George Fildissis - Academia.edu (original) (raw)
Papers by George Fildissis
The International journal of neuroscience, 2021
Background: Evidence suggests that fluctuations of cortisol and vital signs can emerge during the... more Background: Evidence suggests that fluctuations of cortisol and vital signs can emerge during the course of mild Traumatic Brain Injury (mTBI).Objective: To investigate fluctuations of cortisol and vital signs during the acute phase of mTBI in hospitalised patients.Methods: 30 participants (19 patients with mTBI and 11 controls) were examined for saliva cortisol dynamics, heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and body temperature (BT) fluctuations for four consecutive days. Also, the participants completed the Athens Insomnia Scale and Epworth Sleepiness Scales, in order to check for sleep problems.Results: Patients showed elevated levels of cortisol relative to controls (peak at 8 am and lowest levels at 12 am), as well as for most physiological parameters. MAP was significantly higher for patients throughout the measurement period, and BT was elevated for patients relative to controls at almost all measur...
Health science journal, 2016
Background: Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) affects about 15,000 people annu... more Background: Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) affects about 15,000 people annually worldwide and exceeds 30 db at 3 contiguous audiometric frequencies. This study aims at evaluating the clinical efficacy of hyperbaric oxygen therapy (HBO2) in the management of ISSHL. Material and Methods: Fifty six patients were enrolled in the study suffering from ISSHL and tinnitus. The research protocol consisted of five phases. Each phase of the research protocol included five sessions with HBO2. The basic tool for assessing the measurement of auditory acuity is tonal audiogram. The evaluation of tinnitus was assessed using a questionnaire and a visual analogue scale at the beginning and the end of the study. Secondary assessment points included changes in the intensity and the improvement of tinnitus. Results: Fifty-six patients were treated with hyperbaric oxygen in this study, especially for hearing loss combined with tinnitus. All patients completed the first and second ph...
ABSTRACT Objective: To determine the association between ED overcrowding and outcomes for critica... more ABSTRACT Objective: To determine the association between ED overcrowding and outcomes for critically ill patients Design and Setting: We included medical and surgical pts that all of them were intubated promptly to ED of 2 general hospitals of Athens GR, for 12 months. Pts survived > 24hours were divided into 2 groups: ED boarding < 6 hrs (group A) and ED boarding ≥ 6 hrs (group B). In the ED, 196 critically ill patients with a mean age 59.6±20.9 yrs and APACHE II score 24.6±12.7 were intubated. Results: Group A = 76 pts (mean time ED boarding, LOS, mortality): 28 pts were admitted to CCU (30.7±20.4, 7.7±9.3, 42.9%), 32 to ICU (231.25±103.1, 11.9±7.8, 37.5%) and 16 to intermediate unit (191.3±33.5, 7.8±5.7, 0%). Group B = 120 pts (mean time ED boarding, LOS, mortality): 28 pts were admitted to ICU (559.28±101.6, 15.6±10.3, 58.7%) and 92 to intermediate unit (3094.4±3273.4, 19.1±14.5, 78.3%). Hospital LOS was 19.2±20.4 days for group A vs 41.5±62.7 days for group B (P<0.001), and mortality 26.8% vs 45.7% respectively (P<0.001). Delayed admission, higher Apache II, age > 61 yrs, female gender and direct admission to ICU were associated with lower hospital survival (odds ratio 0.815; 95% 0.612-0.976). Conclusions: Boarding time of critically ill from ED to ICUs is very important because it is strongly related to the hospital LOS and mortality rate. Keywords: ED, ICU, boarding time, LOS, mortality, hospital.
Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc, 2020
Introduction The treatment of avascular necrosis of the femoral head (AVNFH) is based on invasive... more Introduction The treatment of avascular necrosis of the femoral head (AVNFH) is based on invasive (e.g., core decompression) and non-invasive methods (e.g., hyperbaric oxygen therapy - HBO2). The purpose of the present study is to evaluate the effect of HBO2 on the quality of life (QoL) of patients with AVNFH. Methods This was a prospective observational non-controlled study of patients with AVNFH treated by HBO2. It was conducted, with the use of Steinberg scale, on 73 patients with AVNFH Stage I or II who were treated with HBO2. Patients' QoL was assessed with EuroQol-5D-5L (EQ), Harris Hip Score (mHHS), MAHORN (MHOT), and VAS, in three different phases: before HBO2; after the completion of the first phase (20 HBO2 sessions, up to two months); and after the completion of the second phase (20 HBO2 sessions, up to two months after the first phase). A reassessment was made on the completion of each phase. Ratings were also made after the completion of each phase, over the first f...
