First name
Georgia
Last name
Kourlaba

Title

Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A "Low-Hanging Fruit" Approach.

Year of Publication

2021

Date Published

2021 Mar 09

ISSN Number

2079-6382

Abstract

Antibiotics are commonly prescribed in Neonatal Intensive Care Units (NICU), where stewardship interventions are challenging. Lowering antibiotic consumption is desperately needed in Greece, a country with high antibiotic resistance rates. We sought to assess the effectiveness of a low-cost and -resource intervention to reduce antibiotic use in Greek NICUs implementing a "low-hanging fruit" approach. A prospective quasi-experimental study was conducted in 15/17 public NICUs in Greece (9/2016-06/2019). The intervention selected was discontinuation of antibiotics within 5 days for neonates with gestational age ≥ 37 weeks, no documented signs or symptoms of sepsis, CRP ≤ 10 mg/L and negative cultures within 3 days of antibiotic initiation. Impact was evaluated by the percentage of discontinued regimens by day 5, length of therapy (LOT) and stay. Trends of antibiotic consumption were assessed with days of therapy (DOT) per 1000 patient-days. Overall, there was a 9% increase ( = 0.003) of antibiotic discontinuation in ≤5 days. In total, 7/13 (53.8%) units showed a ≥10% increase. Overall, 615 days on antibiotics per 1000 patients were saved. Interrupted time-series analysis established a declining trend in DOT/1000 patient-days relative to the pre-intervention trend ( = 0.002); a monthly decrease rate of 28.96 DOT/1000 patient-days ( = 0.001, 95%CI [-45.33, -12.60]). The intervention had no impact on antibiotic choice. Antibiotic use was successfully reduced in Greek NICUs using a "low-hanging fruit" approach. In resource-limited settings, similar targeted stewardship interventions can be applied.

DOI

10.3390/antibiotics10030275

Alternate Title

Antibiotics (Basel)

Title

The Role of Medical Students During COVID-19 Era. A Review.

Year of Publication

2021

Number of Pages

e2021032

Date Published

2021 02 08

ISSN Number

2531-6745

Abstract

<p><strong>BACKGROUND AND AIM OF THE WORK: </strong>Since December 2019, the world has been facing the coronavirus (COVID-19) pandemic crisis. The rapid and effortless spread of the virus has led the World Health Organization to adopt unprecedented large-scale preventive measures. Our aim is to investigate the impact of COVID-19 on the mental health of medical students, and to evaluate their awareness and aptitude for contributing to the fight against COVID-19 contagion.</p>

<p><strong>METHODS: </strong>PubMed electronic database was employed for the research using the following terms: "medical students and COVID-19", "mental health of medical students and COVID-19", "knowledge of medical students and COVID-19", "preventive behavior of medical students and COVID-19".</p>

<p><strong>RESULTS: </strong>Twenty-one articles were included; ten assess the knowledge of medical students on COVID-19, seven present whether they demonstrate appropriate preventive behavior according to global guidelines, seven examine the impact of the pandemic on their mental health, five examine their role on the side of trained healthcare workers. Some articles combine more than one of the above mentioned domains.</p>

<p><strong>CONCLUSIONS: </strong>Medical students seem to demonstrate an adequate level of knowledge upon COVID-19 and implement proper strategies to prevent its spread. Further training is essential to improve some aspects in this field. Social media has proven to be the optimal source of information for medical students, which is incompatible with their future careers as doctors. The pandemic had a negative impact on medical students, expressed as fear regarding the virus spread; nevertheless, many have felt the need to assist healthcare systems under appropriate precautions.</p>

DOI

10.23750/abm.v92i1.10873

Alternate Title

Acta Biomed

PMID

33682809

Title

Willingness of Greek general population to get a COVID-19 vaccine.

