Hyperglycemic Patterns in Acute Stroke Patients.

Background and objective Hyperglycemia following a stroke can independently aggravate the ischemic area. Ensuring adequate glucose management can help avoid complications and minimize mortality and disability in these patients. This study aimed to investigate hyperglycemic patterns in acute stroke patients. Materials and methods We conducted a non-interventional prospective observational study involving acute stroke patients by employing continuous glucose monitoring (CGM) for 72 hours after the onset of stroke symptoms. Admission glucose, patients' total mean glucose (TMG), and time in range (TIR) (70-140 mg/dl) were correlated with the hyperglycemic patterns elicited by the CGM system software. Data were analyzed using SPSS Statistics 26.0 (IBM Corp., Armonk, NY) with descriptive statistics, the Kruskal-Wallis test, and χ2 test. Results Our cohort comprised 105 diabetic and non-diabetic stroke patients. The hyperglycaemic patterns that we observed were as follows: (i) hyperglycemia from 23:00 to 10:00, (ii) 06.00 to 10.00, (iii) at night and after meals, iv) no pattern, v) unspecified patterns. Patients with nocturnal and morning hyperglycemia had admission glucose of 183 mg/dl, mean 72-hour glucose of 156 mg/dl, and TIR of 37%. Patients who did not develop a hyperglycemic pattern either had admission glucose of 131 mg/dl and TIR of 89% or had high admission glucose (197 mg/dl) and a short TIR (14%). Conventional pre-meal capillary glucose tests do not appear to detect these patients' hyperglycemic tendencies. Conclusions These results may indicate the necessity for more intensive measurements during the night or dawn in this patient population. Admission glucose could be considered a predictor of hyperglycemic patterns and contribute to the patient's care plan.

Glucose Fluctuations in Acute Ischemic Stroke.

INTRODUCTION: The Oxfordshire Community Stroke Project denotes four subtypes of ischemic stroke (total and partial anterior infarct, posterior, and lacunar). Hyperglycemia has been associated with a larger infarct size and poor prognosis. AIM: The purpose of the study was to investigate the correlation of glucose fluctuations with the Oxford sub-categories and patient outcomes using a blinded continuous glucose monitoring system. METHODS: This is a non-interventional prospective observational study. Stroke patients with symptoms onset in the last 24h, participated in the study. A glucose sensor was placed for 72 hours. Disability was assessed using the modified Rankin Scale. Stroke subtypes were compared with total mean glucose and time in range using ANOVA analysis. Multiple ordinal logistic regression was employed to analyze outcomes and survival. RESULTS: The sample consisted of 105 diabetic and non-diabetic patients. The overall mean glucose was 127.06 mg/dL and the time in range (70-140 mg/dL) was 70.98%. There was no significant difference between the stroke sub-categories and the total mean glucose. For every one-point increase in the time in range, we expect a 1.5% reduction in the odds of having a worse outcome. Patients with total anterior infarct are 2.31 times more likely to have a worse outcome than lacunar patients. CONCLUSION: The utilization of the Oxford classification may not be necessary for managing acute ischemic stroke glucose levels. Achieving glucose regulation and an increase in time in range can be attained through meticulous control, potentially extending life expectancy. Continuous glucose monitors may aid in achieving this objective.

Post-traumatic stress disorder among Syrian refugees in Greece.

Background: Post-Traumatic Stress Disorder (PTSD) is a psychiatric entity developed by those who have been through a traumatic experience. The civil wars in Syria and neighboring countries during the past few years might trigger such experiences, and the same could be argued for the difficult journey from the actual war zones to Europe. Purpose: To determine the level of PTSD among Arabic-speaking refugees in a Greek refugee camp, who originate primarily from Syria. Methods: This study involves (N = 73) Syrian refugees, all located in Greek camp. Data were gathered using the civilian version of PTSD CheckList (PCL-C). The Arabic version of the PCL-C was used. Individual scores were evaluated via use of DSM-IV criteria. Results: PTSD was found in 58 participants, afflicting both genders (72% of men and 45% of women). In addition, the severity score was recorded to be significantly elevated for the majority of the participants. Finally, the most vulnerable age group was the same for both genders, featuring those between the ages of 35 and 44 years. Conclusions: The findings of this study demonstrated that the traumatic experiences, suffered by these refugees either before and/or on their journey to Greece, had a severe mental impact. It is imperative that all refugees suffering from this disorder be diagnosed in time and receive appropriate support.

