Variability of clinical target volume delineation for rectal cancer patients planned for neoadjuvant radiotherapy with the aid of the platform Anatom-e

Objective: Delineation of treatment volumes is a major source of uncertainties in radiotherapy (RT). This is also true for rectal cancer patients undergoing neoadjuvant RT, with a potential impact on treatment quality. We investigated the role of the digital platform Anatom-e (Anatom-e Information Sytems Ltd., Houston, Texas) in increasing the compliance to follow a specific treatment protocol in a multicentric setting. Materials and methods: Two clinical cases of locally advanced rectal cancer were chosen. Participants were instructed to follow the 2009 Radiation Therapy Oncology Group consensus atlas and asked to manually segment clinical target volumes (CTVs), for both patient 1 and 2, on day 1 with and without the use of Anatom-e. After one week (day 2), the same radiation oncologist contoured again, with and without Anatom-e, the same CT series. Intraobserver (Intra-OV) and interobserver (Inter-OV) variability were evaluated with the Dice similarity coefficient (DSC), the Hausdorff distance (HD) and mean distance to agreement (MDA). Results: For clinical case 1, no significant difference was found for Intra-OV and Inter-OV. For clinical case 2, no significant difference was found for Intra-OV but a statistically significant difference was found for Inter-OV in DSC when using or not the platform. Mean DCS was 0.65 (SD: ±0.64; range: 0.58–0.79) for day 1 vs reference volume without Anatom-e and 0.72 (SD: ±0.39; range: 0.67–0.77) (p = 0.03) with it. Mean MDA was lower with Anatom-e (3.61; SD: ±1.33; range: 2.85–4.78) than without (4.14; SD: ±2.97; range: 2.18–5.21), with no statistical significance (p = 0.21) The use of Anatom-e decreased the SD from 2.97 to 1.33. Mean HD was lower with Anatom-e (26.06; SD: ±2.05; range: 24.08–32.62), with no statistical significance (p = 0.14) compared to that without (31.39; SD: ±1.31; range: 26.14–48.72). Conclusions: The use of Anatom-e decreased the Inter-OV in the CTV delineation process for locally advanced rectal cancer with complex disease presentation planned for neoadjuvant RT. This system may be potentially helpful in increasing the compliance to follow shared guidelines and protocols. Keywords: Rectal cancer, Neoadjuvant radiotherapy, Interobserver variability, Contouring, Target volume delineatio

The importance of an active case detection (Acd) programme for malaria among migrants from malaria endemic countries: The greek experience in a receptive and vulnerable area

Greecehasbeenmalaria-freesince1974. InOctober2011,followinganoutbreakof36locally acquired malaria (LAM) cases in Evrotas Municipality, a Pro-Active Case Detection (PACD) program for malaria was implemented among migrants from malaria-endemic countries, to support early diagnosis and treatment of cases. We evaluated the PACD program for the years 2012–2017 using indicatorssuchasthenumberoflocallyacquiredcases,thedetectionrate/sensitivityandthetimeliness of diagnosis and treatment. We visited each migrant home every 7–15 days to screen migrants for malaria symptoms, performing Rapid Diagnostic Tests (RDTs) and blood smears on symptomatic patients. We estimated: (i) the number of malaria cases detected by the PACD, divided by the total number of reported malaria cases during the same period among the same population; (ii) the time betweenonsetofsymptoms,diagnosisandinitiationoftreatment. Thetotalnumberofmigrantswho were screened for malaria symptoms for the years 2012–2017 was 5057 with 84,169 fever screenings conducted, while 2288 RDTs and 1736 blood smears were performed. During the same period, 53 imported P. vivax malaria cases were detected, while incidence of malaria among migrants was estimated at 1.8% annually. Ten and one LAM cases were also reportedin 2012 and 2015, respectively. Sensitivity of PACD ranged from 86% to 100%; median timeliness between onset of symptoms and diagnosis decreased from 72 h in 2012 to 12 h in 2017 (83% decrease), while timeliness betweendiagnosis and treatment initiation was 0 h. The implementation of PACD could be considered an effective prevention and response tool against malaria re-introduction

Practice and clinical decision-making autonomy among Hellenic critical care nurses

