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

John C. Carapanayiotis (1909. – 1999.): grčki radiolog i pionir fizijatrije u Grčkoj

John C. Carapanayiotis was specialized in physical medicine and rehabilitation in the USA in 1948, at a time when the medical world in post-war Greece was ignorant of this specific medical specialty, and the political, economic and social backdrop was incapable of accepting and understanding the wealth of scientific knowledge that he was trying to introduce. At this point it should be noted that the specialty of Physical Medicine and Rehabilitation was established in Greece in 1973. John C. Carapanayiotis was a member of the American Congress of Physical Medicine during the 1950’s. In the same period, he expressed interest, on behalf of the New York University, in the establishment of a Physical Therapy Clinic in Greece, which would be granted unlimited funding by the Marshal Plan. His efforts clashed constantly with the backward mentality of his time, with the entrenched conservatism and with the bureaucratic red tape. Unfortunately, he was far ahead of his time and was condemned to the same fate as all other visionaries and pioneers in the way that his knowledge and scientific background were not put into practice for decades to come.John C. Carapanayiotis specijalizirao je fizikalnu medicine i rehabilitaciju 1948. u SAD-u, u vrijeme kada medicinski svijet u poslijeratnoj Grčkoj još nije bio upoznat s ovom specifičnom medicinskom specijalizacijom, a politička, ekonomska i društvena pozadina nije bila spremna prihvatiti bogatstvo znanstvenih spoznaja koje je pokušavao uvesti. Specijalizacija fizikalne medicine i rehabilitacije u Grčkoj je osnovana 1973. godine. John C. Carapanayiotis bio je član Američkog kongresa fizikalne medicine tijekom 1950-ih. U istom je razdoblju izrazio zainteresiranost, u ime Sveučilišta u New Yorku, za osnivanje Klinike za fizikalnu terapiju u Grčkoj, kojoj bi Marshallovim planom bilo odobreno neograničeno financiranje. Njegovi su se napori stalno sukobljavali s nazadnim mentalitetom njegova vremena, s ukorijenjenim konzervativizmom i birokracijom. Bio je daleko ispred svoga vremena, osuđen na sudbinu svih ostalih vizionara i pionira kojima se znanje i znanstvena pozadina nisu primjenjivali još desetljećima

Expression of the O-linked N-acetylglucosamine containing epitope H in normal myometrium and uterine smooth muscle cell tumors

Epitope H contains an O-linked N-acetylglucosamine (O-GlcNAc) residue in a specific conformation and/or environment recognized by monoclonal antibody H (mAbH). We have previously shown that epitope H is present in more than one polypeptide and in various types of normal and pathological cells. In the present study, we focused on uterine smooth muscle cell tumors and their adjacent normal myometrium to gain further insight into the expression patterns of epitope H in human tissues. The indirect immunoperoxidase method was applied using the mAbH and the monoclonal anti-cytokeratin 8 antibody (AbCK8) in 50 cases of typical uterine leiomyomas and in five cases of uterine leiomyosarcomas, with four cases belonging to Group II A and one to Group III according to Bell et at. [6]. Western immunoblotting was applied using mAbH and AbCK8 in five cases of uterine leiomyomas and their adjacent myometrium. The main results were as follows: (1) epitope H showed intense immunohistochemical expression in 46% (23/50) and moderate expression in 54% (27/50) of uterine leiomyomas, (2) epitope H showed intense immunohistochemical expression in 40% (2/5) and moderate expression in 60% (3/5) of uterine leiomyosarcomas, (3) epitope H showed no difference in the immunohistochemical expression between leiomyomas and their adjacent myometrium and between leiomyosarcomas and their adjacent myometrium, (4) immunohistochernical expression of cytokeratin 8 was not detected in the normal and neoplastic smooth muscle cells, (5) Western immunoblotting showed that in the smooth muscle cells of the myometrium and leiomyomas, epitope H is localized in four polypeptides with molecular weights of 100, 61, 59, and 54 kDa, and (6) Western immunoblotting did not detect cytokeratin 8 in the normal and neoplastic smooth muscle cells. The present results indicate fluctuations of the epitope expression levels in uterine smooth muscle cell tumors and their adjacent myometrium. These fluctuations may be of interest for gaining insight into the pathogenesis of uterine smooth muscle cell tumors, since O-GlcNAc glycosylation is involved in cell cycle and apoptosis pathways and may modify proteins involved in oncogenesis (tumor suppressor proteins and oncoproteins) and proteins with important biological functions such as cytoskeletal proteins, transcription factors, and heat-shock proteins. Furthermore, the present results indicate that cytokeratin 8, without being present in the cells of the myometrium, leiomyomas and leiomyosarcomas, shares its epitope H, which contains its unique sugar O-N-acetylglucosamine residue, with four other unrelated polypeptides produced by the normal and neoplastic smooth muscle cells. This should be considered when using anti-cytokeratin 8 antibodies in immunohistochemistry against smooth muscle cell tumors to avoid false positive immunohistochemical results. (c) 2006 Elsevier GmbH. All rights reserved

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

Body Composition in Severe Refractory Asthma: Comparison with COPD Patients and Healthy Smokers

Background: Body composition is an important parameter for patients with chronic obstructive pulmonary disease (COPD) whereas the association between asthma and obesity is not fully understood. The impact of severe refractory asthma (SRA) on fat free mass (FFM) has not been investigated. Methodology and Principal Findings: 213 subjects (70 healthy smokers, 71 COPD patients and 72 asthma patients) without significant comorbidities were included in the study. In all patients, body composition assessment (using bioelectrical impendance analysis, skinfold and anthropometric measurements) and spirometry were performed. Differences in fat free mass index (FFMI) between groups were assessed and determinants of FFMI in asthma were evaluated. Patients with SRA had lower values of FFMI compared to patients with mild-to-moderate asthma [18.0(17.3-18.3)-19.5(18.4-21.5), p<0.001], despite the fact that they were more obese. The levels of FFMI in SRA were lower than those of GOLD stage I-III COPD and comparable to those of stage IV COPD patients [18.0(17.3-18.3)-18.8(17.8-20.1), p = ns]. These differences were present even after proper adjustments for sex, age, smoking status, daily dose of inhaled corticosteroids (ICS) and daily use of oral corticosteroids (OCS). In multivariate analysis, independent predictors of FFMI in asthmatic patients were age, use of OCS and the presence of SRA, but not smoking, sex or cumulative dose of ICS used. Conclusions and Significance: SRA is related to the presence of low FFMI that is comparable to that of GOLD stage IV COPD. The impact of this observation on asthma mechanisms and outcomes should be further investigated in large prospective studies