Intensive and Critical Care Nursing
Journal of Pediatric Surgery
Journal of Oncology Pharmacy Practice
Fluoropyrimidine-based regimens are among the most commonly used chemotherapy combinations for th... more Fluoropyrimidine-based regimens are among the most commonly used chemotherapy combinations for the treatment of solid tumors. Several genetic polymorphisms that are implicated with fluoropyrimidine anabolism and catabolism have been associated with the development of life-threatening toxicities. Uridine triacetate is an FDA-approved antidote for 5-fluorouracil or capecitabine overdose and early-onset, life-threatening toxicity within 96 h of last chemotherapy dose. To date, it is not accessible for Greek patients as per the current summary of product characteristic's time restrictions. We report and discuss the course and outcome of capecitabine toxicity in a 66-year-old female colorectal cancer patient with heterozygous dihydropyrimidine dehydrogenase deficiency. This paper highlights the difficulty in timely access of this lifesaving medication for Greek and possibly other European patients.
Chirurgia
Educaţia medicală in contextul pediatric a fost asociată cu rezultate medicale scăzute şi joacă u... more Educaţia medicală in contextul pediatric a fost asociată cu rezultate medicale scăzute şi joacă un rol important în existenţa inegalităţii în acest domeniu. Educaţia medicală precară a părinţilor / tutorilor influenţează rezultatele medicale, în special în cazul copiilor cu boli cronice. Încercând să identificăm rolul educaţiei medicale în contextul chirurgiei pediatrice şi a stomatologiei, am efectuat o reexaminare a literaturii de specialitate relevante. Puţinele studii şi eterogenitatea scăzută a metodologiei nu au dus la rezultate specifice. Nevoia de studii mai extinse în domeniu este evidentă şi esenţială pentru ameliorarea calităţii îngrijirii chirurgicale la copii şi adolescenţi. Cuvinte cheie: educaţie medicală, pediatrie, părinte, chirurgie.
International Journal of Surgery and Medicine
Introduction: Although, the effects of patient education on the effective anticoagulant managemen... more Introduction: Although, the effects of patient education on the effective anticoagulant management, among patients undergoing heart valve replacement with a mechanical prosthesis, have been reported, the evidence of this association remains inconclusive. Aim: To investigate the effect of a nurse-led patient education program for oral anticoagulant therapy on the incidence of thromboembolic and hemorrhagic episodes after surgical heart valve replacement. Methods: A quasi-experimental study was conducted. Patients were allocated to a) a control group (n=100), including those who received the usual education on oral anticoagulants, and b) an intervention group (n=100), with those who attended a nurse-led education program, postoperatively, including verbal courses and written material through an education booklet. We investigated the incidence of hemorrhagic and thromboembolic episodes three months after patients' hospital discharge. Patients' socio-demographic and clinical characteristics were obtained using a structured short questionnaire and through the medical and nursing patient records review. Patients' follow-up data were collected via phone interviews. Results: The baseline characteristics were similar for both groups. Patients who received nurse-led education on oral anticoagulant therapy had a significantly lower 3-month incidence of hemorrhagic episodes compared with controls (1% vs. 14%, p<0.001). However, we found insignificant differences in the 3-month incidence of thromboembolic events between the two groups. Conclusion: The implementation of a nurse-led education program on oral anticoagulants management failed to show effectiveness on the 3-month incidence of thromboembolic episodes. However, this educational intervention seems to be superior to the general patient education, leading to the significantly lower occurrence of hemorrhagic episodes.
Journal of Critical Care
Intensive care unit patients typically exhibit pathologic wakefulness, poor quality of daytime sl... more Intensive care unit patients typically exhibit pathologic wakefulness, poor quality of daytime sleep, nocturnal sleep fragmentation, and sleep patterns that feature the absence of slow wave sleep and rapid eye movement. This article offers a review of the existing literature examining circadian desynchronization in critically ill patients, highlighting contributing factors identified by scholars, and circadian abnormalities observed in these patients. It discusses potential implications for clinical practice and suggests avenues of future research. Elucidating the role of circadian rhythms in the management of critical illness can guide future chronotherapeutic approaches and optimize patient outcomes.
