Purpose:Post-operative pain after breast cancer surgery is a major problem and women undergoing mastectomy and breast reconstruction experience post-operative pain syndromes in approximately one-half of all cases. Patients who have undergone breast reconstruction after mastectomy can suffer from acute postoperative pain with moderate or strong tension. In some cases, chronic neuropathic pain syndromes may occur after surgery. Opioids are used to treat pain, with serious side effects. The systemic postoperative analgesic regimen as thiocochlicoside P.O. along with paracetamol and NSAIDs I.V., which may limit the administration of opioids without reducing pain relief, seems to be necessary.Materials and Methods:This study was a clinical trial randomizing 70 patients undergoing breast reconstruction. Two main protocols of systematic post-operative analgesia, one using thiocochlicoside (group A) and the other without them (group B), were used. Both groups received paracetamol X3 and lornoxicam X2 I.V. systematically. The pain measurement scale (NPS) used to measure post-operative pain. Likert scales were used to evaluate patient’s satisfaction and the difficulty from the side effects . An anonymous questionnaire was used for the data collection.Results:Statistically significant difference was found between pain on the day of surgery (p = 0.017) as well as the three subsequent days (p = 0.000). In group A , pain was reduced directly to half (Χ2 surgery pain = 93.888, p = 0.000) especially on the first post-operative day. In group A the satisfaction with analgesic treatment was higher than in group B (p = 0.002).Conclusion:The use of thiocochlicoside in post-operative analgesia in breast reconstruction after mastectomy contributes to reduce the pain intensity experienced by patients and to reduce the side effects of opioid analgesics as a result of reduced demand for opioid analgesics. Patients who received the analgesia using muscle relaxants-spasmolytic reported greater satisfaction.

Introduction: Heparin is a sulfated polysaccharide belonging to the glycosaminoglycan family with strong anticoagulant activity. It has been widely used to maintain intravascular catheters in patients requiring intravenous medication. It is believed that heparin prevents thrombus formation in the intravascular catheter, but since the 1980s, the necessity of the heparin solution for peripheral intravenous catheter (PIVC) flushing has been questioned in several clinical trials. According to the Institute for Safe Medication Practices (ISMP), there are four special categories of High Alert Medications (HAMs), including heparin. Aim: The aim of this systematic review was to investigate the efficacy of normal saline versus heparin solution in maintaining the patency and functionality of the PIVC and avoiding complications. Methodology: A systematic review using PubMed and Cochrane Library databases was conducted. Original research studies of hospitalized patients with PIVC, regardless of age, published in English, over the last decade (2009-2019) were eligible for inclusion. Results: The review concluded in 10 studies that met the inclusion criteria. From these studies, it appears that it is not fully documented whether the normal saline (N/S 0,9%) is superior to heparin solution (H/S) in the flushing of the PIVC for maintaining its patency and prevent complications. Researchers tend to support the use of N/S 0,9% due to safety, error avoidance, efficiency, ease of use and cost-effectiveness. Concern about the possible complications of the heparin solution was the cause of guidelines development for N/S 0,9% in countries such as Australia. Conclusions: The use of normal saline seems to outweigh the heparin solution in maintaining the patency of PIVC.

Enhanced recovery after surgery (ERAS) protocols are applied in orthopedic surgery and are intended to reduce perioperative stress by implementing combined evidence-based practices with the cooperation of various health professionals as an interdisciplinary team. ERAS pathways include pre-operative patient counselling, regional anesthesia and analgesia techniques, post-operative pain management, early mobilization and early feeding. Studies have shown improvement in the recovery of patients who followed an ERAS program after hip or knee arthroplasty, compared with those who followed a traditional care approach. ERAS protocols reduce post-operative stress, contribute to rapid recovery, shorten length of stay (LOS) without increasing the complications or readmissions, improve patient satisfaction and decrease the hospital costs. We suggest that the ERAS pathway could reduce the LOS in hospital for patients undergoing total hip replacement or total knee replacement. These programs require good organization and handling by the multidisciplinary team. ERAS programs increase patient's satisfaction due to their active participation which they experience as personalized treatment. The aim of the study was to develop an ERAS protocol for oncology patients who undergo bone reconstruction surgeries using massive endoprosthesis, with a view to improving the surgical outcomes.