Year of Publication

2021

Number of Pages

3

Date Published

2021 01 29

ISSN Number

2397-0642

Abstract

<p><strong>BACKGROUND: </strong>Epidemiological data indicate that a large part of population needs to be vaccinated to achieve herd immunity. Hence, it is of high importance for public health officials to know whether people are going to get vaccinated for COVID-19. The objective of the present study was to examine the willingness of adult residents in Greece to receive a COVID-19 vaccine.</p>

<p><strong>METHODS: </strong>A cross-sectional was survey conducted among the adult general population of Greece between April 28, 2020 to May 03, 2020 (last week of lockdown), using a mixed methodology for data collection: Computer Assisted Telephone Interviewing (CATI) and Computer Assisted web Interviewing (CAWI). Using a sample size calculator, the target sample size was found to be around 1000 respondents. To ensure a nationally representative sample of the urban/rural population according to the Greek census 2011, a proportionate stratified by region systematic sampling procedure was used to recruit particpants. Data collection was guided through a structured questionnaire. Regarding willingness to COVID-19 vaccination, participants were asked to answer the following question: "If there was a vaccine available for the novel coronavirus, would you do it?"</p>

<p><strong>RESULTS: </strong>Of 1004 respondents only 57.7% stated that they are going to get vaccinated for COVID-19. Respondents aged &gt; 65 years old, those who either themselves or a member of their household belonged to a vulnerable group, those believing that the COVID-19 virus was not developed in laboratories by humans, those believing that coronavirus is far more contagious and lethal compared to the H1N1 virus, and those believing that next waves are coming were statistically significantly more likely to be willing to get a COVID-19 vaccine. Higher knowledge score regarding symptoms, transmission routes and prevention and control measures against COVID-19 was significantly associated with higher willingness of respondents to get vaccinated.</p>

<p><strong>CONCLUSION: </strong>A significant proportion of individuals in the general population are unwilling to receive a COVID-19 vaccine, stressing the need for public health officials to take immediate awareness-raising measures.</p>

DOI

10.1186/s41256-021-00188-1

Alternate Title

Glob Health Res Policy

PMID

33509291

Title

Prevalence, incidence, length of stay and cost of healthcare-acquired pressure ulcers in pediatric populations: A systematic review and meta-analysis.

Year of Publication

2020

Number of Pages

103843

Date Published

2020 Dec 16

ISSN Number

1873-491X

Abstract

<p><strong>BACKGROUND: </strong>Pressure ulcers are a major problem for national healthcare systems since they frequently occur in hospitalized patients, negatively affecting patients' quality of life and extending duration of hospitalization.</p>

<p><strong>OBJECTIVE: </strong>To systematically review the available evidence regarding the incidence, prevalence, attributable length of stay and cost of hospital-acquired pressure ulcers in pediatric populations.</p>

<p><strong>DESIGN: </strong>A systematic review and meta-analysis.</p>

<p><strong>METHODS: </strong>A systematic search (March 15, 2020) was conducted in PubMed, Scopus, and ProQuest databases. Cross-sectional and cohort studies of neonates and children aged &lt;21 years old were eligible for inclusion when full text was available in English and data for at least one of the following criteria was provided: incidence, prevalence, attributable length of stay or healthcare cost due to hospital-acquired pressure ulcers. Study quality was evaluated using the Joanna Briggs Institute Critical Appraisal Tools. Random effects models were used to synthesize data. Heterogeneity and publication bias were evaluated.</p>

<p><strong>RESULTS: </strong>From the 1055 studies appeared in literature search, 21 studies were included in the systematic review and 19 were included in the meta-analysis. The overall prevalence ranged from 0.47% to 31.2% and cumulative incidence ranged from 3.7% to 27%. The pooled prevalence was estimated at 7.0% (95% confidence interval (CI): 4.3%-10.4%) and the pooled cumulative incidence at 14.9% (95% CI: 7.7%-23.9%). The pooled prevalence among neonates was 27.0% (95% CI: 22.1%-33.1%) among children aged less than 1 year old was 19.2% (95% CI: 9.4%-31.3%) and among children older than 1 year was 12.3% (95% CI: 2.3%-27.9%). The cumulative incidence of hospital-acquired pressure ulcers in neonates was 9.8% (95% CI: 2.9%-19.8%) and in children aged &lt;1 year old was 11.3% (95% CI: 4.4%-20.7%), while no data was available to estimate this figure for children older than 1 year. The attributable length of stay ranged from 0.9 to 14.1 days and the attributable cost ranged from $894.69 to $98,730.24 (United States dollars; value of a dollar in 2020) per patient with hospital-acquired pressure ulcers.</p>