…, 2001
Background: Although mixed venous O 2 saturation (SvO 2) accurately indicates the balance of O 2 ... more Background: Although mixed venous O 2 saturation (SvO 2) accurately indicates the balance of O 2 supply/ demand and provides an index of tissue oxygenation, the use of a pulmonary artery (PA) catheter is associated with significant costs, risks and complications. Central venous O 2 saturation (ScvO 2), obtained in a less risky and costly manner, can be an attractive alternative to SvO 2. Objectives: To investigate whether the values of ScvO 2 and SvO 2 are well correlated and interchangeable in the evaluation of critically ill ICU patients and to create an equation that could estimate SvO 2 from ScvO 2. Methods: Sixty-one mechanically ventilated patients were catheterized upon admission and ScvO 2 and SvO 2 values were simultaneously measured in the lower part of the superior vena cava and PA respectively. Results: SvO 2 was 68.6 B 1.2% (mean B SEM) and ScvO 2 was 69.4 B 1.1%. The difference is statistically significant (p ! 0.03). The correlation coefficient r is 0.945 for the total population, 0.937 and 0.950 in surgical and medical patients, respectively. In 90.2% of patients the difference was !5%. When regression analysis was performed, among 11 models tested, power model [SvO 2 = b0(ScvO 2) b1 ] best described the relationship between the two parameters (R 2 = 0.917). Conclusions: ScvO 2 and SvO 2 are closely related and are interchangeable for the initial evaluation of critically ill patients even if cardiac indices are different. SvO 2 can be estimated with great accuracy by ScvO 2 in 92% of the patients using a power model.
Preoperative and intraoperative risk factors for prolonged mechanical ventilation among cardiac s... more Preoperative and intraoperative risk factors for prolonged mechanical ventilation among cardiac surgery patients 297
European cytokine network
Hyperbaric oxygen (HBO) is a therapeutic intervention with applications in a large variety of dis... more Hyperbaric oxygen (HBO) is a therapeutic intervention with applications in a large variety of diseases, including traumatic injuries and acute or chronic infections. The presence of pro-inflammatory cytokines regulates certain factors including adhesion molecules, which play a significant role in HBO effects. We have investigated the effect of HBO on pro-inflammatory cytokine release [tumor necrosis factor-alpha (TNF-alpha), interleukin 6 and 8 (IL-6 and IL-8)], and the regulation of adhesion molecules [soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular adhesion molecule (sVCAM)] after lipopolysaccharide (LPS) stimulation in 16 healthy individuals, originating from an urban area. A total number of 64 samples were treated, divided into four groups: Group A: not stimulated with LPS and not exposed to HBO. Group B: stimulated with LPS and not exposed to HBO. Group C: not stimulated with LPS and exposed to HBO. Group D: stimulated with LPS and exposed to HBO. The LPS stimulation dose was 100 pg\ml for 0.1 ml whole blood diluted 1:10. After incubation, samples were exposed to HBO with 100% O2 at 2.4 atmospheres absolute (ATA) for 90 min. TNF-alpha, IL-6, IL-8 and sICAM-1, sVCAM levels were determined in culture supernatant, with ELISA. We observed an enhanced effect of LPS stimulation following exposure to HBO, which caused an increase in cytokine production (TNF-alpha, IL-6, IL-8), a reduction in sICAM, and no change to sVCAM, while their levels without stimulation remained almost invariable. The decrease in sICAM levels could be related to the increased levels of IL-8, as the production of this chemokine is involved in the regulation of adhesion molecules.
Intensive Care Medicine
NTRODUCTION. Road accidents cause multiple traumas to patients, which leads to serious problems t... more NTRODUCTION. Road accidents cause multiple traumas to patients, which leads to serious problems to their Quality of Life (QoL) status. In order to regain their original QoL status, they have to pay high financial cost. OBJECTIVES. To investigate changes in QoL in multiple trauma patients during a period of 2 years after discharge and how these changes affect financial cost of rehabilitation. METHODS. This is a prospective observational study of 85 multiple trauma patients due to a road traffic accident and with an ICU stay of more than 24 h (2009–2011) from one Intensive Care Unit (ICU) of one urban hospital in Athens, Greece. RESULTS. Age, family status, living together with other people, monthly household income and presence of a traumatic brain injury are important determinants of patients’ QoL after hospital discharge. QoL after hospital discharge was initially low, but increased over time. Increased monthly household income and absence of traumatic brain injuries were associate...
