Patient Knowledge, Medication Adherence, and Influencing Factors: A Cross-Sectional Study among Hypertensive Patients in Greece.

This study aimed to investigate the knowledge of patients with hypertension about their condition, adherence to antihypertensive medication, and the factors influencing it. A cross-sectional study was conducted in two cardiology outpatient clinics of two tertiary hospitals, in Greece. The study included 188 patients diagnosed with hypertension. The patients' knowledge about their disease and adherence to medication were assessed by using the HK-LS and A-14 scales, respectively. Patients had sufficient knowledge levels about their disease, but significantly low levels of adherence to medication. Patients with higher knowledge levels were more adherent to medications [r(188) = 0.885, p < 0.001]. By using multivariate analysis, higher age (p = 0.018), residence in a more populous area (p = 0.041), more years with the disease (p = 0.012), and a lower number of medications (p = 0.03) were associated with higher levels of knowledge. Conversely, younger age (p = 0.036), lower educational levels (p = 0.048), fewer years with the disease (p = 0.001), and a higher number of medications (p = 0.003) were associated with lower adherence to medication. The Greek patients' hypertension knowledge was sufficient; however, adherence to medication was significantly low. Healthcare managers could utilize our findings to design targeted interventions for improving adherence to medication for these patients.

The Development and Testing of the Hippocratic Heart Failure Self-Care Scale.

BACKGROUND: The adoption of self-care behaviors among patients with congestive heart failure (CHF) is essential for the management of their health condition. However, there is a lack of tools for estimating self-care in CHF patients. We aim to develop and validate the Greek version of the Hippocratic heart failure self-care scale (HHFSCS). METHODS: The scale includes 22 items which are reviewed by a committee of experts. Individuals indicate the frequency at which they follow each self-behavior on a five-point Likert scale. Adult patients with CHF (n = 250) from a General Hospital in Athens participated in the study from June 2020 to March 2021. Reliability coefficients and an explanatory factor analysis (EFA), using a Varimax rotation and the principal component method, were used to assess the psychometric measurements. RESULTS: The Cronbach's alpha coefficient of the HHFSCS was 0.807. The exploratory factor analysis identified two domains that accounted for 88.44% of the variance in the scale items; however, each sub-scale could not be used as an independent scale. Finally, the test-retest showed a significant and strong correlation (r = 0.973, p < 0.001). CONCLUSIONS: The HHFSCS is a reliable and valid tool for assessing self-behaviors in CHF patients. Health professionals can use it in their clinical practice to improve the management of a patient's health conditions.

The Development and Validation of the "Hippocratic Hypertension Self-Care Scale".

BACKGROUND: The adoption of self-care behaviors among patients with arterial hypertension (AH) plays an important role in the management of their health condition. However, a lack of scales assessing self-care is observed. We aimed to develop and validate the Hippocratic hypertension self-care scale. METHODS: From a pool of questions derived from a literature review, 18 items were included in the scale and reviewed by a committee of experts. Participants indicated the frequency at which they followed the self-behavior prescribed in each statement on a five-point Likert scale. Data were collected between April 2019 and December 2019. RESULTS: A total of 202 consecutive adult patients with AH were enrolled in the study. The internal consistency of the scale was found to be 0.807, using Cronbach's alpha coefficient. An exploratory factor analysis identified two domains that accounted for 92.94% of the variance in the scale items; however, each sub-scale could not be used as an independent scale. Finally, the test-retest of the scale showed a significant strong correlation (r = 0.0095, p < 0.001). CONCLUSION: This analysis indicates that the scale is reliable and valid for assessing self-care behaviors in patients with AH. It is suggested that health professionals use it in their clinical practice to improve the management of AH.

Development and Validation of the CVP Score: A Cross-Sectional Study in Greece.

Although central venous pressure (CVP) is among the most frequent estimated hemodynamic parameters in the critically ill setting, extremely little is known on how intensive care unit (ICU) nurses use this index in their decision-making process. The purpose of the study was to develop a new questionnaire for accessing how ICU nurses use CVP measurements to address patients' hemodynamics investigating its validity and reliability. A cross-sectional study was conducted among 120 ICU nurses from four ICUs of Greece. Based on a comprehensive literature review and the evaluation by a panel of five experts, a new questionnaire, named "CVP Score", was created, having eight items. The construct validity and the reliability of the questionnaire were examined. Half of the study participants (51.7%) worked at a specialized ICU, and they had a mean [±Standard Deviation (SD)] ICU experience of 13(±7.1) years. The estimated construct validity of the newly developed tool was acceptable, while the internal consistency reliability as measured by Cronbach alpha was excellent (0.901). CVP Score had acceptable test-retest reliability (r = 0.996, p < 0.001) and split-half reliability (0.855). The CVP score is a valid and reliable instrument for measuring how critical care nurses use CVP measurements in their decision-making process.

