Pathophysiological Mechanisms and Clinical Associations of Non-Alcoholic Fatty Pancreas Disease

Non-Alcoholic Fatty Pancreas disease (NAFPD), characterized by fat accumulation in pancreatic tissue, is an emerging clinical entity. However, the clinical associations, the underlying molecular drivers, and the pathophysiological mechanisms of NAFPD have not yet been characterized in detail. The NAFPD spectrum not only includes infiltration and accumulation of fat within and between pancreatic cells but also involves several inflammatory processes, dysregulation of physiological metabolic pathways, and hormonal defects. A deeper understanding of the underlying molecular mechanisms is key to correlate NAFPD with clinical entities including non-alcoholic fatty liver disease, metabolic syndrome, diabetes mellitus, atherosclerosis, as well as pancreatic cancer and pancreatitis. The aim of this review is to examine the pathophysiological mechanisms of NAFPD and to assess the possible causative/predictive risk factors of NAFPD-related clinical syndromes.

Femoral 3-in-1 Nerve Block for Total Knee Replacement, an Analgesic Approach Not to Be Neglected. Single Center Experience and Literature Review

OBJECTIVES

Total Knee Replacement Surgery (TKR) is one of the most common elective orthopedic operations. Postoperative pain after total knee replacement, remains a challenge. In this retrospective observational study, we evaluated the effectiveness of 3-in-1 nerve block in patients after total knee arthroplasty compared to standard opioid treatment, and we state the reasons why this approach should still be considered.

METHODS

To evaluate the effectiveness of the 3-in-1 nerve block, we assessed the acute pain service archive and compared the values of the visual analog scale, by separating patients into two groups according to the analgesic regimen they received as per local protocols. In group A, patients received 0.25% bupivacaine through a 3 in 1 block catheter and additional meperidine IM if needed, while in group B they received meperidine every six hours.

RESULTS

Our analysis showed the statistically significant better effectiveness of 3-in-1 nerve block with bupivacaine administration in postoperative TKR pain control compared to repeated administration of meperidine.

CONCLUSION

The results of our study suggest that 3-in-1 nerve block with bupivacaine is an option that must always be considered in order to alleviate post-operative pain after TKR.

Greek hospital environments

PURPOSE

The purpose of this paper is three-fold: first, to assess nurse satisfaction levels with working environment (known as favourability) in five Greek public hospitals using the practice environment scale (PES); second, to compare perceptions among nurses employed in surgical and medical departments; and third, to examine relationships between perceptions and nurse educational level and experience.

DESIGN/METHODOLOGY/APPROACH

In total, 532 nurses from five major public hospitals in Greece completed the PES. Descriptive statistics, t-tests and Spearman correlations were employed to analyse the data.

FINDINGS

Nurses perceived their work settings as unfavourable in all five hospitals, with collegial nurse-physician relations emerging as the only positive factor. Compared to medical wards, surgical departments emerged as slightly more positive working environments. Work department notwithstanding, in some cases, education and experience levels affected their perceptions on management, poor care quality, limited nurse involvement in hospital affairs and nursing shortage.

PRACTICAL IMPLICATIONS

Hospital managers do not provide sufficient support for Greek nurses in their working environments.

ORIGINALITY/VALUE

The authors attempted to evaluate nursing practice environments in Greek hospitals, viewed from nurse perspectives. The authors identified insufficient support for nurses' working in these hospitals.

Assessment of the nursing practice environment in Greek Hospitals: a cross-sectional study

Background

The organisational characteristics of the nursing practice environment play a crucial role in nurses' job satisfaction, job retention, quality-of-care service provision and patient outcomes. The widely used Practice Environment Scale of the Nursing Work Index assesses the favourability of these traits, showing the grade of magnetism of these factors in the workplace.

Aims and methods

This study aims to assess the nurse working environment at five public hospitals in Greece, and to compare these data with those of Magnet and non-Magnet hospitals. The Practice Environment Scale of the Nursing Work Index was completed by 532 nurses.

Results

Findings have shown that all five hospitals were assessed by nurses as unfavourable working environments. Four of five subscales were identified as unfavourable by the participants and only Collegial Nurse-Physician Relations were evaluated as a positive organisational trait. The mean scores in all five subscales of favourability were significantly lower than the corresponding scores of non-Magnet hospitals in the US.

Conclusions

The present study shows the favourability grade of Greek hospitals. When compared with Magnet and non-Magnet hospitals in the US, Greek hospitals were perceived as more unfavourable than non-Magnet hospitals. Action to improve the current situation must be taken by hospital management, supporting nurse involvement, continuous education, changing human resources management and adopting evaluation procedures.