Objective: To determine the association between ED overcrowding and outcomes for critically ill p... more Objective: To determine the association between ED overcrowding and outcomes for critically ill patients Design and Setting: We included medical and surgical pts that all of them were intubated promptly to ED of 2 general hospitals of Athens GR, for 12 months. Pts survived > 24hours were divided into 2 groups: ED boarding < 6 hrs (group A) and ED boarding ≥ 6 hrs (group B). In the ED, 196 critically ill patients with a mean age 59.6±20.9 yrs and APACHE II score 24.6±12.7 were intubated. Results: Group A = 76 pts (mean time ED boarding, LOS, mortality): 28 pts were admitted to CCU (30.7±20.4, 7.7±9.3, 42.9%), 32 to ICU (231.25±103.1, 11.9±7.8, 37.5%) and 16 to intermediate unit (191.3±33.5, 7.8±5.7, 0%). Group B = 120 pts (mean time ED boarding, LOS, mortality): 28 pts were admitted to ICU (559.28±101.6, 15.6±10.3, 58.7%) and 92 to intermediate unit (3094.4±3273.4, 19.1±14.5, 78.3%). Hospital LOS was 19.2±20.4 days for group A vs 41.5±62.7 days for group B (P<0.001), and mor...
Journal of PeriAnesthesia Nursing, 2015
We present a case of a 67-year-old Caucasian female who was admitted to the pulmonary clinic of a... more We present a case of a 67-year-old Caucasian female who was admitted to the pulmonary clinic of a general hospital in Athens with fever and respiratory symptoms. A lung biopsy was ordered because a clinical diagnosis of interstitial lung disease was suspected. The patient was then hospitalized in the intensive care unit. Because of the fact that peripheral catheterization was impossible and the prospect of further long-term hospitalization, the patient was referred to a vascular access nursing team composed of perianesthesia nurses to advance a peripherally inserted central catheter and support the line during treatment. The peripherally inserted central catheter line was advanced with no complications, and the position of the catheter was checked using the electrocardiography method.
European cytokine network
Hyperbaric oxygen (HBO) is a therapeutic intervention with applications in a large variety of dis... more Hyperbaric oxygen (HBO) is a therapeutic intervention with applications in a large variety of diseases, including traumatic injuries and acute or chronic infections. The presence of pro-inflammatory cytokines regulates certain factors including adhesion molecules, which play a significant role in HBO effects. We have investigated the effect of HBO on pro-inflammatory cytokine release [tumor necrosis factor-alpha (TNF-alpha), interleukin 6 and 8 (IL-6 and IL-8)], and the regulation of adhesion molecules [soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular adhesion molecule (sVCAM)] after lipopolysaccharide (LPS) stimulation in 16 healthy individuals, originating from an urban area. A total number of 64 samples were treated, divided into four groups: Group A: not stimulated with LPS and not exposed to HBO. Group B: stimulated with LPS and not exposed to HBO. Group C: not stimulated with LPS and exposed to HBO. Group D: stimulated with LPS and exposed to HBO. The L...
European cytokine network, 2007
Traumatic brain injury (TBI) acts as an inducer of the inflammatory reaction expressed by the rel... more Traumatic brain injury (TBI) acts as an inducer of the inflammatory reaction expressed by the release of pro-inflammatory cytokines (interleukin-1beta [IL-1beta], interleukin-6 [IL-6] and interleukin-8 [IL-8]), and causes metabolic alterations in the early, post-traumatic state, either in the brain or/and the systemic circulation. The metabolic changes involve carbohydrates, proteins and lipids. We focused on the serum lipid profile, the impact of trauma on lipoproteins, and their subsequent effects, on inflammation. We investigated the role of cytokines and serum lipids, in patient outcome, reviewing 30-day mortality and the Glasgow Coma Scale (GCS). A total of 75 patients with severe or moderate TBI (GCS <or= 13) were allocated to two groups (group 1 non-survivors and group 2 survivors). One blood sample was collected from each patient within 24h of admission. Cytokines were measured in serum by ELISA and serum lipids using an enzymatic method. We found significantly decreased ...
