Monitoring Seasonal Compliance of Patients with Obstructive Sleep Apnea Using CPAP Systems via SD Card.

Background: Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent upper airway collapse during sleep, leading to neurological and cardiovascular adverse effects. Objective: The present study aimed to explore seasonal compliance with Continuous Positive Airway Pressure (CPAP) therapy among OSA patients in Greece. Methods: Data from 954 OSA patients using CPAP devices were collected during summer and winter months. Factors evaluated included the Apnea-Hypopnea Index (AHI), mask type, mask leaks, and hours of CPAP device usage. Results: The majority of patients were male (78.2%) and aged 60 years or above (58.5%). Most patients had been using CPAP for over 2 years (82.8%), with auto CPAP devices and nasal or pillow masks being most common. Compliance was observed in 57.7% of patients, while 22.1% were non-compliant. A significant number of patients (8.2% and 12%) were compliant only in summer or winter, respectively. Compliance was influenced by duration of CPAP use, BMI up to 25, and the use of nasal/pillow masks. Higher compliance was associated with lower summer severity and both low and severe winter severity. Logistic regression analysis confirmed these findings. Conclusion: The findings suggest that utilizing CPAP device data can provide actionable insights on seasonal compliance among OSA patients. Summer compliance is lower, and the use of nasal/pillow masks and auto CPAP devices is recommended for improved compliance.

A Multivariate Study on the Adherence With Non-invasive Ventilation in People With Obstructive Sleep Apnea.

Background: Obstructive Sleep Apnea (OSA) is a sleep disorder that affects a significant number of people worldwide. While Continuous Positive Airway Pressure (CPAP) devices have been proven to be effective in relieving symptoms, ensuring consistent use of those devices throughout the year can be challenging for a lot of patients. Objective: The present quantitative observational study in non-invasive ventilation for OSA patients explores adherence and attempts to identify independent predicting factors and year-round adherence differences in a large sample of OSA patients from Greece. Methods: Data from 1987 OSA patients using Continuous Positive Airway Pressure (CPAP) devices were collected in 2023. Factors evaluated in the study included the Apnea-Hypopnea Index (AHI), mask type, mask leaks and hours of CPAP device usage. Results: The majority were males (77.2%), aged over 60 years (57.9%). CPAP use varied, with 14.0% in their first year, 44.2% for 2-4 years, and 41.7% for <4 years. Adherence was highest in more than 4 years users (54.9%) and nasal/pillow mask users (59.1%). Seasonal adherence varied, with summer having the most non-adherent patients (32.8%). Multinomial logistic regression showed BMI, mask type and seasonal severity influenced adherence. Full-face masks positively impacted adherence (OR=0.585, p=0.001). Non-adherence was associated with higher mask leaking in spring (OR=3.051, p=0.018) and usage of CPAP for < 4 years (OR=3.855, p=0.001). For 50% and 75% adherence, seasonal mask leaking and usage duration influenced adherence. Conclusion: CPAP device data can provide valuable insights to OSA therapy compliance. Seasonality plays an important role in adherence to the CPAP device use as is the type of mask with relation to air leaking.

Informal carers' experiences and feelings during rehabilitation.

The purpose of this study was to explore the experiences and feelings of people caring for patients with long-term diseases in a rehabilitation centre. A qualitative research approach was used. Fifteen informal carers were interviewed. The study was conducted in a rehabilitation centre in Greece. Three themes emerged. The first was feelings regarding the patient and the carers themselves, as well as the type of care provided and life at home after discharge from the rehabilitation unit. The second was experiences regarding health professionals and delivered care, and other carers. The third theme was expectations and thoughts about the future. Health professionals should plan and implement support interventions within rehabilitation settings in order to address carers' needs in terms of practical guidance not only within the framework of patient care but also relating to the psychological and physical wellbeing of informal carers.

Informal Caregivers in Greek Hospitals: a Unique Phenomenon of a Health System in Financial Crisis.

BACKGROUND: In Greece it is quite common for family members to provide informal unpaid care for another family member during hospitalization, alongside healthcare professionals. Understaffing and lack of nursing personnel, due to austerity measures implemented in Greece during the last eight years, force families to provide informal care during hospitalization. The aim of the research was to study the role of informal caregivers (IC) during a family's member hospitalization, factors affecting their presence and patient's needs that were met by them. MATERIAL AND METHODS: This cross-sectional study was conducted in five medical wards of a tertiary general hospital in big city of Northern Greece, during 14 weeks using a questionnaire with demographics, clinical data, and type and frequency of interventions performed by ICs. Patient/nurse ratio was also recorded. RESULTS: On the total, 210 ICs participated (63.42% response rate). The vast majority of ICs were females, married, close relatives and in their late forties. More than half of them (58.1%, n=122) stayed by their patient bedside for more than 17 hours per day, as it was found that 13.8 patients were allocated to each nurse. Less than one quarter of ICs reported that their patient's status was not serious at all and according to them, one third of the patients were totally dependent and one fifth were totally self-sufficient and able to take care of themselves. Nineteen out of the twenty three interventions performed by caregivers were interventions of basic nursing care. CONCLUSION: The GHS administration officials are called to consider nursing understaffing in order to provide adequate and safe care. As new personnel is very difficult to be hired, family members could be trained, through structured programs, in basic nursing skills and interventions, so that they could participate in their family member's care and provide continuity of care at home.

