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Covid-19 pandemic has influenced stroke care in different ways. Recent reports demonstrated a sharp decline in acute stroke admissions worldwide. Even for patients presented to dedicated healthcare services, management at the acute phase may be sub-optimal. On the other hand, Greece has been praised for the early initiation of restriction measures which were associated with a ‘milder’ surge of SARS-CoV-2 infection. Methods Data derived from a prospective cohort multicenter registry. The study population consisted of first-ever acute stroke patients, hemorrhagic or ischemic, admitted within 48 hours of symptom onset in seven national healthcare system (NHS) and University hospitals in Greece. Two different time periods have been considered, defined as “before Covid-19” (15/12/2019-15/02/2020) and “during Covid-19” (16/02/2020-15/04-2020) era. Statistical comparisons on acute stroke admission characteristics between the two different time periods have been performed. Results This exploratory analysis of 112 consecutive patients showed a reduction of acute stroke admissions by 40% during Covid-19 period. No significant differences were observed regarding stroke severity, risk factor profile and baseline characteristics for patients admitted before and during Covid-19 pandemic period. There is a significant delay between symptom onset to CT scan during Covid-19 era compared to the period before pandemic reached Greece (p=0.03). Conclusions The rate of acute stroke admissions has been reduced by 40% during Covid-19 pandemic. Further research is needed to clarify whether the reduction in stroke volume is actual or not and identifying the reasons underlying the paradox. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess stroke patients' experiences in regards to hospital stay and during discharge. A cross-sectional study with retrospective data collection was conducted including patients (n=135) with firstever acute stroke, who were admitted in seven Public Hospitals in Greece ("Stroke Units Necessity for Patients, SUN4P" registry). The translated version of the NHSStroke Questionnaire in the Greek was used. 48.2% of patients rated their overall experience from the care they received as very good/excellent. 66% of patients reported that they participated in decision making about their care and 21.5% reported not having received help from the hospital's social services regarding any benefits/aids, thus lowering their overall patient experience score (p=0.017). Decision and policymakers must consider factors affecting stroke patients 'experiences during their hospitalization. The development of a national stroke patients' experiences database can help prioritize relevant actions and draw up a commonly accepted management and services redesign framework for patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the appropriateness of use of the Emergency Departments (EDs) and to identify the reasons for inappropriate use. A study with 805 patients visiting the EDs of four large-scale public hospitals in Athens was conducted using the Hospital Urgencies Appropriateness Protocol (HUAP). 38.1% of the visits (n=307) were estimated as inappropriate, due to several reasons such as increased confidence in hospital rather than primary care services/ patients' expectation for improved care in EDs (46.6%), convenience/proximity to patient's residence (44.6%) etc. Ageing, Greek nationality and insurance coverage were related with the appropriate use of EDs (p<0.001, p=0.04 and p=0.005, respectively). The identified distortions must be tackled so as to mitigate ED crowding, waste of resources and increase quality and responsiveness of care. [ABSTRACT FROM AUTHOR]

Experiences and outcomes of critically ill patients reflect quality of intensive care. The aim of this study was twofold: a) to investigate factors affecting patients' experiences to Intensive Care Units (ICUs) and b) to measure patients' post discharge Health-Related Quality of Life (HRQOL). Methods: A cross-sectional study with retrospective data collection was carried out. The participants (n=108) were discharged patients from four ICUs of three military hospitals in Athens. Telephone interviews were conducted using the "Patient Empowerment Questionnaire" and "Quality of life Questionnaire". Results: Patients suffering from pain (p<0.001), polytraumatized or patients underwent a "non-scheduled surgery" (p=0.001) reported worse sleep at night. Mechanical ventilation was associated positively with pain relief (p=0.021). Extended length of stay (p<0.001), bad health status prior ICU admission (p=0.005), "polytrauma" and "non-scheduled surgery" patients (p=0.032), mechanical ventilation (p=0.005) and pain during ICU stay (p=0.04) were correlated with worse HRQOL after discharge. Conclusions: ICU staff must consider the factors that affected patients' experiences during their ICU stay and worsened HRQOL after discharge. Adoption of new technological innovations could help them to improve the quality of intensive care provided. [ABSTRACT FROM AUTHOR]