The International journal of neuroscience, 2021
Background: Evidence suggests that fluctuations of cortisol and vital signs can emerge during the... more Background: Evidence suggests that fluctuations of cortisol and vital signs can emerge during the course of mild Traumatic Brain Injury (mTBI).Objective: To investigate fluctuations of cortisol and vital signs during the acute phase of mTBI in hospitalised patients.Methods: 30 participants (19 patients with mTBI and 11 controls) were examined for saliva cortisol dynamics, heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and body temperature (BT) fluctuations for four consecutive days. Also, the participants completed the Athens Insomnia Scale and Epworth Sleepiness Scales, in order to check for sleep problems.Results: Patients showed elevated levels of cortisol relative to controls (peak at 8 am and lowest levels at 12 am), as well as for most physiological parameters. MAP was significantly higher for patients throughout the measurement period, and BT was elevated for patients relative to controls at almost all measur...
Health science journal, 2016
Background: Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) affects about 15,000 people annu... more Background: Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) affects about 15,000 people annually worldwide and exceeds 30 db at 3 contiguous audiometric frequencies. This study aims at evaluating the clinical efficacy of hyperbaric oxygen therapy (HBO2) in the management of ISSHL. Material and Methods: Fifty six patients were enrolled in the study suffering from ISSHL and tinnitus. The research protocol consisted of five phases. Each phase of the research protocol included five sessions with HBO2. The basic tool for assessing the measurement of auditory acuity is tonal audiogram. The evaluation of tinnitus was assessed using a questionnaire and a visual analogue scale at the beginning and the end of the study. Secondary assessment points included changes in the intensity and the improvement of tinnitus. Results: Fifty-six patients were treated with hyperbaric oxygen in this study, especially for hearing loss combined with tinnitus. All patients completed the first and second ph...
ABSTRACT Objective: To determine the association between ED overcrowding and outcomes for critica... more ABSTRACT Objective: To determine the association between ED overcrowding and outcomes for critically ill patients Design and Setting: We included medical and surgical pts that all of them were intubated promptly to ED of 2 general hospitals of Athens GR, for 12 months. Pts survived > 24hours were divided into 2 groups: ED boarding < 6 hrs (group A) and ED boarding ≥ 6 hrs (group B). In the ED, 196 critically ill patients with a mean age 59.6±20.9 yrs and APACHE II score 24.6±12.7 were intubated. Results: Group A = 76 pts (mean time ED boarding, LOS, mortality): 28 pts were admitted to CCU (30.7±20.4, 7.7±9.3, 42.9%), 32 to ICU (231.25±103.1, 11.9±7.8, 37.5%) and 16 to intermediate unit (191.3±33.5, 7.8±5.7, 0%). Group B = 120 pts (mean time ED boarding, LOS, mortality): 28 pts were admitted to ICU (559.28±101.6, 15.6±10.3, 58.7%) and 92 to intermediate unit (3094.4±3273.4, 19.1±14.5, 78.3%). Hospital LOS was 19.2±20.4 days for group A vs 41.5±62.7 days for group B (P<0.001), and mortality 26.8% vs 45.7% respectively (P<0.001). Delayed admission, higher Apache II, age > 61 yrs, female gender and direct admission to ICU were associated with lower hospital survival (odds ratio 0.815; 95% 0.612-0.976). Conclusions: Boarding time of critically ill from ED to ICUs is very important because it is strongly related to the hospital LOS and mortality rate. Keywords: ED, ICU, boarding time, LOS, mortality, hospital.
Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc, 2020
Introduction The treatment of avascular necrosis of the femoral head (AVNFH) is based on invasive... more Introduction The treatment of avascular necrosis of the femoral head (AVNFH) is based on invasive (e.g., core decompression) and non-invasive methods (e.g., hyperbaric oxygen therapy - HBO2). The purpose of the present study is to evaluate the effect of HBO2 on the quality of life (QoL) of patients with AVNFH. Methods This was a prospective observational non-controlled study of patients with AVNFH treated by HBO2. It was conducted, with the use of Steinberg scale, on 73 patients with AVNFH Stage I or II who were treated with HBO2. Patients' QoL was assessed with EuroQol-5D-5L (EQ), Harris Hip Score (mHHS), MAHORN (MHOT), and VAS, in three different phases: before HBO2; after the completion of the first phase (20 HBO2 sessions, up to two months); and after the completion of the second phase (20 HBO2 sessions, up to two months after the first phase). A reassessment was made on the completion of each phase. Ratings were also made after the completion of each phase, over the first f...
