18% of eligible patients had a 30-day and 31-180-day readmission, respectively. The rate of in-hospital complications and readmissions at both periods were not significantly different between individuals with previous stroke/TIA or not. Cardiac causes represented 28% of 30-day and 32% of 31-to-180-day readmissions, and congestive failure, bleeding and infections were the most common readmission diagnoses. New stroke/TIA accounted for 4% and 6% of the total non-cardiac readmissions at 30- and 31-to-180-day, respectively, and was higher among those with previous stroke/TIA. Female sex as well as index hospitalization LOS >1 day were factors independently associated with 30-day readmissions, whereas LOS, diabetes, renal disease, COPD, and anemia were among the factors associated with 31-180-day readmission. History of stroke/TIA was among the strongest factors associated with non-cardiac causes of readmission. ConclusionUnplanned rehospitalizations were common after LAAC and showed similar frequency for patients with and without previous ischemic stroke/TIA. Female sex as well as index hospitalization length-of-stay >1 day were among the strongest factors which were independently associated with 30-day readmissions

Pre-operative use of aspirin in patients undergoing coronary artery bypass grafting: a systematic review and updated meta-analysis

Background: Aspirin therapy improves saphenous vein graft (SVG) patency in patients undergoing coronary artery bypass graft (CABG), however, its use in the pre-operative period remains controversial. Therefore, we conducted a systematic review and meta-analysis of randomized-controlled trials (RCTs) to update the evidence about risk and benefits of pre-operative aspirin therapy in patients undergoing CABG.Methods: Electronic databases (Medline, Embase, PubMed, Cochrane Library, and Scopus) were searched to identify RCTs evaluating the effect of aspirin versus placebo/control before CABG. Two investigators independently and in duplicate screened citations and extracted data and rated the risk of bias. The strength of evidence was appraised using the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Meta-analysis was performed using a random-effects model. The main outcomes of interest were 30-day mortality, peri-operative myocardial infarction (MI), chest tube drainage and SVG occlusion.Results: A total of 13 RCTs involving 4,377 participants (2,266/2,111 pre-operative aspirin/control) met the inclusion criteria. Pre-operative aspirin reduced the risk of SVG occlusion [risk ratio (RR): 0.69, 95% confidence interval (CI): 0.49-0.97, P=0.03, I-2=16%], but no differences in mortality (RR: 1.41, 95% Cl: 0.73-2.74, I-2=0%) and MI (RR: 0.84, 95% CI: 0.69-1.03, I-2=0%) were found. However, pre-operative aspirin increased chest tube drainage (MD: 100.40 mL, 95% CI: 24.32-176.47 mL, P=0.01, I-2=84%) and surgical re-exploration (RR: 1.52, 95% CI: 1.02-2.27, P=0.04, I-2=8%), with no significant difference in RBC transfusion (RR: 1.06, 95% CI: 0.90-1.25, I-2=35%).Conclusions: Based on trials where the rated body of evidence was of low to very-low quality, pre-operative aspirin improves SVG patency but increases chest tube drainage and need for surgical re-exploration