The Early Mobilization of Patients on Extracorporeal Membrane Oxygenation: A Systematic Review.

Patients on extracorporeal membrane oxygenation (ECMO) often require prolonged periods of bed rest owing to the severity of their illness. Care is also required to maintain the position and integrity of the ECMO cannula. However, they experience a range of effects due to prolonged bed rest. This systematic review examined the possible effects of the early mobilization in patients on ECMO. The database PUBMED was searched by using appropriate keywords: "rehabilitation", "mobilization", "ECMO" and "extracorporeal membrane oxygenation". The selection criteria for the article search were the following: (a) studies published in the last five years, (b) descriptive studies, (c) randomized studies, (d) published in the English language and (e) studies in adults. A total of 259 studies were found, 8 of which were finally selected. Most of the studies showed that early intensive physical rehabilitation related to a decrease in in-hospital stay and a reduction in the duration of mechanical ventilation and doses of vasopressors. In addition, improvements in the functional status and rate of mortality were observed along with a reduction in health care costs. Exercise training should be a fundamental part of the management of patients on ECMO.

Impact of nurse-initiated education on HeartScore in patients with hypertension: a randomised trial.

BACKGROUND: People with hypertension experience significant damage to major organs due to insufficient management of cardiovascular risk factors. AIMS: To assess the impact of nurse-led educational interventions on the total cardiovascular risk among people with hypertension. METHOD: the study was an interventional randomised study. The sample (n=92) was randomly assigned to the either the control or intervention group. The HeartScore tool was used to assess patients' total cardiovascular risk between December 2017 and March 2018. FINDINGS: 56.6% of the control group and 55.4% of the intervention group were women, with a mean age of 64.4 years and 66.2 years respectively (P>0.05). Total cholesterol reduced in both groups; however, improvement was greater in the intervention group (P<0.05). Total cardiovascular risk fell in the intervention group from 4.75 to 4.33 (P>0.05), while the control group saw an increase in risk from 10.03 to 12.65 (P=0.035). CONCLUSION: Nurse-led educational interventions should be incorporated in the usual care of patients with hypertension, in order to achieve the best management of the condition.

The presence of obesity paradox in Greek patients with chronic heart failure.

PURPOSE: To investigate the effect of body mass index (BMI) values on 1- and 2-year mortality rates in patients with chronic heart failure (HF). PATIENTS AND METHODS: We conducted a retrospective cohort study of 112 patients with confirmed HF who visited the HF outpatient unit of a tertiary hospital of Athens, Greece, during a 5-month period (December 2012 - April 2013). These patients were assigned to four groups based on their BMI category. Data collection was carried out through a review of the medical patient records and the filling in of a structured questionnaire, including information on the demographic and clinical patient variables. Additionally, 1- and 2-year patient mortality was recorded. The statistical significance was two-tailed, and p-values of less than 0.05 were considered significant. The statistical analysis was performed with Mann-Whitney U test, χ2 test, and Student's t-test using the SPSS software (IBM SPSS 21.0 for Windows). RESULTS: Obese patients had significantly lower 1-year (13% vs 34.6%, p=0.039) and 2-year (4% vs 21.4%, p=0.022) mortality rates compared with those with normal BMI values. Additionally, we found clinically and not statistically significant lower mortality in overweight and obese patients, when compared with normal BMI and overweight patients, respectively. CONCLUSION: Obesity paradox seems to be present in our study, translating to significantly lower long-term mortality rates of obese patients compared to those with normal BMI. The significantly higher left ventricular ejection fraction and hematocrit levels among obese HF patients could justify our study findings. Further research is needed due to the inherent weaknesses of BMI and the other study limitations.

Perioperative neutrophil to lymphocyte ratio as a predictor of poor cardiac surgery patient outcomes.