Investigation of Healthcare Satisfaction of Roma Living in Camps or Urban Complex of Central Greece.

Background: Roma in Greece face multiple discrimination, particularly in the areas of housing, education, employment and health. Objective: The aim of this study is to explore the perceptions and beliefs of Greek Roma living both in camps and in urban neighborhoods for public health structures as well as to assess their satisfaction with health care services. Methods: The study sample consisted of 185 subjects (94 females and 91 males) with a mean age of 39.8 years (SD = 15.7). Of the people involved in the study, 80 come from the settlement of Larissa and 105 from the camp of Tyrnavos. A special survey questionnaire, "The scale of attitudes, feelings and satisfaction of Roma health services", was used for collecting the data. The statistical analysis was carried out using the SPSS statistical program. Results: The statistical indicators of the sample, taken together, indicate a moderate trend towards a negative escalation of attitudes, feelings and satisfaction of health services. Based on the t-test results for independent samples, the average score on the Roma satisfaction scale of the Larissa settlement (M = -0,41, SD = 0,74) was not found to differ, statistically significantly, from the Roma population of the Tyrnavos camp (M = -0,61, SD = 0,94), t (182) = 1,680 (p = 0,095). Conclusion: The results of this study, despite its reasonable limitations, lead to a redefinition of some views regarding the attitude of the Roma towards the public health and care system, as well as the needs created.

Professional Mental Rehearsal: the Power of "Imagination" in Nursing Skills Training.

BACKGROUND: Mental rehearsal is a form of training used by nurse educators to enhance the performance of clinical skills. The use of imagination may facilitate cognitive and affective modification and subsequently may even reduce extraneous cognitive load. OBJECTIVE: The aim of the study was to investigate the efficacy of mental rehearsal in cardiopulmonary resuscitation training of nursing students. METHODS: This is a comparative study with a random sample of 52 Nurse-Assistant students who were randomly divided into two groups. A 10-minute educational video on CPR and defibrillation was shown to both groups with the experimental group having additional time to be coached on mental rehearsal. Student performance was subsequently timed and errors/overall performance recorded. Descriptive statistics and Mann-Whitney test was used for group comparisons analysis. RESULTS: Students in the control group needed 8.5 minutes on average as compared to 6.2 minutes for the experimental group to complete cardiopulmonary resuscitation training. This equals to a difference of 2.5 minutes faster time for the experimental group (p<0.001). For overall mistakes the mental rehearsal group had 1.3 fewer mistakes on average (p=0.003). In terms of mistakes when executing cardiopulmonary resuscitation training there were 0.9 fewer mistakes in the experimental group (p=0.021). CONCLUSION: The use of mental rehearsal might be the first step in improving the teaching of nursing skills. Differences in skill acquisition in favor of mental rehearsal are important, especially when this technique is used in the teaching of life-saving skills such as cardiopulmonary resuscitation and the use of defibrillate.

Investigating Nurses Stress Response Strategies During the COVID-19 Pandemic.

BACKGROUND: Stress response strategies are a conscious effort to solve personal and interpersonal problems, aiming to minimize stress. OBJECTIVE: The aim of this study is to investigate the stress response strategies of nurses during the COVID-19 pandemic. METHODS: The sample consisted of 550 Greek nurses working in Greece and other European countries (460 women and 90 men). Ways of Coping was used as the data collection tool. Participants were invited to complete the questionnaire via online GOOGLE FORMS. The statistical processing was carried out using a descriptive and inferential analysis via the statistical package for Social Science (SPSS v.21). RESULTS: Analysis of the results shows a statistically significant difference between the two genders in the questionnaire's subscales "Search for social support" (Women=1.88, Men=1.57, p<0.001) and "Wishful Thinking" (Women=1.76, Men=1.51, p <0. Also, there was a statistically significant difference in terms of country of work regarding the following subscales: 'Search for social support' (Greece=1.85, Outside Greece=1.67, p=0.019), 'Wishful Thinking' (Greece=1.74, Outside Greece=1.51, p=0.005) and 'Problem Solving Assertion' (Greece=1.39, Outside Greece=1.13, p=0.001). CONCLUSION: Stress response strategies for nurses are fundamental in addressing the difficult situations and conditions they face due to the COVID-19 pandemic.