<p><strong>CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: </strong>The results of this meta-analysis indicate that hospital-acquired pressure ulcers occur frequently in pediatric populations with a great variation across different age groups. Moreover, although limited data are available, it seems that hospital-acquired pressure ulcers have significant economic implications for the healthcare systems since they prolong patients' hospitalization stay; these findings further highlight the need for implementation of patient-based prevention strategies.</p>

<p><strong>SYSTEMATIC REVIEW REGISTRATION NUMBER: </strong>Not registered Tweetable abstract Hospital-acquired pressure ulcers occur frequently in pediatric populations, prolonging their hospitalization and increasing the healthcare cost.</p>

DOI

10.1016/j.ijnurstu.2020.103843

Alternate Title

Int J Nurs Stud

PMID

33373805

Title

Increasing healthcare workers' uptake of seasonal influenza vaccination in a tertiary-care pediatric hospital in Greece with a low-cost, tailor-made, multifaceted strategy.

Year of Publication

2020

Date Published

2020 May 16

ISSN Number

1873-2518

Abstract

<p><strong>BACKGROUND: </strong>Healthcare workers' (HCW) seasonal influenza vaccination (SIV) is critical to prevent nosocomial influenza. However, HCW vaccination rates remain unacceptably low in many European institutions. A two-year three-step initiative was implemented at a tertiary-care pediatric hospital with 750 beds in Athens, Greece with the aim of increasing SIV among HCW.</p>

<p><strong>METHODS: </strong>Α cross-sectional anonymous survey of HCWs was conducted during the 2015-16 influenza season with the aim to evaluate attitudes, knowledge, and specific barriers and facilitators for SIV. Stratified analysis was used to identify factors associated with no prior history of influenza vaccination. Multifaceted interventions were implemented in the 2016-2017 season. These included 1) education around influenza disease and SIV, and 2) communication of availability and opportunity (time and place) of SIV. Interventions were designed to target HCWs with the lowest SIV rates in the previous three years.</p>

<p><strong>RESULTS: </strong>We achieved a 67% response rate, with 363 respondents (106 doctors, 145 nurses, 101 other hospital staff; 11 did not provide their profession). Most (64%) had not been vaccinated in the previous three years; only 14% received the vaccine annually. Non-vaccination rates were significantly higher among nurses (76%) and cleaning and food-service workers (73%) compared to doctors (40%) (P&nbsp;&lt;&nbsp;0.001). Protection of self, family, patients and colleagues were the most common motivations. Concerns about the safety and effectiveness of the vaccine, the belief that one does not belong to a high-risk group were the most common barriers. The interventions led to an increase in SIV uptake by the HCWs in the hospital, from 19% to 31%.</p>

<p><strong>CONCLUSIONS: </strong>In a country with very low reported rates of vaccination among HCWs, a simple, low-cost, tailor-made intervention strategy can lead to an increase in SIV uptake. Stratifying data according to vaccination history may reveal a diversity of targets for improvement that might otherwise be missed.</p>

DOI

10.1016/j.vaccine.2020.05.021

Alternate Title

Vaccine

PMID

32430148

Title

Length of stay, cost, and mortality of healthcare-acquired bloodstream infections in children and neonates: A systematic review and meta-analysis.

Year of Publication

2020

Number of Pages

1-13

Date Published

2020 Jan 03

ISSN Number

1559-6834

Abstract

<p><strong>OBJECTIVE: </strong>To estimate the attributable mortality, length of stay (LOS), and healthcare cost of pediatric and neonatal healthcare-acquired bloodstream infections (HA-BSIs).</p>

<p><strong>DESIGN: </strong>A systematic review and meta-analysis.</p>

<p><strong>METHODS: </strong>A systematic search (January 2000-September 2018) was conducted in PubMed, Cochrane, and CINAHL databases. Reference lists of selected articles were screened to identify additional studies. Case-control or cohort studies were eligible for inclusion when full text was available in English and data for at least 1 of the following criteria were provided: attributable or excess LOS, healthcare cost, or mortality rate due to HA-BSI. Study quality was evaluated using the Critical Appraisal Skills Programme Tool (CASP). Study selection and quality assessment were conducted by 2 independent researchers, and a third researcher was consulted to resolve any disagreements. Fixed- or random-effect models, as appropriate, were used to synthesize data. Heterogeneity and publication bias were evaluated.</p>

