Treatment with Umbilical Cord Blood Platelet Lysate Gel Improves Healing of Diabetic Foot Ulcer.

BACKGROUND: This study was conducted to examine the hypothesis that umbilical cord blood platelet lysate (UCB-PL) gel has a significant impact on the healing rate of DFU. Μethods: In this open-labeled, randomized controlled trial, 110 patients were randomized to treatment with UCB-PL gel (UCB-PL group, n = 52) every three days for one month or dressing with normal saline (control group, n = 58). All participants were followed up for 20 weeks post treatment. Ulcer surface area was assessed with the imitoMeasure application at two, four, and six weeks, and two, four and six months. This study's main outcome was the reduction in ulcer size over the six-month study period. RESULTS: The mean ulcer area at baseline was 4.1 cm2 in the UCB-PL group and 1.7 cm2 in the control group. At six months post treatment, patients on the UCB-PL treatment displayed a significant reduction in ulcer size compared to baseline 0.12 (0-8.16) in contrast to a more modest change in the control group 1.05 (0-24.7). The ulcer area was decreased at the end of the study in 40 patients (97.6%) in the UCB-PL group and 27 (73%) in the control group (Fisher's p = 0.002). CONCLUSIONS: The application of UCB-PL gel in DFU resulted in a significant reduction in ulcer size compared to regular saline dressing.

Validation of Dimensions of Learning Organization Questionnaire (DLOQ) in health care setting in Greece.

Background: In health care systems the organizational learning is a continuous process to improve actions through better knowledge and detect or correct errors. This study examines the validity and reliability of the Dimensions of Learning Organization Questionnaire in addition to the applicability of the instrument in a Greek health care cultural context. Design and methods: A cross-sectional study was carried out in 6 general hospitals of Attica and the sampling scheme was the stratified sampling. Questionnaires were distributed to 487 healthcare professionals and 380 valid questionnaires were returned. The research tool used in this survey is the extensive form of DLOQ, which has been adapted and translated into Greek language. Data analysis was carried out with SPSS 25. Results: Three leading experts of the health sector examined the face validity assessment of the translated DLOQ and stated that it is characterized by high face validity. As regard construct validity of the DOLQ throughout Multitrait-Multimethod Matrix, was proved that all the variables of the same factors are statistically significantly correlated (p<0.001), and their correlation coefficients have moderate to high power ranging between 0.563 and 0.798. Moreover, the discriminant validity was demonstrated as certain correlation coefficients between variables of different factors were found to be higher than of certain correlation coefficients between variables of the same factors. The internal consistency among the items of the DOLQ range between 0.842 and 0.977 and they are considered to be good to excellent. Conclusions: Our results confirmed that DLOQ is a valuable tool in measuring Learning Organizational in Greek public hospitals.

Physical, psychological and economic burden of two-wheel users after a road traffic injury: Evidence from intensive care units of three EU countries.

INTRODUCTION: This study aimed to assess the physical, psychological, and economic burden shouldered by severely injured two-wheel users in three European countries as well as the cost resulting from their hospitalization. METHODS: A total of seven public hospitals were involved in three countries: Greece, Italy, and Germany. Participants enrolled during a 12-month period starting in April 2013. Eligibility criteria included an injury sustained at Road Traffic Crashes (RTC) irrespective of the type of vehicle, hospitalization 1 day in the Intensive Care Unit (ICU) or sub-ICU, and age 18 years or over. Patients were interviewed at 1, 6, and 12 months upon admission. The study used widely recommended classifications for injury severity (Abbreviated Injury Severity [AIS]; Maximum Abbreviated Injury Severity [MAIS]) and standardized measures such as the Disability Assessment Schedule II (WHODAS 2.0), "Impact of Event Scale" (IES-R), Center for Epidemiological Studies Depression Scale (CES-D Scale). Health Care Expenditure was assessed through the Monash University Accident Research Centre (MUARC's) framework, which included measures of 'Direct' and 'Indirect' costs. Diagnosis-related groups (DRGs) were used to estimate hospitalization costs. RESULTS: A total of 54 two-wheel users enrolled in the study in all the countries and 32 completed all follow-up questionnaires. Physical disability increased over 12 months following the injury. Post Traumatic Stress Disorder (PTSD) symptoms of avoidance remained at high levels over the study period. PTSD symptoms of intrusion improved significantly during the second half of the year under investigation. The total annual cost of injury for the two-wheel users who were hospitalized in the selected ICU of all the partner countries for severe injury in 2013/2014, was estimated at €714,491 made up of €123,457 direct and €591,034 indirect costs. Men, aged 50-64 years and those who sustained slight injuries primarily at the lower extremities presented higher indirect costs per person. A total of €1032.092 was spent on hospitalization payments. Women, aged 65+ and those who sustained severe injuries at the central body region presented higher direct costs per person. Women, aged 50-64 years, those with severe injuries and a major injury at the central body and the upper body region presented the highest hospitalization costs per person. CONCLUSIONS: There is a need for effective strategies to early detect and treat groups at risk of being confronted with prolonged psychosocial and economic consequences. PRACTICAL IMPLICATIONS: A holistic understanding of the impact of injury on individuals is important in order to achieve effective treatment of psychological co-morbidities in a timely manner.

