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  • The purpose of this study was to define the ICU medical and nursing profile in terms of staffing levels, nursing training and education. A questionnaire was sent to 40 Greek general ICUs collecting data relating to the organization and staffing of each ICU, type of ICU, number of beds, medical staff, nursing staff and supporting personnel, number of nurse full time equivalents to run one ICU bed and nurse/patient ratio. Data were collected from 31 ICUs (77.5%) with 270 beds, from community (20), university (5) and private hospitals (6). There were 769 nurses 70% of them being registered and 30% assistant nurses. The nursing full time equivalent/ICU bed was 2.84 and the nurse/patient ratio per morning, afternoon and night shift was 1.78, 2.26 and 2.6 respectively. The number of physicians available per functional unit of 8 beds was 4.4. There were 1.77 physiotherapists and 1 medical secretary available per 12 beds. The supporting and cleaning personnel was 1/0.91, 1/1.93, 1/15 and 1/0.89, 1/1.35, 1/5.2 ICUs per shift respectively. In conclusion, there is an inadequate number of ICU nurses necessary to provide appropriate care and observation to the critically ill patient. The challenge for the service is to provide the resources in terms of adequate staffing and good working conditions so that nurses can work freely to promote the art of nursing in order to protect themselves and their patients. Pneumon 2001, 14 (1): 38-46
     
  • The standard posterolateral thoracotomy has been used for many decades in a great number of thoracic operations. The procedure during which the lateral thoracic wall muscles - the latissimus dorsi and the serratus anterior - are being spared, represents an alternative approach. Since 1997, our department undertook 53 posterolateral thoracotomies in a random sample of patients, whereas the serratus anterior muscle, as well as the greatest part of the latissimus dorsi muscle, have been spared. During this type of thoracotomy, the skin incision is identical to the standard procedure, the latissimus dorsi muscle is partially divided and the serratus anterior muscle is mobilized, after its posterior margin is identified and his posterior fascia divided and thereafter, the hemithorax is entered through the 4th, 5th or 6th interspace. By sparing the serratus anterior muscle, as well as the greatest part of the latissimus dorsi muscle, faster patient recovery, while postoperative pain and use of analgetics, as well as duration of hospital stay are descreased. The time required for exposure of the chest cavity is increased, resulting in a decrease of closing time. In conclusion, the muscle-sparing posterolateral thoracotomy technique offers many advantages regarding postoperative patient recovery, pain, as well as duration and cost effectiveness of hospital stay. We strongly believe that it may be a reasonable alternative to the standard posterolateral approach. Pneumon 2001, 14 (1): 47-50
     
  • Aim of the study was to document the problems and care needs of a group of lung cancer patients attending a private pulmonary practice with a special interest in palliative care. The records of 58 patients (53 men, median age 65 years, range 22-87 years) with primary (46) or metastatic (12) lung malignancies, were examined. Clinical problems, medications and additional therapeutic modalities used, as well as requirements for consultations and admissions were tabulated for each patient. The mean number of problems per patient was 6 (range 1-11). The most frequent were various types of pain, cough, dyspnoea, anorexia-cachexia, fever and haemoptyses. On average, patients used more than 3 kinds of drugs (range 1-10) and the most commonly used were corticosteroids, Η2-receptor antagonists, antibiotics and vitamins. Thirty four patients required additional interventions (e.g. palliative radiotherapy or frequent chest aspirations). The burden of care was born by spouses (32) and children (16). Thirty patients required 2-4 visits, and 13 patients more than 10 visits. Forty five patients spent most of their illness at home, and 34 died there. During the terminal stage there was a frequent need for relief admissions for palliative interventions, cerebral metastases, respiratory distress or poor general condition. In conclusion, lung cancer patients face a large number of problems, use many drugs and need frequent medical visits and interventions. The burden of their care is born mostly by members of their families. Their management requires specialised knowledge and cooperation of various specialities, both in hospital and in the community. Pneumon 2001, 14 (1): 51-60
     