Background: Nursing autonomy has been associated with better patient-outcomes; therefore, it is a priority for critical care nursing management. Low authority has been a persistent complaint of Hellenic intensive care unit nurses; however, issues of nursing autonomy have not been previously addressed empirically in Hellas. Purpose: To investigate: (1) the perceived contribution to clinical decision-making, (2) the degree of autonomy in technical tasks, and (3) factors related to practice autonomy in critical care nurses in Hellas. Additionally, because of the lack of sufficient tools, this study also aimed to construct and to validate a new tool for assessing practice and clinical decision-making autonomy among Hellenic intensive care unit nurses. Materials and methods: A Hellenic intensive care nursing autonomy scale, focused on technical aspects of care, was developed through literature review, a panel of experts and a pilot study in a random sample of 120 respondents. Items were refined by factor analysis, which revealed three major conceptual categories of autonomy: (1) basic technical, (2) advanced technical, and (3) clinical decision. Hellenic intensive care nursing autonomy (Likert 4, range: 38-152), was distributed to all nurses employed in intensive care units in Hellas (n = 807; attrition: 27%). Comparisons, correlation and multivariate regression were employed. Results: The Hellenic intensive care nursing autonomy scale exhibited appropriate reliability (Cronbach's α = 0.86) and validity properties. Autonomy scores were moderate (mean: 105.24 ± 9.58). Highest autonomy was attributed to basic technical tasks, followed by advanced technical tasks and decision-making. Male gender and higher education were predictors of higher overall, advanced technical and decision-making autonomy (P = 0.01). Bachelor degree graduates scored higher in decisional autonomy (P = 0.03). Intensive care unit experience and type of intensive care unit were also important determinants of decisional autonomy (P = 0.02). Conclusions: The results revealed moderate autonomy in technical tasks and low decisional autonomy among Hellenic intensive care unit nurses. Factors related to the educational preparation of nurses, gender issues and institutional characteristics might hinder intensive care unit nurses' autonomy in Hella

Attitudes toward Vaccinations and Vaccination Coverage Rates among Dental Students in Greece

Our aim was to study attitudes toward vaccinations, full vaccination rates and susceptibility rates against vaccine-preventable diseases among students attending a University Dental School. A total of 134 students were studied. Full vaccination rates were as follows: 56.5% against measles and mumps, 70.6% against rubella, 32.3% against varicella, 44.1% against hepatitis A, 45.9% against hepatitis B, and 87.7% against COVID-19. In the past decade, 63.2% of students had received a booster shot against tetanus–diphtheria, 47.8% against pertussis, and 28.1% against poliomyelitis, while 29.4% of students had been vaccinated against influenza in the past year. Susceptibility rates were 40.4% for measles, 42.4% for mumps, 28.3% for rubella, 32.3% for varicella, 55.3% for hepatitis A, 54.1% for hepatitis B, 36.8% for tetanus–diphtheria, 52.2% for pertussis, and 71.9% for poliomyelitis. Overall, 123 (91.8%) students favored mandatory vaccinations, mainly for all dentists (88.4%), while 11.6% of students favored them only for dentists who provide care to high-risk patients. In conclusion, most dental students favored mandatory vaccinations, yet we found significant vaccination gaps and susceptibility rates against vaccine-preventable diseases. Vaccinations for dental students should be intensified. A national vaccination registry for healthcare personnel including dental students is urgently needed

Marketing in Greek National Health System

Introduction: The international financial situation in combination with an aging population and the appropriation of health services imposes the management of hospital services as a necessity for the survival of hospitals.Aim: To examine the perceptions of 450 upper administrative hospital executives (Nursing, Medicine and Administrative services) in the wider region of Attica, on marketing, communication, and public relations in health-care.Population study: Four hundred and fifty (450) higher health executives from the three basic fields of services in health institutions (medical, nursing, administration) constituted the total sample of the research. These people are employed at 9 of the 36 hospitals in the 3 Health Regions of Attica (H.Re).Materials and method:The type of design that was chosen (to gather data) for the study of attitudes and perceptions of the health personnel of the health institutions of G.S.H (Greek System of Health) is a cross- sectional survey.Results: The participating subjects, even though expressed some reservations at first, formed a favorable attitude towards marketing and its application in the field of health-care. Statistically important correlations emerged between the perceptions of executives and their socio-demographic background including age, sex, education, and profession, work experience in health-care and specifically in their current position in the services as well as statistically important differences between doctors, nurses and administrators as to their perceptions of some issues in marketing.Conclusions: From the comments in the survey it appears there is a need to apply marketing correctly when providing quality care, respecting the patients’ rights and using human and not financial criteria as a guide. Based on the results of the research, important proposals are being submitted in the areas of health-care research, education and clinical practice