Exploring the barriers of utilizing theoretical knowledge in clinical settings: A qualitative study.

OBJECTIVES: Although effective performance in clinical settings requires the integration between theory and practice, there is a gap between theoretical knowledge as taught in the classroom and what the students experience in clinical settings. This study aimed to elicit and explore the barriers of utilizing theoretical knowledge in clinical settings. METHODS: A qualitative study was adopted with a conventional content analysis approach. Fifteen nursing and paramedic's students, faculty members and experienced nursing staff participated in the study. Data were collected by semi-structured individual interviews until data saturation and concurrently analyzed via MAXQDA 10. RESULTS: Five main categories emerged as barriers of utilizing theoretical knowledge in the clinical settings i.e. non-standard practices in clinical settings; lack of trust in clinical competence; lack of perceived professional support; insufficiencies in teaching and learning process; and differences between doing things in simulated and real clinical situations. CONCLUSION: Transferring theory into practice in a structured manner requires professional support in the workplace, trust and the opportunity for direct experience, using valid and up-to-date knowledge by clinical staff and bridging the simulated situations with real life scenarios.

Refugees and Migrants in Greece: An Ethnographic Reflective Case Study.

INTRODUCTION: Greece has experienced a double challenge of being under austerity for the past decade and also facing an influx of refugees and migrants (R&Ms), mostly fleeing war zones. The purpose of this case study is to report on a shelter camp in Greece. METHOD: An ethnographic case study technique was used. Data were collected via interviews, personal observations, and field notes. Analytic themes based on the coded data and personal memo writing were created. The sample consisted of the shelter camps' living social reality. RESULTS: Analysis revealed five thematic categories: ground rules, makeshift layout, food and drinks, children, and nursing perspectives. These were subsequently collated into a coherent "story" about routine daily life in the shelter camp. DISCUSSION: As camp facilities had been hastily erected, the services were basic and life was harsh. The need to provide better facilities including social and psychological support for R&Ms is evident for this particular host facility. IMPLICATIONS FOR PRACTICE: In Greece, R&Ms and staff cooperation is constantly sought as this new societal arrangement is a highly complex and volatile mix for everybody involved. Nurses have both a humanistic and a professional duty to be involved and help out. As the camp was run by the army, one could question the impact on culturally conflicting care provision.

Service provision for stroke: The Greek paradox.

Stroke remains a leading cause of mortality, as well as of subsequent serious long-term physical and mental morbidity. This places special demands for updated clinical excellence and optimum organization of stroke care services. Stroke units have been shown to improve patient outcomes. Thus, many western countries have developed and implemented sophisticated stroke facilities and corresponding public awareness strategies. These cannot be easily "translated" in Greece due to special features on the hospital administration system such as a unique rotation system for acute admissions and long-standing austerity. Yet, despite adverse conditions, clinicians within the Greek health care system have been exceeding themselves in their attempt to provide optimum care outcomes. An example of such efforts is the improvisation of stroke bays (SBs) as part of a medical or neurology ward, providing sophisticated treatments. New centralized policy decisions are now needed in order to improve stroke services nationwide. These should be tailored to the country's geography and health care mapping especially as there is already considerable technical knowhow and local efforts in place. A pragmatic solution would be to create a "grid" of services for stroke, by providing a comprehensive stroke centers in each of the two major cities and SBs at a prefectural level. Once these are established, more efforts should be taken to educate the public on stroke recognition and subsequently on facilities available.