Intensive and Critical Care Nursing
Journal of Pediatric Surgery
Journal of Oncology Pharmacy Practice
Fluoropyrimidine-based regimens are among the most commonly used chemotherapy combinations for th... more Fluoropyrimidine-based regimens are among the most commonly used chemotherapy combinations for the treatment of solid tumors. Several genetic polymorphisms that are implicated with fluoropyrimidine anabolism and catabolism have been associated with the development of life-threatening toxicities. Uridine triacetate is an FDA-approved antidote for 5-fluorouracil or capecitabine overdose and early-onset, life-threatening toxicity within 96 h of last chemotherapy dose. To date, it is not accessible for Greek patients as per the current summary of product characteristic's time restrictions. We report and discuss the course and outcome of capecitabine toxicity in a 66-year-old female colorectal cancer patient with heterozygous dihydropyrimidine dehydrogenase deficiency. This paper highlights the difficulty in timely access of this lifesaving medication for Greek and possibly other European patients.
Chirurgia
Educaţia medicală in contextul pediatric a fost asociată cu rezultate medicale scăzute şi joacă u... more Educaţia medicală in contextul pediatric a fost asociată cu rezultate medicale scăzute şi joacă un rol important în existenţa inegalităţii în acest domeniu. Educaţia medicală precară a părinţilor / tutorilor influenţează rezultatele medicale, în special în cazul copiilor cu boli cronice. Încercând să identificăm rolul educaţiei medicale în contextul chirurgiei pediatrice şi a stomatologiei, am efectuat o reexaminare a literaturii de specialitate relevante. Puţinele studii şi eterogenitatea scăzută a metodologiei nu au dus la rezultate specifice. Nevoia de studii mai extinse în domeniu este evidentă şi esenţială pentru ameliorarea calităţii îngrijirii chirurgicale la copii şi adolescenţi. Cuvinte cheie: educaţie medicală, pediatrie, părinte, chirurgie.
International Journal of Surgery and Medicine
Introduction: Although, the effects of patient education on the effective anticoagulant managemen... more Introduction: Although, the effects of patient education on the effective anticoagulant management, among patients undergoing heart valve replacement with a mechanical prosthesis, have been reported, the evidence of this association remains inconclusive. Aim: To investigate the effect of a nurse-led patient education program for oral anticoagulant therapy on the incidence of thromboembolic and hemorrhagic episodes after surgical heart valve replacement. Methods: A quasi-experimental study was conducted. Patients were allocated to a) a control group (n=100), including those who received the usual education on oral anticoagulants, and b) an intervention group (n=100), with those who attended a nurse-led education program, postoperatively, including verbal courses and written material through an education booklet. We investigated the incidence of hemorrhagic and thromboembolic episodes three months after patients' hospital discharge. Patients' socio-demographic and clinical characteristics were obtained using a structured short questionnaire and through the medical and nursing patient records review. Patients' follow-up data were collected via phone interviews. Results: The baseline characteristics were similar for both groups. Patients who received nurse-led education on oral anticoagulant therapy had a significantly lower 3-month incidence of hemorrhagic episodes compared with controls (1% vs. 14%, p<0.001). However, we found insignificant differences in the 3-month incidence of thromboembolic events between the two groups. Conclusion: The implementation of a nurse-led education program on oral anticoagulants management failed to show effectiveness on the 3-month incidence of thromboembolic episodes. However, this educational intervention seems to be superior to the general patient education, leading to the significantly lower occurrence of hemorrhagic episodes.
Journal of Critical Care
Intensive care unit patients typically exhibit pathologic wakefulness, poor quality of daytime sl... more Intensive care unit patients typically exhibit pathologic wakefulness, poor quality of daytime sleep, nocturnal sleep fragmentation, and sleep patterns that feature the absence of slow wave sleep and rapid eye movement. This article offers a review of the existing literature examining circadian desynchronization in critically ill patients, highlighting contributing factors identified by scholars, and circadian abnormalities observed in these patients. It discusses potential implications for clinical practice and suggests avenues of future research. Elucidating the role of circadian rhythms in the management of critical illness can guide future chronotherapeutic approaches and optimize patient outcomes.
