Increased Job Burnout and Reduced Job Satisfaction for Nurses Compared to Other Healthcare Workers after the COVID-19 Pandemic.

Nurses experience high levels of job burnout and low levels of job satisfaction, while the COVID-19 pandemic has deteriorated working conditions. In this context, our aim was to compare levels of job burnout and job satisfaction among nurses and other healthcare workers (HCWs) after the COVID-19 pandemic. Moreover, we investigated the influence of demographics and job characteristics on burnout and satisfaction. We conducted a cross-sectional study with 1760 HCWs during June 2023. We used the single-item burnout measure and the "Job Satisfaction Survey". In our sample, 91.1% of nurses experienced high levels of burnout, while the respective percentage for the other HCWs was 79.9%. Nurses' satisfaction was lower than other HCWs. In particular, 61.0% of nurses experienced low levels of satisfaction, while the respective percentage for the other HCWs was 38.8%. Multivariable analysis identified that nurses, HCWs with an MSc/PhD diploma, shift workers, and those who considered their workplace as understaffed had higher burnout score and lower satisfaction score. Our results showed that the nursing profession was an independent factor of burnout and satisfaction. Several other demographic and job characteristics affected burnout and satisfaction. Policy makers, organizations, and managers should adopt appropriate interventions to improve work conditions.

Photosensitivity During Quinolone Therapy in Diabetic Foot Patients May Falsely Indicate Treatment Failure.

Acute bacterial skin and skin structure infections (ABSSSI), also referred to as skin and soft tissue infections, or skin and skin structure infections, with or without osteomyelitis (OM) in diabetic foot are complications of diabetes. Quinolones are a widely used class of antibiotics in ABSSSI and OM, and photosensitivity is among their adverse reactions. Its appearance may falsely indicate treatment failure. We describe 2 such cases. The first patient is a 49-year-old male with type 2 diabetes mellitus (DM), who presented with left lower limb ulcer with fever (39 °C) over a week. He began treatment with ciprofloxacin, clindamycin, and linezolid. Although his clinical condition and laboratory tests improved, the redness of the left lower limb increased. Clinical examination revealed redness on the face and the parts of the body that had been exposed to sunlight. The patient continued the same antimicrobial therapy and was given instructions to avoid exposure to sunlight. Redness and infection improved, and the patient was discharged. The second case is a 72-year-old male with a history of type 2 DM, admitted to hospital because of an infected ulcer of the first toe of the right limb. The patient received intravenous treatment with levofloxacin and clindamycin. On the fourth hospital day, the patient presented redness (with eczematous plaques) on his left lower limb. Clinical examination revealed that the patient's bed was placed near a window and his left limb was exposed to direct sunlight. Patient's bed was changed to avoid sun exposure. Symptoms began to improve over the next few days.

Clinical and Demographic Predictors of Health-Related Quality of Life After Orthopedic Surgery With Implant Placement.

BACKGROUND: Orthopedic surgeries can rehabilitate injuries and at the same time improve the patients' quality of life. The study aimed to assess patients' health-related quality of life (HRQOL) six months after an orthopedic surgery with implant placement. MATERIALS AND METHODS: A cross-sectional study with the use of a structured questionnaire among 103 patients was conducted. The 36-Item Short Form Survey (SF-36) questionnaire was used to evaluate patients' quality of life. RESULTS: According to the findings of the multivariate linear regression analysis, low age, marital status (married in comparison to unmarried/ divorcees/widows), reduced intensity of the pain, and low educational attainment were associated with a better quality of life. Furthermore, the patients who were living with another person and the patients who underwent surgery on a part of the body other than the hip presented better quality of life. The results of the multivariate analysis explained 33%-67% of the variance of the SF-36 HRQOL. CONCLUSION: Measuring quality of life is a valuable asset that helps to reveal the frail patient groups, in which health professionals will prioritize their care and the state in turn will design primary care services to meet their needs after discharge from the hospital.

Successful Treatment of Diabetic Foot Osteomyelitis with Dalbavancin.