<p><strong>RESULTS: </strong>In total, 21 studies were included in the systematic review and 13 studies were included in the meta-analysis. Attributable mean LOS ranged between 4 and 27.8 days; healthcare cost ranged between $1,642.16 and $160,804 (2019 USD) per patient with HA-BSI; and mortality rate ranged between 1.43% and 24%. The pooled mean attributable hospital LOS was 16.91 days (95% confidence interval [CI], 13.70-20.11) and the pooled attributable mortality rate was 8% (95% CI, 6-9). A meta-analysis was not conducted for cost due to lack of eligible studies.</p>

<p><strong>CONCLUSIONS: </strong>Pediatric HA-BSIs have a significant impact on mortality, LOS, and healthcare cost, further highlighting the need for implementation of HA-BSI prevention strategies.</p>

DOI

10.1017/ice.2019.353

Alternate Title

Infect Control Hosp Epidemiol

PMID

31898557

Title

The timing and redosing of perioperative antimicrobial prophylaxis in Greek children.

Year of Publication

2019

Number of Pages

1-2

Date Published

2019 Sep 17

ISSN Number

1559-6834

Abstract

<p>Appropriate use of perioperative antimicrobial prophylaxis (PAP) is essential to attain optimal patient outcomes; inappropriate dose, timing, and drug choice can increase the risk of surgical site infections (SSIs). Although the appropriateness of PAP use in children regarding the selection of antimicrobial agents and duration of PAP has been studied in Greece, no published data regarding the timing and intraoperative redosing of PAP are available. Moreover, to our knowledge, data are limited regarding PAP timing and redosing in pediatric surgical populations worldwide.</p>

<p>In this study, we assessed the timing of administration of PAP and the need for redosing in pediatric patients in Greece, and we sought to determine adherence to published guidelines.</p>

DOI

10.1017/ice.2019.244

Alternate Title

Infect Control Hosp Epidemiol

PMID

31526403

Title

Attributable length of stay and cost for pediatric and neonatal central line-associated bloodstream infections in Greece.

Year of Publication

2019

Date Published

2019 Jan 04

ISSN Number

1876-035X

Abstract

<p><strong>BACKGROUND AND OBJECTIVE: </strong>Central line-associated bloodstream infections (CLABSIs) are the most frequent pediatric hospital-acquired infections and are associated with significant morbidity and healthcare costs. The aim of our study was to determine the attributable length of stay (LOS) and cost for CLABSIs in pediatric patients in Greece, for which there is currently a paucity of data.</p>

<p><strong>METHODS: </strong>A retrospective matched-cohort study was performed in two tertiary pediatric hospitals. Inpatients with a central line in neonatal and pediatric intensive care units, hematology/oncology units, and a bone marrow transplantation unit between June 2012 and June 2015 were eligible. Patients with confirmed CLABSI were enrolled on the day of the event and were matched (1:1) to patients without CLABSI (non-CLABSIs) by hospital, unit, and LOS prior to study enrollment (188 children enrolled, 94 CLABSIs). The primary outcome measure was the attributable LOS and cost. Baseline demographic and clinical characteristics were recorded. Attributable outcomes were calculated as the differences in estimates of outcomes between CLABSIs and non-CLABSIs, after adjustment for propensity score and potential confounders.</p>

<p><strong>RESULTS: </strong>There were no differences between the two groups regarding their baseline characteristics. After adjustment for age, gender, matching characteristics, central line management after study enrollment, and propensity score, the mean LOS and cost were 57.5days and €31,302 in CLABSIs versus 36.6days and €17,788 in non-CLABSIs. Overall, a CLABSI was associated with a mean (95% CI) adjusted attributable LOS and cost of 21days (7.3-34.8) and €13,727 (5,758-21,695), respectively. No significant difference was detected in LOS and cost by hospitalization unit.</p>

<p><strong>CONCLUSIONS: </strong>CLABSIs were found to impose a significant economic burden in Greece, a finding that highlights the importance of implementing CLABSI prevention strategies.</p>

DOI

10.1016/j.jiph.2018.12.004

Alternate Title

J Infect Public Health

PMID

30616938

Title

Surveillance for central-line-associated bloodstream infections: Accuracy of different sampling strategies.