Factors Affecting Mental Patients' Behaviors and Attitudes Regarding Smoking

Background: Patients with mental health problems are in high risk to develop addiction, since smoking incidence is three times higher than that of the general population. The aim of the study was to investigate the factors affecting mental health patients' smoking habits. Methods: The sample of study were 356 patients out of 403 initially approached, with 142 hospitalized in hospital facilities and 214 in community settings. The «Smoking in psychiatric hospitals" and General Health Questionnaire (GHQ-28) questionnaires were used. A principal component analysis was performed using the correlation coefficients of the various variables and an orthogonal varimax rotation, in order to interpret the seven factors emerging. Among the variables the most important factors appeared to be the type of healthcare facility, legal status, depression and age. Results: The type of healthcare facility was correlated to demographic characteristics, clinical features, psychopathology and functionality, but also to the attitudes and behaviors related to smoking. More specifically, the in-hospital patients were heavier smokers, about 90% of the patients said they would consider quitting smoking. The various variables had only a small effect on the intention to quit smoking. The comparison of the coefficients of determination of each variable, showed that age had the strongest effect (R2=0.152), while the GHQ D subscale (severe depression) had the least significant effect (R2=0.023). From all (7) factors, it appears that hospitalization was positively correlated with factor 5 and negatively with the factors 2, 3 and 6, legal status (commitment order) negatively with factors 1 and 4, while depression (or consuming antidepressants) positively factor 4 and negatively to factors 1 and 3. Finally, age was the only variable that is associated with the agent 7. Conclusions: Patients are permissive to staff's smoking in the healthcare facility and may resist attempts to restrict it. It is important that these conclusions are taken into account in any systematic attempt to limit smoking within mental health settings.

Pain in chronic kidney disease: prevalence, cause and management.

Pain is an unpleasant sensory and emotional experience and is the most common symptom experienced by renal patients. It can be caused by primary co-morbid diseases, renal replacement therapies, medication or treatment side effects, and its intensity varies from moderate to severe. Pain management in renal patients is difficult, since the distance between pain relief and toxicity is very small. This paper will provide an algorithm for pain management proposed using paracetamol, nonsteroid anti-inflamatory drugs (NSAIDs), mild and stronger opioids as well as complementary techniques. Quality of Life (QoL) and overall enhancement of the patient experience through better pain management are also discussed. To improve pain management it is essential that nurses recognise that they have direct responsibilities related to pain assessment and tailoring of opioid analgesics and better and more detailed education.

CE: continuing education article. Integration of palliative care for patients with stage 5 chronic kidney disease.

Patients with advanced chronic kidney disease (Stage 5 CKD) have palliative care needs similar to patients with cancer. The decision not to commence dialysis or to withdraw from active treatment can have a profound impact upon all those closely involved in the patient's care. It is essential that every effort is made to minimise the physical and psycho-social symptoms experienced by patients who require palliative care. Effective teamwork across professional boundaries and specialities will ensure that patients and their families are provided with maximum comfort during their final days. All members of the healthcare team must strive to ensure patient and family are actively encouraged in the decision-making process surrounding palliative care needs.

CE: Continuing Education Article: MANAGEMENT OF ANAEMIA IN CHRONIC KIDNEY DISEASE.

SUMMARY Anaemia is an almost universal issue that develops in the later stages of chronic kidney disease (CKD) primarily due to a lack of erythropoietin (EPO) and the depressed EPO response in bone marrow. This can have a profound effect on the patient's lifestyle and quality of life. Knowledge of both the psychosocial and clinical areas of CKD is imperative for healthcare professionals so that they can be at the forefront of improvements of CKD patient care.

Management of co-morbid diseases in a patient with established renal failure.

This follows on from an article relating to chronic kidney disease (CKD) and co-morbidities. Not only do these co-morbid diseases cause problems to patients with CKD, they continue to impact upon them when they develop established renal failure (ERF). Various co-morbid conditions can affect the patient including diabetes, hypertension, anaemia and cardiovascular issues. As nephrology nurses we play a fundamental role in patient education, monitoring and management of these factors.

Comparison of nephrology nursing interventions across five European countries.

Comparing nursing interventions between different countries is helpful towards developing a common nursing culture within Europe. The aim of the study was to compare the frequency of 14 specific nursing interventions indicators across five European countries (Belgium, Scotland, Czech Republic, Greece and the North of England). Data were collected as an integral part of the European Practice Database Project across two cycles (2005 and 2006) involving 172 renal centres. Using Pearson's chi-square and descriptive statistics the frequency of 11 out of the 14 nurse intervention indicators was found to vary significantly across the five countries. Indeed specific nurse interventions such as delegation, telephone consultations and laboratory data interpretation potentially identify where nurse activity is changing in response to pressures such as advancing nurse roles, staff shortages and increased patient demand.