INTRODUCTION: Dalbavancin is a new antibiotic against multi-drug resistant Gram (+) bacteria. Dalbavancin has an extremely long half-life. Current indication is skin and soft tissue infections (ABSSSI), but researchers have successfully administered it off-label to osteomyelitis (OM) patients. AIM: We present a case of successful treatment of diabetic foot (DF) OM. CASE REPORT: A 53-year-old male presented to our DF clinic, with recently diagnosed diabetes mellitus, with very bad glycaemic control (HbA1c=12,5%). He had diabetic neuropathy, but no peripheral arteriopathy. Two months before, because of an accident with hot water, he presented left foot ulcer, followed by ABSSSI and 1st toe and 1st metatarsal OM (plain x-ray findings). A multi-drug resistant Enterococcus faecium was isolated in cultures and a targeted treatment with tigecycline and daptomycin was administered. The patient also received 1,5 gr dalbavancin upon discharge. 2 weeks later, he continued treatment at home with linezolid and tedizolid. A complete medical record with patient's history, informed consent and relative literature was sent to Greek National Health Care Organization (EOPYY), requesting administering off-label another 1,5 gr dalbavancin. In the meanwhile, he was admitted for iv tigecyclin, and continued treatment with linezolid at home. He finally received a second dose of 1,5 g dalbavancin. Patient received totally 14 weeks' targeted therapy, mostly off-hospital. When he completed treatment, foot was in excellent condition and x-ray had significantly improved. CONCLUSION: Dalbavancin, due to its extremely long half-life, could potentially be the drug of choice for OM caused by multi-drug resistant Gram (+) cocci, in order to avoid hospitalization, especially on non-complient patients. Further research is necessary.

Ointments containing Ceratothoa oestroides extract: Evaluation of their healing potential in the treatment of diabetic foot ulcers.

Diabetic foot ulceration is a common and severe complication of diabetes, causing substantial social, medical, and economic burdens. Treatment of foot ulcers remains challenging, thus requiring increasing awareness and more efficient management. This study investigates the efficacy of ointments, containing as main active ingredient the olive oil extract of the marine isopod Ceratothoa oestroides, in the treatment of patients with diabetic foot ulcers. Fifty-two patients were allocated into four treatment groups either receiving therapy with an ointment containing extract of C. oestroides or extract of C. oestroides and eosin or extract of C. oestroides and cefaclor or no treatment. Patients were monitored for a period of 135 days by evaluation of transepidermal water loss, skin hydration, planimetry, photo-documentation, and clinical condition. Treatment with the extract of C. oestroides demonstrated significant healing properties that became evident after 45 days of treatment and resulted in complete ulcer healing in 61% of the patients. A significant improvement in transepidermal water loss (p < 0.001), skin hydration levels (p < 0.001), and wound area (p < 0.001) was observed in all patients. Similar efficacy was demonstrated for the combination of C. oestroides extract with eosin treatment (p < 0.001). On the contrary, the combination of C. oestroides extract with cefaclor antibiotic agent completely inhibited the healing properties of the isopod extract and did not improve water loss, skin hydration, or wound area. An important factor for C. oestroides extract healing properties is its selective activity against Gram negative bacteria. Ointments containing C. oestroides extract alone or combined with the antimicrobial agent eosin emerges as an effective regimen for the treatment of diabetic foot ulcers.

Marine Isopod Ceratothoa Oestroides Extract: a Novel Treatment for Diabetic Foot Ulcers? Case Report of an Immunosuppressed Patient.

INTRODUCTION: Diabetic foot ulcer (DFU) is a common lower-extremity complication in patients with diabetes mellitus. A novel DFU treatment is tested by using an ointment containing as healing agent olive oil isopod Ceratothoa oestroidesextract. CASE REPORT: A 58 years old obese man,smoker, with a history of unregulated Type 2 Diabetes Mellitus, peripheral neuropathy and Hodgkin lymphoma was referred to Athens-Greece university hospital Laikon. The patient presented clinically with a lower extremity DFU and peripheral neuropathy with dysesthesia and disturbed sensation of hot and cold. He was treated with an ointment containing C. oestroides extract for five months, without any antimicrobial treatment. Therapy was evaluated by measurement of the transepidermal water loss, skin hydration, photo documentation and planimetry. At each patient's visit, DFU presented a satisfactory healing process. Five months after treatment initiation the patient had complete healing of his DFU. Blood tests after treatment revealed a significant reduction of the levels of the inflammatory markers. Ulcer cultures did not reveal any microbial development neither before nor after treatment. CONCLUSION: The administration of the C. oestroides extract ointment proved to be effective in this case. Although these results should be further investigated, the reported case suggests a novel option for the management of neuropathic diabetic foot ulcers, especially in patients with severe co-morbidities.

Nursing staff and patients' length of stay.