…, 2001
Background: Although mixed venous O 2 saturation (SvO 2) accurately indicates the balance of O 2 ... more Background: Although mixed venous O 2 saturation (SvO 2) accurately indicates the balance of O 2 supply/ demand and provides an index of tissue oxygenation, the use of a pulmonary artery (PA) catheter is associated with significant costs, risks and complications. Central venous O 2 saturation (ScvO 2), obtained in a less risky and costly manner, can be an attractive alternative to SvO 2. Objectives: To investigate whether the values of ScvO 2 and SvO 2 are well correlated and interchangeable in the evaluation of critically ill ICU patients and to create an equation that could estimate SvO 2 from ScvO 2. Methods: Sixty-one mechanically ventilated patients were catheterized upon admission and ScvO 2 and SvO 2 values were simultaneously measured in the lower part of the superior vena cava and PA respectively. Results: SvO 2 was 68.6 B 1.2% (mean B SEM) and ScvO 2 was 69.4 B 1.1%. The difference is statistically significant (p ! 0.03). The correlation coefficient r is 0.945 for the total population, 0.937 and 0.950 in surgical and medical patients, respectively. In 90.2% of patients the difference was !5%. When regression analysis was performed, among 11 models tested, power model [SvO 2 = b0(ScvO 2) b1 ] best described the relationship between the two parameters (R 2 = 0.917). Conclusions: ScvO 2 and SvO 2 are closely related and are interchangeable for the initial evaluation of critically ill patients even if cardiac indices are different. SvO 2 can be estimated with great accuracy by ScvO 2 in 92% of the patients using a power model.
Preoperative and intraoperative risk factors for prolonged mechanical ventilation among cardiac s... more Preoperative and intraoperative risk factors for prolonged mechanical ventilation among cardiac surgery patients 297
European cytokine network
Hyperbaric oxygen (HBO) is a therapeutic intervention with applications in a large variety of dis... more Hyperbaric oxygen (HBO) is a therapeutic intervention with applications in a large variety of diseases, including traumatic injuries and acute or chronic infections. The presence of pro-inflammatory cytokines regulates certain factors including adhesion molecules, which play a significant role in HBO effects. We have investigated the effect of HBO on pro-inflammatory cytokine release [tumor necrosis factor-alpha (TNF-alpha), interleukin 6 and 8 (IL-6 and IL-8)], and the regulation of adhesion molecules [soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular adhesion molecule (sVCAM)] after lipopolysaccharide (LPS) stimulation in 16 healthy individuals, originating from an urban area. A total number of 64 samples were treated, divided into four groups: Group A: not stimulated with LPS and not exposed to HBO. Group B: stimulated with LPS and not exposed to HBO. Group C: not stimulated with LPS and exposed to HBO. Group D: stimulated with LPS and exposed to HBO. The LPS stimulation dose was 100 pg\ml for 0.1 ml whole blood diluted 1:10. After incubation, samples were exposed to HBO with 100% O2 at 2.4 atmospheres absolute (ATA) for 90 min. TNF-alpha, IL-6, IL-8 and sICAM-1, sVCAM levels were determined in culture supernatant, with ELISA. We observed an enhanced effect of LPS stimulation following exposure to HBO, which caused an increase in cytokine production (TNF-alpha, IL-6, IL-8), a reduction in sICAM, and no change to sVCAM, while their levels without stimulation remained almost invariable. The decrease in sICAM levels could be related to the increased levels of IL-8, as the production of this chemokine is involved in the regulation of adhesion molecules.
Intensive Care Medicine
NTRODUCTION. Road accidents cause multiple traumas to patients, which leads to serious problems t... more NTRODUCTION. Road accidents cause multiple traumas to patients, which leads to serious problems to their Quality of Life (QoL) status. In order to regain their original QoL status, they have to pay high financial cost. OBJECTIVES. To investigate changes in QoL in multiple trauma patients during a period of 2 years after discharge and how these changes affect financial cost of rehabilitation. METHODS. This is a prospective observational study of 85 multiple trauma patients due to a road traffic accident and with an ICU stay of more than 24 h (2009–2011) from one Intensive Care Unit (ICU) of one urban hospital in Athens, Greece. RESULTS. Age, family status, living together with other people, monthly household income and presence of a traumatic brain injury are important determinants of patients’ QoL after hospital discharge. QoL after hospital discharge was initially low, but increased over time. Increased monthly household income and absence of traumatic brain injuries were associate...