Year of Publication

2018

Number of Pages

1-6

Date Published

2018 Aug 29

ISSN Number

1559-6834

Abstract

<p><strong>BACKGROUND: </strong>Active daily surveillance of central-line days (CLDs) in the assessment of rates of central-line-associated bloodstream infections (CLABSIs) is time-consuming and burdensome for healthcare workers. Sampling of denominator data is a method that could reduce the time necessary to conduct active surveillance.</p>

<p><strong>OBJECTIVE: </strong>To evaluate the accuracy of various sampling strategies in the estimation of CLABSI rates in adult and pediatric units in Greece.</p>

<p><strong>METHODS: </strong>Daily denominator data were collected across Greece for 6 consecutive months in 33 units: 11 adult units, 4 pediatric intensive care units (PICUs), 12 neonatal intensive care units (NICUs), and 6 pediatric oncology units. Overall, 32 samples were evaluated using the following strategies: (1) 1 fixed day per week, (2) 2 fixed days per week, and (3) 1 fixed week per month. The CLDs for each month were estimated as follows: (number of sample CLDs/number of sampled days) × 30. The estimated CLDs were used to calculate CLABSI rates. The accuracy of the estimated CLABSI rates was assessed by calculating the percentage error (PE): [(observed CLABSI rates - estimated CLABSI rates)/observed CLABSI rates].</p>

<p><strong>RESULTS: </strong>Compared to other strategies, sampling over 2 fixed days per week provided the most accurate estimates of CLABSI rates for all types of units. Percentage of estimated CLABSI rates with PE ≤±5% using the strategy of 2 fixed days per week ranged between 74.6% and 88.7% in NICUs. This range was 79.4%-94.1% in pediatric onology units, 62.5%-91.7% in PICUs, and 80.3%-92.4% in adult units. Further evaluation with intraclass correlation coefficients and Bland-Altman plots indicated that the estimated CLABSI rates were reliable.</p>

<p><strong>CONCLUSION: </strong>Sampling over 2 fixed days per week provides a valid alternative to daily collection of CLABSI denominator data. Adoption of such a monitoring method could be an important step toward better and less burdensome infection control and prevention.</p>

DOI

10.1017/ice.2018.187

Alternate Title

Infect Control Hosp Epidemiol

PMID

30156182

Title

Perioperative antimicrobial prophylaxis in pediatric patients in Greece: Compliance with guidelines and impact of an educational intervention.

Year of Publication

2015

Date Published

2015 Dec 1

ISSN Number

1531-5037

Abstract

<p><strong>BACKGROUND/PURPOSE: </strong>Appropriate antimicrobial prophylaxis (PAP) prevents surgical site infections (SSI). The aim of this study was to evaluate the effectiveness of an educational intervention to improve adherence to PAP guidelines in pediatric patients.</p>

<p><strong>METHODS: </strong>A three-phase prospective study with a pre-post design was conducted from April 2013 to December 2014. All patients who underwent one or more surgical procedures were enrolled. A modified Centers for Disease Control's (CDC) Denominator for Procedure form was used to collect clinical and PAP data. The educational intervention was targeted at all pediatric surgeons in the department. Outcomes assessed were the appropriateness of the agent selected for PAP (according to international guidelines) and appropriate termination of PAP within 24h of surgery completion. SSI rates were calculated before and after the intervention.</p>

<p><strong>RESULTS: </strong>During the study period 889 children were enrolled (219 in the preintervention and 670 in the postintervention period). The percentage of patients receiving appropriate PAP improved from 6.2% to 77.1% after the educational intervention (p&lt;0.001). The median duration of PAP was reduced from 5 to 1days in preintervention and postintervention period, respectively. There was no increase in the rate of SSIs (0.93% and 0.92%, p=0.992, in preinterventionand postintervention, respectively).</p>

<p><strong>CONCLUSIONS: </strong>An educational intervention targeted at pediatric surgeons improved the selection of agent and timely discontinuation of PAP.</p>

DOI

10.1016/j.jpedsurg.2015.11.017

Alternate Title

J. Pediatr. Surg.

PMID

26711690

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