PURPOSE: The purpose of this paper is to investigate the effect of nurse staffing, nurse education and work experience on patients' length of stay (LOS) in the Greek public hospitals. DESIGN/METHODOLOGY/APPROACH: A cross-sectional study, with retrospective administrative data, was implemented. From all seven Regional Health Authorities of Greece, 25 general surgical units in 17 public hospitals participated in the study. FINDINGS: All over the hospitals were studied, 32,287 patients ⩾17 years old and 203 nursing staff, who were working in the study units, were included in the analysis. According to the multivariate linear regression model, increased years of experience as a nurse (b= -0.04, 95% CI= -0.06 to -0.02, p=0.001) and increased percentage of registered nurse to the total nursing staff (b= -1.18, CI= -1.88 to -0.47, p=0.03) were associated with decreased patient LOS. ORIGINALITY/VALUE: This was the first extended study in Greece, which explored the relationship between nurse staffing, nurse education, work experience and the LOS. The role that nurse staffing play together with its characteristics in the provision toward the quality healthcare services has already been recognized worldwide. The findings revealed the great shortage of nursing staff and the significant correlation between the work experience and educational level to patients' LOS.

Efficacy of a Ceratothoa oestroides Olive Oil Extract in Patients With Chronic Ulcers: A Pilot Study.

Chronic wounds unresponsive to existing treatments constitute a serious disease burden. Factors that contribute to the pathogenesis of chronic ulcers include oxidative stress, comorbid microbial infections, and the type of immune system response. Preclinically, and in a case study, a formulation containing a Ceratothoa oestroides olive oil extract promoted wound healing. Patients with chronic venous and pressure ulcers, clinically assessed as being unresponsive to healing agents, were treated for 3 months with an ointment containing the C oestroides extract combined with antibiotic and/or antiseptic agents chosen according to the type of bacterial infection. Treatment evaluation was performed using the Bates-Jensen criteria with +WoundDesk and MOWA cell phone applications. After 3 months of treatment, C oestroides resulted in an average decrease of 36% in the Bates-Jensen score of ulcers (P < .000), with the decrease being significant from the first month (P < .007). The combined use of topically applied antibiotics and antiseptics efficiently controlled microbial ulcer infection and facilitated wound healing. In relation to other factors such as initial wound size, chronicity appeared to be an important prognostic factor regarding the extent of wound healing. Future clinical investigations assessing the wound healing efficacy of the C oestroides olive oil extract are warranted.

Patient Survival After Acute Voluntary Poisoning With a Huge Dose of Oxcarbazepine and Olanzapine.

INTRODUCTION: Oxcarbazepine is a carbamazepine pre-drug with less drug interactions. Its adverse effects, including hyponatremia, somnolence and ataxia, are dose dependent. Olanzapine is an atypical antipsychotic drug most commonly used to manage psychoses and symptoms of irritability and aggressive behavior. Main side effects include extrapyramidal and anticholinergic symptoms, weight gain, and hyperglycemia. CASE REPORT: In this manuscript a case of oxcarbazepine and olanzapine intoxication is discussed. A 45-year-old woman, previously diagnosed with bipolar disorder and chronic alcoholism, was presented two hours after ingestion of 30,000mg of oxcarbazepine and 140 mg of olanzapine, combined with alcohol. She was immediately treated with gastric lavage and administration of activated charcoal. During her hospitalization she was hemodynamically and respiratory stable with no neurological signs and symptoms except for somnolence. Another side effect was hyponatremia. She was discharged from our department in stable clinical condition after being evaluated by a psychiatrist. CONCLUSION: Early approach is crucial for the management of drug intoxication. Late symptoms can be avoided through close monitoring of vital signs, mental status and laboratory values. Psychiatric consultation is essential for a better long-term outcome.

Parental Occupational Exposures and Risk of Childhood Acute Leukemia.

INTRODUCTION: Acute leukemia, accounting for 20% of all cancers diagnosed in individuals younger than 19 years old, is the most prevalent childhood malignancy. Among environmental risk factors, parental occupational exposures have attracted scientific interest as potential predisposing factors for childhood leukemia. The role of parental occupational exposure to social contacts, harmful chemicals, electromagnetic fields and ionizing radiation has been investigated with conflicting and inconsistent results. AIM: A case-control study aiming to assess the association between parental occupational exposures to social contacts, chemicals and electromagnetic fields and the risk of offspring acute leukemia. MATERIAL AND METHODS: 108 children with acute leukemia and equal number of matched controls were included. Data on parental occupations before conception, during pregnancy, during breastfeeding and after birth, and on potential risk factors was recorded. Associations between parental exposure and risk of childhood leukemia were estimated. RESULTS: Parental occupational exposure during the four periods of exposure was not associated with childhood leukemia. High birth weight and family history of cancer were associated with the development of childhood acute leukemia. A weak association of maternal medication use during pregnancy and leukemia risk emerged. CONCLUSIONS: Since the causative factors of childhood leukemia remain unknown, further investigation is mandatory for the reduction of disease burden.

