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Lazaridis LD, Rizos E, Bounou L, Theodorou-Kanakari A, Kalousios S, Mavroeidi EA, Roma M, Chatzidakis A, Vlachonicolou G, Miltiadou K, Gkolfakis P, Tziatzios G, Triantafyllou K. An educational intervention to optimize use of proton pump inhibitors in a Greek university hospital. Ann Gastroenterol 2021; 34:781-787. [PMID: 34815643 PMCID: PMC8596207 DOI: 10.20524/aog.2021.0654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/20/2021] [Indexed: 11/11/2022] Open
Abstract
Background Misuse of proton pump inhibitors (PPIs) is an alarming issue for patients and healthcare systems. Methods We conducted a 3-phase interventional, prospective study in a Greek university hospital. During Phase I, we collected data from patients' records to evaluate the appropriate use of PPIs. During Phase II, educational seminars about the proper use of PPIs were offered to the medical staff. In Phase III we collected data from the records of patients admitted to the hospital department with the highest rate of inappropriate PPI administration during Phase I, to evaluate the efficacy of the intervention. Inappropriate use was defined as either PPI administration without indication, or lack of use despite adequate indication. Appropriateness of PPI use was measured at admission, during hospitalization and at discharge. Results The rate of inappropriate PPI use was higher (51.7% and 48.6%) during hospitalization than at admission (34.9% and 21.9%), but at discharge was similar to pre-hospitalization levels (26.9% and 23.6%), in Phases I and III, respectively. At discharge during Phase I, the inappropriate use of PPIs was significantly higher (odds ratio 3.79, 95% confidence interval 1.98-7.19) for internal medicine patients than for surgical patients. The educational intervention failed to reduce the inappropriate use of PPIs during hospitalization (51.7% vs. 48.6%, P=0.478) or at discharge (26.9% vs. 23.6%, P=0.391) in the internal medicine patients. Conclusions The rate of inappropriate PPI use is almost double during hospitalization compared to the rates at admission and at discharge. Implementation of an educational intervention failed to reduce the inappropriate use of PPIs in internal medicine patients.
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Affiliation(s)
- Lazaros-Dimitrios Lazaridis
- Hepatogastroenterology Unit, Second Department of Internal Propaedeutic Medicine-, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Evripidis Rizos
- Hepatogastroenterology Unit, Second Department of Internal Propaedeutic Medicine-, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Lamprini Bounou
- Hepatogastroenterology Unit, Second Department of Internal Propaedeutic Medicine-, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Anna Theodorou-Kanakari
- Hepatogastroenterology Unit, Second Department of Internal Propaedeutic Medicine-, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Sotirios Kalousios
- Hepatogastroenterology Unit, Second Department of Internal Propaedeutic Medicine-, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Electra-Antonia Mavroeidi
- Hepatogastroenterology Unit, Second Department of Internal Propaedeutic Medicine-, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Maria Roma
- Hepatogastroenterology Unit, Second Department of Internal Propaedeutic Medicine-, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Alexandros Chatzidakis
- Hepatogastroenterology Unit, Second Department of Internal Propaedeutic Medicine-, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Georgia Vlachonicolou
- Hepatogastroenterology Unit, Second Department of Internal Propaedeutic Medicine-, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Konstantinos Miltiadou
- Hepatogastroenterology Unit, Second Department of Internal Propaedeutic Medicine-, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, Second Department of Internal Propaedeutic Medicine-, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Propaedeutic Medicine-, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Propaedeutic Medicine-, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
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Miltiadou K, Chatzidakis A, Lazaridis LD, Oikonomopoulos N, Polymeros D, Papanikolaou IS, Triantafyllou K. Unfolding the stomach in the chest. Endoscopy 2021; 53:E423-E424. [PMID: 33506465 DOI: 10.1055/a-1327-1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Konstantinos Miltiadou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic and Research Institute, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Alexandros Chatzidakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic and Research Institute, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Lazaros-Dimitrios Lazaridis
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic and Research Institute, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Nikolaos Oikonomopoulos
- 2nd Radiology Department, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Dimitrios Polymeros
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic and Research Institute, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic and Research Institute, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic and Research Institute, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
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Papanikolaou IS, Tziatzios G, Chatzidakis A, Facciorusso A, Crinò SF, Gkolfakis P, Deriban G, Tadic M, Hauser G, Vezakis A, Jovanovic I, Muscatiello N, Meneghetti A, Miltiadou K, Stardelova K, Lacković A, Bourou MZ, Djuranovic S, Triantafyllou K. COVID-19 in the endoscopy unit: How likely is transmission of infection? Results from an international, multicenter study. World J Gastrointest Endosc 2021; 13:416-425. [PMID: 34630891 PMCID: PMC8474700 DOI: 10.4253/wjge.v13.i9.416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) significantly affected endoscopy practice, as gastrointestinal endoscopy is considered a risky procedure for transmission of infection to patients and personnel of endoscopy units (PEU).
