The aim of the study was to examine the impact of moral resilience on quiet quitting, job burnout, and turnover intention among nurses. A cross-sectional study was implemented in Greece in November 2023. The revised Rushton Moral Resilience Scale was used to measure moral resilience among nurses, the Quiet Quitting Scale to measure levels of quiet quitting, and the single-item burnout measure to measure job burnout. Moreover, a valid six-point Likert scale was used to measure turnover intention. All multivariable models were adjusted for the following confounders: gender, age, understaffed department, shift work, and work experience. The multivariable analysis identified a negative relationship between moral resilience and quiet quitting, job burnout, and turnover intention. In particular, we found that increased response to moral adversity and increased moral efficacy were associated with decreased detachment score, lack of initiative score, and lack of motivation score. Additionally, personal integrity was associated with reduced detachment score, while relational integrity was associated with reduced detachment score, and lack of initiative score. Moreover, response to moral adversity was associated with reduced job burnout. Also, increased levels of response to moral adversity were associated with lower probability of turnover intention. Moral resilience can be an essential protective factor against high levels of quiet quitting, job burnout, and turnover intention among nurses. This study was not registered.
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.
Introduction: COVID-19 pandemic causes drastic changes in workplaces that are likely to increase quite quitting among employees. Although quite quitting is not a new phenomenon, there is no instrument to measure it.Aim: To develop and validate an instrument assessing quiet quitting among employees. Methods: We identified and generated items through an extensive literature review and interviews with employees. We carried out the content validity by content experts and we calculated the content validity ratio. We checked face validity by conducting cognitive interviews with employees and calculating the item-level face validity index. We performed exploratory and confirmatory factor analysis to assess the “Quiet Quitting” Scale (QQS) factorial structure. We checked the concurrent validity of the QQS using four other scales, i.e., “Job Satisfaction Survey” (JSS), “Copenhagen Burnout Inventory” (CBI), “Single Item Burnout” (SIB) measure, and a single item to measure turnover intention. We estimated the reliability of the QQS measuring Cronbach’s alpha, McDonald’s Omega, Cohen’s kappa, and intraclass correlation coefficient. Results: After expert panel review and item analysis, nine items with acceptable corrected item-total correlations, inter-item correlations, floor and ceiling effects, skewness, and kurtosis were retained. Exploratory factor analysis extracted three factors, namely detachment, lack of initiative, and lack of motivation, with a total of nine items. Confirmatory factor analysis confirmed this factorial structure for QQS. We found statistically significant correlations between QQS and JSS, CBI, SIB, and turnover intention confirming that the concurrent validity of the QQS was very good. Cronbach’s alpha and McDonald’s Omega of the QQS were 0.803 and 0.806 respectively. Intraclass correlation coefficient for the total QQS score was 0.993 (p < 0.001). Cohen’s kappa for the nine items ranged from 0.836 to 0.945 (p < 0.001 in all cases). Conclusions: QQS, a three-factor nine-item scale, has robust psychometric properties. QQS is a brief, easy-to-administer, valid, and reliable tool to measure employees’ quiet quitting. We recommend the use of the QQS in different societies and cultures to assess the validity of the instrument.
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.
Primary Health Care (PHC) is an integral part of both a country’s health system and of the overall social and economic development of the community. In Greece, in an effort to improve the provision of the PHC services on a national level, the Ministry of Health established the first Local Health Units (TOMYs) in December 2017. These new PHC units aimed to contribute to the provision of quality primary care services to citizens, while at the same time favoring the health system by improving the health of the population and helping to reduce health costs. Within this context, it is important for patients/PHC services’ recipients to be able to evaluate their experiences, as accumulated during their visits at these new health PHC structures. The aim of this paper was to evaluate the quality of medical and nursing care in the newly established PHC units (TOMYs) in Greece, using patient experience measures.
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.