Assessment of telomerase activity in leukocytes of type 2 diabetes mellitus patients having or not foot ulcer: Possible correlation with other clinical parameters.

Telomerase is the enzyme that maintains telomere length by adding telomeric repeats after each cell division. Numerous metabolic factors such as obesity, insulin resistance or physical inactivity have been associated with shortened telomeres. In the present study, we assessed telomerase activity in diabetic patients having or not foot ulcer. A total of 90 adult patients with type 2 diabetes mellitus (T2DM) were studied. Patients were allocated into two groups according to the absence or presence of active foot ulcers as follows: Νon-ulcer group (N=58) and ulcer group (N=32). Our data revealed that the patients with diabetic ulcers had significantly greater waist circumference and neuropathy disability score, while exhibiting lower telomerase activity, indicating the possible existence of a common clinical profile among ulcer-bearing diabetic patients. Validation of our findings by extending the study in larger patient groups may contribute to the understanding of T2DM pathophysiology and its main clinical implications.

Topical Treatment of Skin Injury Inflicted in Mice by X-Ray Irradiation.

BACKGROUND/AIMS: There is no treatment, without side effects, efficiently preventing or curing skin burns, caused by radiotherapy. A new experimental topical treatment protocol was assessed in mice receiving orthovoltage X-rays at an equivalent dose to that applied to human breast cancer patients in conventional radiotherapy. METHODS: SKH-HR2 female hairless mice were irradiated on their dorsum with a total dose of 4,300 cGy during a 1-month period (20 fractions). The treatment group received a combination of 3 topical products, an oil-in-water cream, a gel containing Pinus halepensis bark aqueous extract, and an ointment containing olive oil extract of the marine isopod Ceratothoa oestroides. The positive control group was treated with a conventionally used commercial gel, whereas the negative control group did not receive any topical treatment. Skin alterations were evaluated by macroscopic examinations, measurements of transepidermal water loss (TEWL), melanin content, erythema intensity, hydration, and histopathology assessment. RESULTS: Sixty days after radiation, TEWL and hydration values were abnormal and elements of acute, chronic, and granulomatous inflammation were present in all cases. The severest damage was detected in the deeper dermis. Treatment showed a comparatively beneficial effect on chronic and granulomatous inflammation while positive control was beneficial on acute inflammation. CONCLUSION: Skin anti-inflammatory treatment was the most effective but must be applied for several months. Further preclinical studies should be conducted, assimilating a human cancer radiation therapeutic schema with the aim of optimizing skin inflammation treatment.

Synthetic and Natural Nutritional Supplements: Health "Allies" or Risks to Public Health?

BACKGROUND: The modern way of life involves high stress levels, poor eating habits, lack of exercise, obesity and other detrimental health factors. Nutritional supplements (NS) are complexes of nutrients with variant activity that may infer reversal to nutrient depletion. They tend to be popular amongst social categories associated with the healthy life style, such as the elite and amateur athletes, military people and the general population. OBJECTIVE: An overview of the state of play with regard to nutritional supplements - natural and synthetic-, is important both from toxicological and commercial point of view. METHOD: From a thorough literature review on nutritional supplements, several patents of application have been identified and herewith reviewed which recommend natural vegetable extracts as food supplements for prophylaxis, therapy, protection of immune system, diabetes, oxidative stress, cancer, chronic inflammations and other health conditions. Besides, nutritional supplements of pharmacological validity and high popularity are discussed relative to their contents and group of use. RESULTS: Cases of adulteration or unintentional contamination of commercial products with abusing substances (doping substances, narcotics etc.) or toxic compounds (heavy metals, plant toxics) have shed light to the problem of causing recalls of some products by the FDA. CONCLUSION: From the safety/ quality point of view, NS lack of harmonisation and sovereign laws/ institutional controls on the market and their wide commercialization may possibly lead to risks to public health.