AIM To assess the impact of COVID-19 on endoscopy during the first European lockdown (March-May 2020).
METHODS Patients undergoing endoscopy in nine endoscopy units across six European countries during the period of the first European lockdown for COVID-19 (March-May 2020) were included. Prior to the endoscopy procedure, participants were stratified as low- or high- risk for potential COVID-19 infection according to the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) joint statement, and contacted 7-14 d later to assess COVID-19 infection status. PEU were questioned regarding COVID-19 symptoms and/or infection via questionnaire, while information regarding hospitalizations, intensive care unit-admissions and COVID-19-related deaths were collected. The number of weekly endoscopies at each center during the lockdown period was also recorded.
RESULTS A total of 1267 endoscopies were performed in 1222 individuals across nine European endoscopy departments in six countries. Eighty-seven (7%) were excluded because of initial positive testing. Of the 1135 pre-endoscopy low risk or polymerase chain reaction negative for COVID-19, 254 (22.4%) were tested post endoscopy and 8 were eventually found positive, resulting in an infection rate of 0.7% [(95%CI: 0.2-0.12]. The majority (6 of the 8 patients, 75%) had undergone esophagogastroduodenoscopy. Of the 163 PEU, 5 [3%; (95%CI: 0.4-5.7)] tested positive during the study period. A decrease of 68.7% (95%CI: 64.8-72.7) in the number of weekly endoscopies was recorded in all centers after March 2020. All centers implemented appropriate personal protective measures (PPM) from the initial phases of the lockdown.
CONCLUSION COVID-19 transmission in endoscopy units is highly unlikely in a lockdown setting, provided endoscopies are restricted to emergency cases and PPM are implemented.
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Affiliation(s)
- Ioannis S Papanikolaou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Alexandros Chatzidakis
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia AOU, Foggia 1245, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, Verona 37138, Italy
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels 1070, Belgium
- Department of Medical Oncology, Institut Jules Bordet, Brussels 1000, Belgium
| | - Gjorgi Deriban
- University Clinic of Gastroenterohepatology, Medical Faculty, University "Ss. Cyril and Methodius" Skopje, Skopje 12345, Republic of North Macedonia
| | - Mario Tadic
- Department of Gastroenterology, Dubrava University Hospital Zagreb, Zagreb 10040, Croatia
| | - Goran Hauser
- Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Antonios Vezakis
- 2nd Department of Surgery, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Ivan Jovanovic
- Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, University of Belgrade Faculty of Medicine, Beograd 12345, Serbia
| | - Nicola Muscatiello
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia AOU, Foggia 1245, Italy
| | - Anna Meneghetti
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, Verona 37138, Italy
| | - Konstantinos Miltiadou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Kalina Stardelova
- University Clinic of Gastroenterohepatology, Medical Faculty, University "Ss. Cyril and Methodius" Skopje, Skopje 12345, Republic of North Macedonia
| | - Alojzije Lacković
- Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Maria-Zoi Bourou
- 2nd Department of Surgery, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Srdjan Djuranovic
- Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, University of Belgrade Faculty of Medicine, Beograd 12345, Serbia
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
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Miltiadou K, Kalantzis I, Paraskeva M, Solomos Z, Tsifi A, Theodoridis D, Riza E, Triantafyllou K, Kosmas C. Advanced Lung Cancer Survival in Times of Economic Hardship: A Greek Paradigm. Asian Pac J Cancer Care 2020. [DOI: 10.31557/apjcc.2020.5.s1.19-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: Greece has been affected more than any other European country from the financial crisis that began in 2010. Just 20 months after Greece exited an eight-year long aid program, forecasts of a new recession within 2020 due to COVID-19 pandemic make concerns regarding the compromise of health care quality within the new crisis relevant once again. In this study we sought to evaluate clinical outcomes in patients with advanced lung cancer in the pre-crisis and crisis era in a dedicated oncology centre in Greece. Methods: A retrospective analysis of 522 consecutive medical records of lung cancer patients admitted in a Greek dedicated cancer hospital between the years 2008-2013 was performed. Progression Free Survival (PFS) and Overall Survival (OS) were calculated for advanced lung cancer compared over two consecutive time periods using 2010 as a cutoff point.Result: 71 and 78 patients comprised the study sample for the two periods. PFS and OS were similar over the two periods (7.73 [6.42-9.04] vs. 6.03 [5.02-7.04] and 13.70 [9.61-17.79] vs. 11.08 [7.74-15.92] months, respectively). Higher Performance Status (PS) was associated with worse survival measures over both periods, while no statistical significance was reached for OS in the latter period. Dissimilarities in PFS were observed between beneficiaries of different insurance trusts. Conclusion: Clinical outcomes for advanced lung cancer have not changed as a result of the financial crisis in our institution. The insurance provider seems to affect health outcomes. This old paradigm could serve as new guidance in the forthcoming recession due to COVID-19 pandemic.