In-Hospital Administration of Insulin by Nurses in Northern Greece: An Observational Study.

OBJECTIVE: The purpose of this study is to explore current practice regarding insulin administration by nurses in a Greek public hospital. DESIGN AND METHODS: A mixed-methods qualitative data collection design was used with ad hoc nonparticipant observation and post hoc interviews with the staff involved. Insulin management and administration was observed and compared to international guidelines. A sample of 20 nurses from two medical wards was assessed on 100 occasions of insulin administration, and 8 nurses were subsequently interviewed. RESULTS: Inter-rater agreement was found to be satisfactory (average κ 0.840). In 61% of all instances, nurses washed their hands before administering insulin, and, in 70%, they donned gloves before injections. In 64.5% of all instances, the nurses did not clean the insulin bottle before inserting the needle, and in 42.7% of instances, they did not check for air bubbles in the syringe. In 89.1% of instances, nurses did not check the injection site for appropriateness or other possible complications. However, in 90.9%, they cleaned the skin at the injection site with an alcohol swab. In 70.9% of all instances, the needle was placed vertically to the skin but without a skinfold. In 89.1% of instances, post-injection care was rated as poor. CONCLUSION: Overall, compliance with international guidelines regarding insulin administration techniques, as observed in these sample wards, is not satisfactory. Nurses in this Greek hospital tend to administer subcutaneous injections in ways not reflected in current research findings, practice guidelines, or evidence-based care recommendations. Evidently, Greek nurses in this sample require updating on current evidence-based practice, clinical guidelines, and protocols of care regarding routine insulin administration.

An Overview of Stroke Infrastructure, Network, and Nursing Services in Contemporary Greece.

This article describes the provision of stroke services in Greece and addresses the possible effects of the hospital rotation system. Unique to Greece is a centrally administered rotation system for hospital 24-hour on-call systems in the major cities. This means that a hospital may admit new patients only during specific 24-hour periods every 3 to 5 days. All Greek city hospitals must conform to this rotation basis for emergency and scheduled admissions. Patients with stroke arrive to designated rotation on-call hospital via ambulance or taxi or by private means and are first seen in the accident and emergency department where they are given priority attention accordingly and allocated to a neurology ward, medical ward, or stroke bay if the hospital has one. Occasionally, a neurosurgical consultation is sought; the patient may be admitted directly to a neurosurgery ward. Some attempts have been made to reach a degree of specialization in stroke bays, but with only a few of these, situated only in major cities, the vast majority of patients are still admitted to neurology or medical wards. Nurses and physicians in Greece continue to strive to improve outcomes for their patients with stroke despite adverse circumstances.

Validation of international stroke scales for use by nurses in Greek settings.

BACKGROUND: Improving stroke outcomes by educating nurses in state-of-the-art stroke nursing skills is essential, but unfortunately, to date, there are limited validated stroke assessment scales for routine clinical and research use in Greece. OBJECTIVE: The aim of this paper is to validate and culturally adapt three internationally recognised stroke scales for use in Greece. METHODS: A critical appraisal of the international literature was undertaken to identify suitable scales to assess stroke impact: neurological, functional status and level of dependence. We identified: Scandinavian Stroke Scale (SSS), Barthel Index (BI) and modified Rankin Scale (mRS). They were formally translated and culturally adapted from English to Greek. Their validity was tested using Cronbach's alpha and Median Discrimination Index, while construct validity was checked by Principal Component Analysis (PCA). These were used on 57 consecutively selected patients with stroke from a Greek hospital, mean age 67.7 (±6.7 SD) years, range 54-85 years, length of stay, 8.5 (±2.7 SD) days. RESULTS: All three scales show high internal consistency. The Cronbach's α on admission/ discharge for the SSS ranged from 0.86 to 0.88. The BI's reliability ranged from 0.95 to 0.93. The Median Discrimination Index was 0.70 (SSS) and 0.83 (BI). PCA showed that although a significant general factor (F1) explains most of the variance (57.0% on admission and 56.4% on discharge) a second factor (F2) of less significance was also highlighted. The convergent validity of the three scales was confirmed. DISCUSSION: The stroke tools selected showed high reliability and validity, thus making these suitable for use in Greek clinical/academic environments. All three scales used are almost routinely undertaken in stroke studies internationally and form a backdrop for bio-statistical, functional and social outcome post-stroke. CONCLUSIONS: The Greek version of the stroke tools show that both SSS and BI have high internal consistency and reliability and together with the mRS could be used in any Greek stroke care delivery setting.