PURPOSE: The purpose of the present study was to investigate the association between the perioperative neutrophil to lymphocyte ratio (NLR) and cardiac surgery patient outcomes. PATIENTS AND METHODS: A retrospective cohort study of 145 patients who underwent cardiac surgery in a tertiary hospital of Athens, Greece, from January to March 2015, was conducted. By using a structured short questionnaire, this study reviewed the electronic hospital database and the medical and nursing patient records for data collection purposes. The statistical significance was two-tailed, and p-values <0.05 were considered significant. The statistical analysis was performed with Mann-Whitney U test and Spearman's correlation coefficient, by using the Statistical Package for Social Sciences software (IBM SPSS 21.0 for Windows). RESULTS: The increased preoperative levels of NLR were associated with significantly higher mortality, both in-hospital (p=0.001) and 30-day (p=0.002), prolonged postoperative hospital length of stay (LOS), both in the cardiac intensive care unit (ICU) (p=0.002), and in-hospital (p=0.018), and likewise with delayed tracheal extubation (p≤0.001). Furthermore, patients with elevated NLR during the second postoperative day had significantly higher in-hospital mortality (p=0.018), increased incidence of pneumonia (p=0.022), higher probability of readmission to the ICU (p=0.002), prolonged ICU LOS (p≤0.001), and delayed tracheal extubation (p≤0.001). CONCLUSION: Increased perioperative NLR seems to be associated with significantly higher mortality and morbidity in cardiac surgery patients. At the same time, NLR is a significant and inexpensive biomarker for the early identification of patients at high risk for complications. In addition, NLR levels could lead clinicians to perform measures for the optimal therapeutic patient approach.

The level of anxiety, depression and quality of life among patients with heart failure in Greece.

PURPOSE: The assessment of the level of anxiety, depression and quality of life among patients with heart failure. METHODS: It was an observational study. The populations were 231 patients with heart failure who were hospitalized in cardiology departments of 2 general hospitals in Athens, from September 1, 2010 through January 31, 2012. We used the "Minnesota Living with Heart Failure Questionnaire - MLHFQ" to evaluate patients' quality of life and the " State-Trait Anxiety Inventory - STAI" and the "Maastricht Questionnaire - MQ" to evaluate the level of stress and depression, respectively. RESULTS: The mean age of patients was 66.1±10.1years. The quality of life was poor, since the average score in MLHFQ was 65.4±20.6. Also, patients revealed high levels of both trait and state anxiety (mean score in STAI was 54.5±9.4 and 52.8±8.5 respectively) and depression (mean score in MQ was 34.3±8.4). Factors associated with poor quality of life and high levels of anxiety and depression were older age, low level of education, unemployment, poor economic situation, multiple hospitalizations (> 4 times) and heart failure stages III and IV in NYHA (p<0.001 in all cases). CONCLUSION: Patients with heart failure present severe symptoms of anxiety and depression and poor quality of life. Assessing those patients for these symptoms and providing holistic health care by a multidisciplinary team, will lead to the prevention and early treatment not only of physical but also of the psychosocial manifestations of the disease.

Translation and validation of the Greek version of the hypertension knowledge-level scale.

AIMS AND OBJECTIVES: To translate and validate a Greek version of the Hypertension Knowledge-Level Scale. BACKGROUND: The major barrier in the management of hypertension is the lack of adherence to medications and lifestyle adjustments. Patients' knowledge of the nature of hypertension and cardiovascular risk factors is a significant factor affecting individuals' adherence. However, few instruments have been developed to assess patients' knowledge level and no one has been translated into Greek. DESIGN: This study used a case control study design. METHODS: Data collection for this research occurred between February 7, 2013 and March 10, 2013. The sample included both hypertensives and non-hypertensives. Participants simultaneously completed the version of the Hypertension Knowledge-Level Scale. A total of 68 individuals completed the questionnaire. RESULTS: Coefficient alpha was 0·66 for hypertensives and 0·79 for non-hypertensives. The difference for the mean scores in the entire scale between the two samples was statistically significant. In addition, significant differences were observed in many sub-dimensions and no correlation was found between level, knowledge and age, gender and education level. CONCLUSIONS: Findings provide support for the validity of the Greek version of the Hypertension Knowledge-Level Scale. RELEVANCE TO CLINICAL PRACTICE: The translation and validation of an instrument evaluating the level of knowledge of hypertension contribute to assessing the provided educational intervention. Low knowledge level should lead to the development of new methods of education, therefore nurses will have the opportunity to amplify their role in patients' education and develop relationships based on honesty and respect.