SUN4Patients is an observational study for the monitoring of patients with first ever acute stroke. For the support of this study, an online platform has been developed which facilitates the collection of various information related to hospital discharge, health services utilization and loss of productivity of the patients. This paper presents the main characteristics of the platform and the methodology followed for its design and implementation. [ABSTRACT FROM AUTHOR]

The purpose of the study was to investigate the experiences of discharged patients from Intensive Care Units (ICUs). A study with retrospective data collection (n= 112) was conducted via interviews using the Intensive Care Experience Questionnaire. 93% of participants reported positive experiences from the ICU. Frightening experiences were restricted to minimum levels (mean score=9/25), while the feeling of security was prevalent (96.5%) and care satisfaction was high (mean score= 18.2 / 20). Communicating the aforementioned experiences, professionals may better understand patients' needs in order to improve the IT systems and patients' hospitalization. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) is a common metabolic disease characterized by high blood glucose levels, and it is considered as a modern global threat. Glucose monitoring is an important component of modern therapy for diabetes mellitus. Self-monitoring blood glucose (SMBG) by finger pricking or flash glucose monitoring (FGM) allows individual planning of treatment. The aim of this study was to investigate patients' experiences with self-monitoring blood glucose methods., Methods: A cross-sectional study was conducted using the Glucose Monitoring Experiences Questionnaire (GME-Q), consisted of 22 items with an overall score ranging from 1 to 5 (higher score indicates better experiences). The study included adult patients with diabetes mellitus type 1 (DM 1) or type 2 (DM 2)., Results: Out of 253 participants (mean age, 56.4 years), 65.6% were suffering from DM type 2 and 34.4% from DM type 1, whereas 48.6% were using SMBG and 49.8% FGM. The mean score of convenience and effectiveness were higher in the group of patients using FGM, while SMBG found to be more discreet. The results of the analysis suggested that there was no relation between gender and effectiveness, discreetness or convenience of the method used for glucose monitoring. Furthermore, participants with diabetes type 2 reported higher "convenient" and "discreetness" score than patients with diabetes type 1. The analysis also indicated that there was no relation between the age of the participants and the effectiveness, discreetness and convenience of any glucose monitoring method., Conclusions: Improved self-glucose monitoring experiences are an essential component to achieve effective management of patients suffering from both DM 1 and DM 2. More research should be conducted on the field of glucose monitoring experiences, related to the cost of the methods, the user's training and the ability to support insulin/diet calculations.

The aim of the study was to evaluate the quality of life (QoL) of patients with diabetes mellitus (DM) Methods: A cross-sectional study was conducted using the Audit of Diabetes-Depended Quality of Life (ADDQoL) questionnaire. The study included adult patients with diabetes mellitus type 1 (DM 1) or type 2 (DM 2). Results: A total of 253 patients were enrolled in the study. Despite the fact that the majority of participants stated a good QoL, DM has a negative impact on all 19 domains of ADDQoL. The greater negative impact referred to the domain "freedom to eat". There was no relation between overall score of QoL and age, gender or type of DM. On the contrary, we found statistically significant relation between age, gender, type of DM, presence of comorbidities and specific domains of Qol. Conclusions: Our findings, which are in accordance with the literature, highlight the great negative impact of DM on QoL of diabetics and they could be used by health professionals and policy makers to improve patients' well-being.

Covid-19 pandemic continues to cause great losses in human lives and adverse consequences in many sectors of the EU economy. The aim of the paper is to evaluate the effects of the pandemic in small and medium-sized enterprises (SMEs), in culture - entertainment industry and to investigate the effectiveness of the corresponding entrepreneurship support measures have been taken. This review was conducted based on related articles that were published during the years 2020-2021, using the online databases of Google Scholar, Science Direct, Elsevier, PubMed, OECD, IOBE. A total of 16 eligible studies were included in this literature review. EU authorities have launched measures, setting up policy and funding instruments to mobilize the economy. The impact of these measures is of great significance for many EU countries and sectors. However, measures taken for small and medium-sized enterprises, tourism and culture were not evaluated effectively to get the sectors back on track. Those measures were effective in short term and were insufficient to boost the recovery of the EU economy in long term. Since Covid-19 still exists, the fear of a recurrence is fed back. Long-term support measures need to be re-evaluated and new strategies must be established, that will set, sustainability criteria for companies, according to future investment and development policies.