Infection control measures during the COVID-19 outbreak: An experience from reopening dental clinics in a university environment.

Abstract Βackground: After almost three months of quarantine due to COVID-19 pandemic the national authorities in accordance with the administration of the Dental School of the National and Kapodistrian University of Athens, made a huge effort to reopen the dental clinics of the School of Dentistry. Methods: The clinics were divided into three categories depending on the production of aerosol. Safety protocols for all personnel, students and patients were incorporated into daily routine. Labs, clinics and examinations were under surveillance of the Infection Control Committee of the School. All groups of students were subdivided, and appropriate distances were kept in all clinics and auditoriums. Strategies to lower patient attendance, reduce of aerosol, check the indoor air quality, monitor all visitors, control sterilization process and waste disposal are discussed further in this paper. Results: Many of the guidelines incorporated urgently due to the pandemic, are about to remain in many settings of the Dental School for future evaluation and better function of labs and clinics. Conclusion: A period of two months for training dental students in advanced safety protocols is needed while reopening due to COVID-19. The cost for protective equipment and single use materials tripled during the operation of dental clinics and laboratories due to COVID-19. Τhe amount of hazardous waste produced in the dental clinics doubled in a period of two months. Public health can be protected if safety protocols and use of protective equipment is used by both staff and students

Antimicrobial Effectiveness of an Usnic-Acid-Containing Self-Decontaminating Coating on Underground Metro Surfaces in Athens

(1) Background: Surfaces have been implicated in the transmission of infections. We aimed to assess how effective an usnic-acid-containing self-decontaminating coating was on the surfaces of the Athens underground metro. (2) Methods: Two samples were collected from each of 60 surfaces of a station and a wagon before the application of the coating and 9 and 20 days after, and they were tested for bacteria, fungi, and SARS-CoV-2 using conventional microbiological and molecular methods. Bacteria and fungi growth were expressed in colony forming units (CFUs)/102cm2. (3) Results: Before the application of the coating, 50% of the samples tested positive for the targeted microbes: 91.7% for bacteria, 18.3% for fungi, and 8.3% for SARS-CoV-2. After nine days, 3.3% of the samples tested positive for bacteria and 6.6% after 20 days. The average amount of bacteria before the coating was applied was 8.5 CFU/102cm2 compared to 0 and 0 CFU/102cm2 after application (100% and 95% reduction); all samples collected after the application were negative for SARS-CoV-2 and fungi (100% reduction). (4) Conclusion: An usnic-acid-containing self-decontaminating coating was highly effective in eliminating bacterial, fungal, and SARS-CoV-2 contamination of surfaces in the underground metro

Performance Evaluation of a Rapid Antigen Test (RAT) during Omicron Pandemic Wave in Greece, Conducted by Different Personnel, and Comparison with Performance in Previous Wave (Alpha Variant) Period

Due to the prevailing ambiguity regarding the performance of rapid antigen tests (RATs) for B.1.1.529 (Omicron) variant diagnosis, a commercial RAT was evaluated in the emergency ward of a general hospital in Larissa, Central Greece. The sampling and the evaluation were repeated twice by different personnel. Discordance between the two samplings was observed regarding the sensitivity (47.5%, 95% CI: 39.0–56.1 vs. 78.6%, 95% CI: 69.1–86.2) and specificity (93.8%, 95% CI: 86.0–97.9 vs. 100.0%, 95% CI: 93.3–100.0) of the RAT. Furthermore, the test displayed slightly lower sensitivity (78.6% vs. 85.5%, 95% CI: 79.1–90.5) compared to its initial evaluation that was conducted by our team when the B.1.1.7 (Alpha) variant was dominant