Nursing interventions in stroke care delivery: An evidence-based clinical review.

INTRODUCTION: Generally, nursing interventions during the acute stages following a stroke aim at preventing secondary brain injury (intracranial hypertension), maintaining the airways (due to paralysis of the pharynx muscles), providing general body support (vital signs, fluid and electrolyte balance), and anticipating the occurrence of complications (atelectasis and pneumonia). AIM: This literature review is to prioritize nursing interventions for acute stroke and to update nursing roles and input considering recommended levels of evidence of care to date. METHOD AND MATERIALS: A systematic review was undertaken, and databases searched were Electronic Library Information Navigator (ELIN), Medline and the Cumulative Index to Nursing and Allied Health Literature from 1990 to 2015, using the OVID interface. RESULTS: The search originally yielded 400 articles of which 65 were selected for analysis and 12 of these included evidence synthesis (class I-IV, level A-Good Clinical Practice [GCP]). To facilitate early patient recovery, advanced nursing care should include the routine practice of a wide range of specific nursing interventions such as continence management, pressure area care, swallowing management, and early mobilization. Other important nursing interventions include the prevention of pulmonary thromboembolism and early antiplatelet therapy. CONCLUSIONS: For over 20 years, it has been established that specialized stroke care save lives, reduce disability, shorten length of stay, and generally have been associated with improved patient outcomes. Highly specialized nursing input is of paramount importance in achieving optimum patient outcomes and high quality of interdisciplinary care, providing a comprehensive, interactive, and holistic approach for both acute stroke and rehabilitation.

Exploring the experiences of nurses and doctors involved in stroke care: a qualitative study.

AIMS AND OBJECTIVES: To describe the current stroke care delivery arrangements in Greece and to explore nursing and medical staff knowledge, skills and attitudes, towards stroke care and management. BACKGROUND: Stroke care is diverse in the Greek public healthcare system and is delivered in a medical, neurology or a recently introduced, specialised unit. These settings are available alternatively under a central rota system. DESIGN: Descriptive qualitative investigation using semi-structured interviews. METHODS: A purposeful sample of 21 hospital staff were interviewed and verbatim data was transcribed for content analysis. Staff were selected from the various settings involved in stroke care; six medical and 15 nursing staff (12 female) were interviewed. RESULTS: A number of themes emerged from the interview data and these include: (1) current facilities, (2) admission destination, (3) stroke nursing care, and (4) family involvement and continuing education needs. DISCUSSION: Innovation and development can occur, even in the face of adversity, due to the commitment, passion and insight of healthcare professionals to enhance stroke care to aspire to international standards. CONCLUSIONS: Greek stroke nurses can achieve their professional potential within the appropriate working environment. The Stroke Bay working ethos and environment enhances professional autonomy and scope of practice. RELEVANCE TO CLINICAL PRACTICE: By exploring staff's knowledge and attitudes towards stroke care, nurses and healthcare professionals in general will gain a better understanding of their multiple clinical roles as stroke care providers by reflecting on their patients' needs.

Global specialized stroke care delivery models.

Stroke services still vary enormously from country to country, with many countries providing no special services at all. The aim of this article is to provide a concise overview of the various types of acute stroke delivery systems at present available and critically describe merits and shortcomings. A systematic literature review was undertaken from 1990 to July 2014. Several models for stroke services have been developed mostly in the past 3 decades, mainly in the Western world. These include state-of-the-art stroke services ranging from highly specialized stroke centers to mobile stroke units for the community. In this light, the recommendations of the structure and organization of stroke units and stroke centers by the European Stroke Organization were recently published. What differentiates the various models of stroke care delivery across the globe is the diversity of services ranging from low key conventional care to highly sophisticated facilities with life saving interventional features via integrated stroke care infrastructure. Effective in-hospital care for stroke should start in the emergency department where a swift and appropriate diagnosis should be made. The role of all brain neuroimaging procedures should have a defined a priori and proper demarcation between actions according to updated stroke care pathways and clinical protocols, which should be followed closely. These essential actions initiated by well-trained staff in the emergency department, should then be carried on in dedicated stroke facilities that is, a stroke unit.