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Kalantzis I, Nonni A, Pavlakis K, Delicha EM, Miltiadou K, Kosmas C, Ziras N, Gkoumas K, Gakiopoulou H. Clinicopathological differences and correlations between right and left colon cancer. World J Clin Cases 2020; 8:1424-1443. [PMID: 32368535 PMCID: PMC7190956 DOI: 10.12998/wjcc.v8.i8.1424] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/28/2020] [Accepted: 04/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The differences in histopathology and molecular biology between right colon cancer (RCC) and left colon cancer (LCC) were first reported in the literature by Bufill in 1990. Since then, a large number of studies have confirmed their differences in epidemiology, clinical presentation, comorbidities and biological behaviours, which may be related to the difference in prognosis and overall survival (OS) between the two groups.
AIM To investigate statistically significant differences between Greek patients with LCC and RCC.
METHODS The present observational study included 144 patients diagnosed with colon cancer of any stage who received chemotherapy in a Greek tertiary oncology hospital during a 2.5-year period. Clinical information, comorbidities, histopathologic characteristics and molecular biomarkers were collected from the patients’ medical records retrospectively, while administered chemotherapy regimens, targeted agents, progression-free survival (PFS) periods with first- and second-line chemotherapy and OS were recorded retroactively and prospectively. Data analysis was performed with the SPSS statistical package.
RESULTS Eighty-six males and 58 females participated in the study. One hundred (69.4%) patients had a primary lesion in the left colon, and 44 (30.6%) patients had a primary lesion in the right colon. Patients with RCC were more likely to display anaemia than patients with LCC [odds ratio (OR) = 3.09], while LCC patients were more likely to develop rectal bleeding (OR = 3.37) and a feeling of incomplete evacuation (OR = 2.78) than RCC patients. Considering comorbidities, RCC patients were more likely to suffer from diabetes (OR = 3.31) and coronary artery disease (P = 0.056) than LCC patients. The mucinous differentiation rate was higher in the right-sided group than in the left-sided group (OR = 4.49), as was the number of infiltrated lymph nodes (P = 0.039), while the percentage of high-grade differentiation was higher in the group of patients with left-sided colon cancer than in RCC patients (OR = 2.78). RAS wild-type patients who received anti-epidermal growth factor receptor (EGFR): Treatment experienced greater benefit (PFS: 16.5 mo) than those who received anti-vascular endothelial growth factor treatment (PFS: 13.7 mo) (P = 0.05), while among RAS wild-type patients who received anti-EGFR treatment, LCC patients experienced greater benefit (PFS: 15.8 mo) than the RCC subgroup (PFS: 5.5 mo) in the first-line chemotherapy setting (P = 0.034). BRAF-mutant patients had shorter PFS (9.3 mo) than BRAF wild-type patients (14.5 mo) (P = 0.033). RCC patients showed a shorter tumour recurrence period (7.7 mo) than those with LCC (14.5 mo) (P < 0.001), as well as shorter (OS) (58.4 mo for RCC patients; 82.4 mo for LCC patients) (P = 0.018).
CONCLUSION RCC patients present more comorbidities, worse histological and molecular characteristics and a consequently higher probability of tumour recurrence, poor response to targeted therapy and shorter OS than LCC patients.
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Affiliation(s)
- Ioannis Kalantzis
- Department of Gastroenterology, Korgialenio-Mpenakeio Hellenic Red Cross Hospital, Athens 11526, Greece
- Department of Oncology, Metaxa Anticancer Hospital, Piraeus 18537, Greece
| | - Afroditi Nonni
- First Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens 11527, Greece
| | - Kitty Pavlakis
- First Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens 11527, Greece
| | - Eumorphia-Maria Delicha
- Independent Biostatistical Consultant, ASTAT, Statistics in Clinical Research, Glyfada 16675, Greece
| | - Konstantinos Miltiadou
- Hepatogastroenterology Unit, Second Department of Internal Medicine, Attikon University General Hospital, Athens 12462, Greece
- Department of Oncology, Metaxa Anticancer Hospital, Piraeus 18537, Greece
| | - Christos Kosmas
- Department of Oncology, Metaxa Anticancer Hospital, Piraeus 18537, Greece
| | - Nikolaos Ziras
- Department of Oncology, Metaxa Anticancer Hospital, Piraeus 18537, Greece
| | - Konstantinos Gkoumas
- Department of Gastroenterology, Korgialenio-Mpenakeio Hellenic Red Cross Hospital, Athens 11526, Greece
| | - Harikleia Gakiopoulou
- First Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens 11527, Greece
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