Biovigilance for the Quality and Safety of Medical Products of Human Origin.

Progress in science and technology in the health services has led to the development of methods of regenerating and replacing solid organs, tissues and cells, using human body components to create medical products of human origin intended for clinical use. In the activities in which products of human origin are used, however, from the point of donation and harvesting to the subsequent care of the recipient, medical products of human origin are exposed to the risk of specific complications related to the transmission of infectious diseases, and further side-effects. Biovigilance system application is a basic requirement for ensuring the quality and safety of tissues and cells intended for human use. The quality system focuses on error prevention, maintaining a consistent pattern of agreed assays for tissues and cells intended for clinical use. The implementation of quality and safety standards, the development of medical protocols and cooperation protocols between member states, the implementation of Single European Code (SEC), and the development of electronic traceability systems, all aim at vigilance and the surveillance of medical products of human origin from donation to transplantation.

Psychological distress and physical disability in patients sustaining severe injuries in road traffic crashes: Results from a one-year cohort study from three European countries.

The current study aimed to follow-up a group of road crash survivors for one year and assesses the impact of injury on their psychological and physical condition. All crash survivors that were admitted to the intensive or sub-intensive care units of selected hospitals in Greece, Germany and Italy over one year period (2013-2014), were invited to participate in the study and were interviewed at three different time-points as follows: (a) at one month (baseline data), (b) at six months, and (c) at twelve months. The study used widely recommended classifications for injury severity (AIS, MAIS) and standardized health outcome measures such as the Disability Assessment Schedule II (WHODAS 2.0) to measure disability, "Impact of Event Scale" (IES-R) to measure Post-Traumatic Stress Disorder (PTSD), Center for Epidemiological Studies Depression Scale (CES-D Scale) to measure depression. A total of 120 patients were enrolled in the study in all the partner countries and 93 completed all follow up questionnaires. The risk of physical disability was 4.57 times higher [CI 1.98-2.27] at the first follow up and 3.43 times higher [CI 1.43-9.42] at the second follow up as compared with the time before the injury. There was a 79% and an 88% lower risk of depression at the first and the second follow up respectively, as compared with the baseline time. There was also a 72% lower risk of Post-Traumatic Stress at the second follow up as compared with the baseline time. A number of factors relevant to the individuals, the road crash and the injury, were shown to distinguish those at higher risk of long-lasting disability and psychological distress including age, marital status, type of road user, severity and type of the injury, past emotional reaction to distress. The study highlights the importance of a comprehensive and holistic understanding of the impact of injury on an individual and further underlines the importance of screening and treating psychological comorbidities in injury in a timely manner.

Experiences of cancer caregiving in socioeconomically deprived areas of Attica, Greece.

The shift of the majority of cancer care from inpatient to outpatient settings has given rise to a number of issues that have not yet been adequately addressed. This is especially true in countries undergoing rapid and profound socioeconomic changes that have substantially affected the health care sector. We conducted 12 in-depth interviews with family cancer caregivers residing in socioeconomically deprived areas of Attica, Greece. Using an inductive thematic approach, we identified three major themes: (a) the truth within boundaries, focusing on the flow of information in the triad doctor-caregiver-patient; (b) the evil called "cancer," reflecting caregivers' perceptions of the illness; and (c) being left "high and dry," reflecting participant experiences of home-based care. Against a background of financial crisis, this study underlines the need for safeguarding the rights of chronically ill patients and ensuring that informal cancer care, apart from a cost-effective solution, will also be an efficient one.

Comparative analysis and evaluation of the effectiveness of demographic policies in EU countries (2009-2010).

PURPOSE: This article contains a comparative analysis and evaluation of the effectiveness of population policies in European Union (EU) countries, using multivariate analysis. DATA AND METHODS: To study these differences, it is primarily necessary to have the relevant data. The most recent database available was developed by the OECD in 2007 and currently covers OECD countries and most EU Member States. We used multivariate analysis to categorize the indicators into the following groups: (a) economic indicators, (b) indicators reconciling work and family life, and (c) demographic indicators. RESULTS: The results of measuring the degree of coherence of factors reveal that the four most important factors influencing the effectiveness of population policy are (i) the average maternal age at first childbirth, (ii) social protection expenditure, (iii) GDP, and (iv) public spending for benefits. Based on the data from the evaluation of the correlation matrix of variables and data, the classification of countries, according to the values of the coefficients of analysis, appears as follows: the Nordic countries (together with France and the United Kingdom), the Southern European countries and the Northern countries: Estonia, Latvia, Lithuania (by a very slight margin Romania), and Bulgaria, Poland, Slovakia (and, marginally, Malta). CONCLUSIONS: The key comparative findings from benchmarking best practices in the context of the European experience are the following: The EU is being demographically transformed as a direct result of an increase in average life expectancy and immigration and a decrease in fertility. Demographic factors are influenced by specific features, in contrast with economic factors which seem be less stable.