To assess stroke patient-reported experiences and hospital staff experiences, during hospital stay., Methods: Stroke patient-reported experiences (n=387) were recorded using the translated and culturally adapted NHS-Stroke Questionnaire into Greek and staff experiences (n=236) were investigated using the Compassion Satisfaction and Burnout subscales of the ProQOL questionnaire., Results: Staff's mean compassion satisfaction score was 39.2 (SD=6.3) and mean burnout score was 24.3 (SD=5.6). Only 38.5% of the staff stated that there is smooth cooperation with healthcare professionals of other specialties/disciplines. Personnel working in an NHS Hospital was more satisfied and less burned-out when compared to personnel working at a University Hospital (p=0.02 and p<0.001, respectively). Mean total patient-reported experiences score was 81.9 (SD=9.5). Bivariate analysis revealed statistically significant differences for total patient-reported experiences among the eight study hospitals (p>0.001)., Conclusions: Health policy planners and decision-makers must take into consideration the results of such self-reported measures to establish innovative techniques to accomplish goals such as staff-specialization, continuous training and applying formal frameworks for efficient cooperation amongst different disciplines.

The aim of this study was to present the descriptive characteristics of the Stroke Units Necessity for Patients (SUN4P) registry., Methods: The study population derived from the web-based SUN4P registry included 823 patients with first-ever acute stroke. Descriptive statistics were used to present patients' characteristics., Results: The vast majority of patients (80.4%) had an ischemic stroke, whereas 15.4% had a hemorrhagic stroke. Hypertension was the leading risk factor in both patients. The patients with ischemic stroke had higher prevalence of traditional cardiovascular risk factors such as diabetes mellitus, dyslipidemia and smoking and most commonly cryptogenic stroke (39%). National Institutes of Health Stroke Scale (NIHSS) was higher among patients with hemorrhagic in comparison to those with ischemic stroke (10.5 vs 6 respectively). Moreover, all patients had similar rate of disability prior to stroke, as shown by Modified Rankin Scale (mRS=0)., Conclusions: These data are in accordance with current evidence and should be thoroughly assessed in order to ensure optimal therapeutic management of stroke patients.

The aim of this study was to calculate the average operational cost per sub-type of stroke patient and to investigate cost drivers (e.g. ALoS, NIHSS score, age) correlated to cost., Methods: Direct medical costs (diagnostic imaging and clinical laboratory exams, overheads/bed cost, pharmaceuticals, ringers and other non-durables and inpatient rehabilitation) per patient were calculated from the providers' (hospitals') perspective. Resource use data derived from the "SUN4P" web-based registry and unit costs were retrieved from publically available sources and were assigned to resource use., Results: The sample comprised 6,282 inpatient days of 750 patients (mean age: 75.5±13.3 years) admitted from July 2019 to July 2021, in nine public hospitals. Mean length of stay was 8.4±7.6 days and mean total operational cost was calculated to €1,239.4 (from which 45% and 35% related to diagnostic exams and overheads/bed cost respectively). Mean cost related to hemorrhagic stroke patients that were discharged alive was calculated significantly higher compared to mean cost related to ischemic stroke patients who didn't undertake thrombolysis and were also discharged alive from the hospital (€2,155.2 vs. €945.2, p<0.001). Linear regression analysis revealed that length of stay was significantly correlated with cost (coefficient beta=232, 95% CI confidence interval = 220-243, p<0.001)., Conclusions: These findings are in accordance with current evidence and should be thoroughly assessed to rationalize inpatient reimbursement rates in order to achieve improved value of care.

The aim of this study was to evaluate accessibility of stroke patients to optimal healthcare technology in Greece. Methods: The study population consisted of 313 first ever stroke patients derived from the "Stroke Units Necessity for Patients, SUN4P" registry. Descriptive statistics were used, to present patients' characteristics and resources utilization Results: The vast majority of patients (91.7%) conducted a CT scan during the acute phase (within the first 24hours). Almost, (65%) were admitted to wards of Internal Medicine Departments, whereas only 21% of patients were admitted to a Stroke Unit. Of note, a total of 6.9% of ischemic stroke patients received intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rtPA). Conclusions: Preliminary results from SUN4P underline the urgent necessity for the re-organization of acute stroke care in Greece, as rates of admissions to stroke units and rtPA treatment during the acute phase are currently below optimal.