A lot of women choose the immediate breast reconstruction after mastectomy. The most common method is breast reconstruction using tissue expanders. Women's way of life and the economic crisis have created the need for adopting enhanced recovery after surgery (ERAS) protocols and early hospital discharge. The present study aims at informing perioperative nurses about the ERAS protocols and encouraging their implementation. ERAS protocols in breast cancer patients undergoing immediate post-mastectomy breast reconstruction include a combination of evidence-based interoperative interventions with the participation of surgeons, anesthetists, nurses, physiotherapists, and dietitians as members of the multidisciplinary team. This is a multifactorial approach to postoperative rehabilitation and care of the surgical patient. ERAS protocols are easy to apply, reduce morbidity, perioperative anxiety, postoperative pain, postoperative complications and hospitalization. In addition, they reduce the cost of treatment and hospitalization. The patient's approach to breast cancer following an ERAS protocol is divided into three phases: pre-surgical, intraoperative and post-operative. It starts before the patient’s hospitalization and continues until they are discharged, requiring active participation throughout the process. The total average hospitalization for post-mastectomy rehabilitation decreased from 3.6 days, prior to ERAS implementation, to 0 (discharging the same day) to 1.2 days post-surgery, releasing 30% of the beds. In conclusion, the ERAS protocols, following evidence-based perioperative care, promote the rapid recovery of patients aiming at reducing post-operative stress and its effects.

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Background: The pressure ulcers constitute a major clinical problem with enormous socio-economic consequences worldwide. Nurses' knowledge on pressure ulcers’ management plays a crucial role in the prevalence of pressure ulcers.Aim: The investigation of nurses’ knowledge, working in a general hospital, regarding the prevention and management of pressure ulcers. Material and Method: It was a cross-sectional study using a structured questionnaire. The sample consisted of 54 nurses and assistants working in medical and surgical departments of a General Hospital in Athens, Greece. The collection of data took place from June 2019 until November 2019. The analysis of data conducted using the IBM SPSS® program, version 25 (IBM Corp. in Armonk, NY).Results: The mean age of the participants was 42,73 ±8,42 years, and 90,6% were women, with an average work experience of 19,05±9,84 years. The age of nurses of the sample was not associated with the knowledge regarding the prevention of pressure ulcers (p = 0,80).  No significant differences were found between their knowledge and the department of work, or the years of work experience and the related seminars organized in the department (p > 0,05). Nurses who had a postgraduate degree had statistically significant more correct answers (p = 0,01).Conclusions: Despite the development of nursing science in the treatment of pressure ulcers, nurses continue to present insufficient knowledge in the daily clinical practice. Τhe implementation of clinical guidelines and the continuing education courses may help nurses to enhance their knowledge.

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Introduction: In Greece, it is estimated that annually 600 new cases of cervical cancer are diagnosed, being the third most common form of cancer in women after breast cancer (22.9%) and colon cancer (9.4%).In addition to being life-threatening, such a diagnosis can also represent the psychological impact of gynecological cancers; there are negative emotional consequences of such a diagnosis for both patients and their families affecting the quality of life (QOL) of patients with gynecological cancer.Aim: To examine the quality of life (QOL) of women with recent diagnosis of gynecologic cancer (RDGC) in Greece during their illness and to identify the psychosocial problems and the symptoms faced by women in the early stages of the disease.Material and Method: A prospective study of 63 patients with RDGC before undergoing hysterectomy, who completed the EORTC QLQ-C30 questionnaire.Results: The patients were between 45 and 50 years old (19.6%). Impaired physical functioning of women with RDGC was associated with strenuous activity or a long walk. Emotionally, patients showed a lack of concentration, tension, anxiety, irritation and depression. Age was negatively correlated with depression (p-value = 0.05<0.1). More than half of women had pain and few of them suffered a lot. Pain, shortness of breath (dyspnea) and fatigue caused discomfort and interference with daily living activities. More than half had sleeping disorders. Constipation and lack of appetite were common symptoms of the digestive system. Most women had no social or financial problems and rated their quality of life “very good”.Conclusions: Women with a RDGC, besides the common physical symptoms such as fatigue, pain, anorexia, sleep disorders and loss of appetite, had also emotional disorders. The feeling of depression was present in most patients. It was found that the younger the patient, the more depressed they feel.