  • The purpose of this study was to assess the quality of care provided to patients who underwent thoracotomy for histologically proven primary lung cancer. The study was based on retrospective analysis of hospital data from 234 patients hospitalized in the two Thoracic Surgery Departments of the «SOTIRIA» Hospital in Athens. The approach was focused on the technical aspect of care while the assessment was based on process and outcome indicators, i.e. length of stay, 30-day postoperative morbidity, re-admissions, re-operations, operability, resectability, ratio of pneumonectomies/total number of resections and blood transfusion rate. Hospital stay was found to be very long. Seventy-six per cent of the patients were hospitalised, postsurgically in the ICU, with a mean length of stay 3 days. The rate of pneumonectomies/total number of resections was found to be 19.65%. The operability rate was 21.66% and the resectability rate 88.46%. The rate of 30-day post-operative morbidity was 7.69%. Re-operation and re-admission rates were satisfactory but their causes should be analyzed. Fifty-one per cent of the patients were transfused perioperatively , with a mean blood quantity of 3 units. We noticed statistical differences between the two departments concerning mean length of stay, transfusion frequency and rate of pneumonectomies/total number of resections. Pneumon 2001, 14 (1): 61-69
     
  • The aim of our study was evaluation of C-reactive protein (CRP) levels in patients with COPD exacerbation. We studied 38 COPD patients with clinical evidence of exacerbation and 21 COPD patients in a steady clinical state from the outpatient department. The patients in exacerbation were evaluated by chest x-ray, white blood cell count, sputum cultures, PaO2 levels and CRP blood levels.There was a statistical increase in the values of CRP of the patients in exacerbation, in comparison with those being in a steady state (p<0.001). There was no correlation between the CRP values of patients in exacerbation and their PaO2 values. There was statistical correlation between the values of CRP and the white blood cell count in those patients (R=0.469 p<0,01). Only six sputum cultures were positive for pathogens. CRP is of value in the assessment of exacerbations of COPD, where routine bacterial culture of sputum is often unreliable, but it is not necessarily a marker of bacterial infection "per se". Pneumon 2001, 14 (1): 70-73
     
  • The aim of this study was to evaluate the causes of hospitalization of female patients in a Pulmonary Department. We studied the female patients that had been hospitalized in our clinic during the last four years (1996-1999). We grouped our female patients in pulmonary disease-categories, studied the group number of the hospitalized females for the last four years and for each year, separately. We did not take under consideration those patients who had been admitted to our department for the same cause. Subsequently, 1055 female patients were found to be hospitalized in our clinic for the last four years. Comparing the whole number of patients being hospitalized, we did not found any statistical difference. Comparing the group-number of individuals, we did not prove any statistical difference in the annual incidence of each disease. In conclusion, the most important causes of female-patients hospitalization were COPD (25%), pulmonary infection (14%), bronchial asthma (13%), lung cancer (12%) and pneumonia (9%). Other pulmonary diseases as tuberculosis, sarcoidosis, collagen diseases of the lung, represent a smaller percentage. At the same time, 2084 male patients were hospitalized in our department. Out of them, 29.7% were suffering from lung cancer, 29.2% from COPD, 7.9% from pneumonia, 5.4% from respiratory infection and 3.74% from asthma. There was a statistical significant difference in the incidence of COPD, lung cancer and bronchial asthma between males and females that were hospitalized for that time period (p<0,001). Pneumon 2001, 14 (1): 74-80
     
  • We present the case of a 48-years old man, smoker, with cough, hemoptysis and dyspnea. The chest x-ray in the context of showed a broad, medially concave, kidney shaped opacity at the left hemithorax. The patient received diuretics and three days later the density disappeared. The final diagnosis was left cardiac failure (phantom tumor) in the context of aortic valve stenosis. Although the localization of pleural fluid at the left is unusual we should keep in mind this possibility when history or clinical examimation support it. The patient may avoid inappropriate or invasive diagnostic procedures such as biopsy or surgery. Pneumon 2001, 14 (1): 81-85
     
  • We report a 67 years old woman with cholobronchial fistula due to hydatic disease. Fistula was suspected at her presentation, after clinical picture and serologic evaluations. Diagnosis was confirmed by sputum analysis, which revealed hooklets and biliary components. The patient underwent emergency surgical treatment. Pneumon 2001, 14 (1): 86-93
     
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