Objective: To determine the association between ED overcrowding and outcomes for critically ill p... more Objective: To determine the association between ED overcrowding and outcomes for critically ill patients Design and Setting: We included medical and surgical pts that all of them were intubated promptly to ED of 2 general hospitals of Athens GR, for 12 months. Pts survived > 24hours were divided into 2 groups: ED boarding < 6 hrs (group A) and ED boarding ≥ 6 hrs (group B). In the ED, 196 critically ill patients with a mean age 59.6±20.9 yrs and APACHE II score 24.6±12.7 were intubated. Results: Group A = 76 pts (mean time ED boarding, LOS, mortality): 28 pts were admitted to CCU (30.7±20.4, 7.7±9.3, 42.9%), 32 to ICU (231.25±103.1, 11.9±7.8, 37.5%) and 16 to intermediate unit (191.3±33.5, 7.8±5.7, 0%). Group B = 120 pts (mean time ED boarding, LOS, mortality): 28 pts were admitted to ICU (559.28±101.6, 15.6±10.3, 58.7%) and 92 to intermediate unit (3094.4±3273.4, 19.1±14.5, 78.3%). Hospital LOS was 19.2±20.4 days for group A vs 41.5±62.7 days for group B (P<0.001), and mor...
Journal of PeriAnesthesia Nursing, 2015
We present a case of a 67-year-old Caucasian female who was admitted to the pulmonary clinic of a... more We present a case of a 67-year-old Caucasian female who was admitted to the pulmonary clinic of a general hospital in Athens with fever and respiratory symptoms. A lung biopsy was ordered because a clinical diagnosis of interstitial lung disease was suspected. The patient was then hospitalized in the intensive care unit. Because of the fact that peripheral catheterization was impossible and the prospect of further long-term hospitalization, the patient was referred to a vascular access nursing team composed of perianesthesia nurses to advance a peripherally inserted central catheter and support the line during treatment. The peripherally inserted central catheter line was advanced with no complications, and the position of the catheter was checked using the electrocardiography method.
European cytokine network
Hyperbaric oxygen (HBO) is a therapeutic intervention with applications in a large variety of dis... more Hyperbaric oxygen (HBO) is a therapeutic intervention with applications in a large variety of diseases, including traumatic injuries and acute or chronic infections. The presence of pro-inflammatory cytokines regulates certain factors including adhesion molecules, which play a significant role in HBO effects. We have investigated the effect of HBO on pro-inflammatory cytokine release [tumor necrosis factor-alpha (TNF-alpha), interleukin 6 and 8 (IL-6 and IL-8)], and the regulation of adhesion molecules [soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular adhesion molecule (sVCAM)] after lipopolysaccharide (LPS) stimulation in 16 healthy individuals, originating from an urban area. A total number of 64 samples were treated, divided into four groups: Group A: not stimulated with LPS and not exposed to HBO. Group B: stimulated with LPS and not exposed to HBO. Group C: not stimulated with LPS and exposed to HBO. Group D: stimulated with LPS and exposed to HBO. The L...
European cytokine network, 2007
Traumatic brain injury (TBI) acts as an inducer of the inflammatory reaction expressed by the rel... more Traumatic brain injury (TBI) acts as an inducer of the inflammatory reaction expressed by the release of pro-inflammatory cytokines (interleukin-1beta [IL-1beta], interleukin-6 [IL-6] and interleukin-8 [IL-8]), and causes metabolic alterations in the early, post-traumatic state, either in the brain or/and the systemic circulation. The metabolic changes involve carbohydrates, proteins and lipids. We focused on the serum lipid profile, the impact of trauma on lipoproteins, and their subsequent effects, on inflammation. We investigated the role of cytokines and serum lipids, in patient outcome, reviewing 30-day mortality and the Glasgow Coma Scale (GCS). A total of 75 patients with severe or moderate TBI (GCS <or= 13) were allocated to two groups (group 1 non-survivors and group 2 survivors). One blood sample was collected from each patient within 24h of admission. Cytokines were measured in serum by ELISA and serum lipids using an enzymatic method. We found significantly decreased ...