A qualitative study on discrimination and ethical implications in stroke care in contemporary Greece.

Contemporary stroke care is diverse, contributing to complex ethical dilemmas and controversies. In Greece, continuing austerity measures and an ageing population are expected to increase the burden of stroke on health care delivery. We sought to explore ethical views and stances of health care professionals caring for stroke patients in Greece. Forms of discrimination against elderly hospitalized patients were also addressed. A qualitative design was adopted whereby an informal focus group interview and follow-up, face-to-face individual interviews were undertaken. The sample consisted of 12 nurses working in clinical areas with stroke patients. Their mean age was 31 years with a mean work experience of 10 years. Individual discussions were audio taped after subject consent and were transcribed verbatim subsequently for keywords-in-context analysis. Analysis of the focus interview revealed several recurring themes, namely, ward destination, admission policies, the concepts of age as related to stroke. Individual interviews highlighted several other topics, such as preferences for specific types of patients, communication capacity of the patient's condition, and his or her individual characteristics as a favoring or limiting factors, and challenges to age-related criteria for treatment. There is an age-related criteria of 65 years for ward destination after stroke as set by a ministerial decree, which is still practiced. Moreover, younger stroke patients may be offered more thorough assessments and clinical tests and therapies. Discrepancies in the level of care pose an ethical concern regarding levels of care for older stroke patients in Greece. A longstanding, age-related national policy in Greece regarding hospital admission criteria is shown to be a detrimental influence on ward admission for stroke patients. This policy, coupled with prehospital care protocols, was shown to promote ageism against this patient group. The age-related agenda in the Greek health care system has suffused care delivery with pockets of discrimination.

To abort or not? A Greek dilemma--case study.

UNLABELLED: Abortion is a major issue in contemporary Greece as it is often practiced but not debated openly and accordingly. AIM: To present and discuss critically a real case scenario with strong ethical implications concerning abortion under two polar ethical doctrines, i.e. Utilitarianism and Deontologism. DISCUSSION: From a Deontological point of view the baby's life should be spared regardless of reason. In contrast, Utilitarians reason that the effect on the mother and family life should be drawn into the decision equation. The mother, who was heavily influence by her religious beliefs, decided to keep the baby, and the pregnancy continued as planned. CONCLUSION: The importance of weighing up the views of the patient and respecting her autonomy is crucial when dealing with such issues. Health care professionals need to be adequately prepared in order to facilitate and support patients and families in similar circumstances.

Bladder catheterization in Greek nursing education: An audit of the skills taught.

INTRODUCTION: The auditing of nurse teaching is in its infancy in Greece. One area urgently in need of audit is the teaching of male catheterization. AIMS: To assess the current educational model regarding male bladder catheterization at a sole tertiary education nursing establishment in a major Greek city and to improve nurse undergraduate training by implementing appropriate recommendations for change to the current educational module and support these changes in the long term. METHODS: A systematic search of international databases for guidelines or best practice regarding bladder catheterization was conducted. Audit measures included direct observation of the teaching process and compilation of a checklist. RESULTS: The shortcomings are discussed under the following headings: patient pre-preparation, choice and quality of materials used, appropriate aseptic techniques, catheter withdrawal, connecting and handling the drainage bag, diminishing risk of Catheter Associated Urinary Track Infections (CAUTIs), no problem solving trouble-shooting training, textbook and educational resources, lack of national guidelines, setting of the educational experience. CONCLUSIONS: The main problem with the teaching process exposed by the audit is entrenched use of an outmoded textbook with little effort to enrich teaching with current evidence base practices.