Abstract Background: Continuous education is crucial to improve nurses’ knowledge and keep them update to new information. Aim: To evaluate the effectiveness of an e-learning activity regarding research methodology and fragility fractures in a sample of nurses. Moreover, we investigated the impact of demographic characteristics on knowledge level of nurses. Methods: We conducted a before-after study with a convenience sample of nurses working in different clinical settings. We conducted an e-learning activity regarding research methodology and fragility fractures. We developed 10 questions to assess the knowledge level of nurses before and after the e-learning activity. We created an online form of the questionnaire with Google forms. Our nurses completed the study questionnaire before and after the e-learning activity to assess differences in their knowledge. Additionally we measured overall evaluation, material evaluation, and educators’ evaluation in a scale from 0 to 10 with higher values indicating higher levels of evaluation. Results: Study population included 93 nurses. Among our sample, 86% (n=80) were females and 14% (n=13) were males. Mean age of nurses was 37.1 years, while mean years of experience was 13.6. Percentage of correct answers was improved after the e-learning activity for all questions. Moreover, we found a statistically significant improvement in eight questions (p<0.05) and a marginal statistically significant improvement in two questions (p<0.10). Mean knowledge score before the e-learning activity was 5.5, while after the e-learning activity improved to 7.6 (p<0.001). Conclusions: Effectiveness of the e-learning activity was very high, since nurses improved their knowledge in all fields. Continuous education is essential for nurses to improve their knowledge and thus provide high quality of healthcare especially in fragility fracture patients.
<sec><title>Background</title><p>There is an absence of valid and specific psychometric tools to assess TikTok addiction. Considering that the use of TikTok is increasing rapidly and the fact that TikTok addiction may be a different form of social media addiction, there is an urge for a valid tool to measure TikTok addiction.</p></sec><sec><title>Objective</title><p>To develop and validate a tool to measure TikTok addiction.</p></sec><sec><title>Methods</title><p>First, we performed an extensive literature review to create a pool of items to measure TikTok addiction. Then, we employed a panel of experts from different backgrounds to examine the content validity of the initial set of items. We examined face validity by performing cognitive interviews with TikTok users and calculating the item-level face validity index. Our study population included 429 adults who have been TikTok users for at least the last 12 months. We employed exploratory and confirmatory factor analysis to examine the construct validity of the TikTok Addiction Scale (TTAS). We examined the concurrent validity by using the Bergen Social Media Addiction Scale (BSMAS), the Patient Health Questionnaire-4 (PHQ-4), and the Big Five Inventory-10 (BFI-10). We used Cronbach's alpha, McDonald's Omega, Cohen's kappa, and intraclass correlation coefficient to examine reliability.</p></sec><sec><title>Results</title><p>We found that the TTAS is a six-factor 15-item scale with robust psychometric properties. Factor analysis revealed a six-factor structure, (1) salience, (2) mood modification, (3) tolerance, (4) withdrawal symptoms, (5) conflict, and (6) relapse, which accounted for 80.70% of the total variance. The concurrent validity of the TTAS was excellent since we found significant correlations between TTAS and BSMAS, PHQ-4, and BFI-10. Cronbach's alpha and McDonald's Omega for the TTAS were 0.911 and 0.914, respectively.</p></sec><sec><title>Conclusion</title><p>The TTAS appears to be a short, easy-to-use, and valid scale to measure TikTok addiction. Considering the limitations of our study, we recommend the translation and validation of the TTAS in other languages and populations to further examine the validity of the scale.</p></sec>
Abstract Introduction Adequate dental restoration including the use of implants is critical in healthy eating habits of diabetic patients and appropriate metabolic control. Aim To investigate the relationship between diabetes mellitus and dental implants stabilization and osseointegration. Methods A retrospective study was conducted in a private dental clinic in Athens. Data collection referred to the period between January 2016 and August 2021. During this time period, all cases related to implant placement in diabetic patients at the clinic were recorded. In particular, 93 implants were recorded in 36 diabetic patients. During the same time period, 93 implant cases involving non-diabetics at the clinic were randomly taken from the clinic records to provide the comparison group. The implant stability quotient was measured immediately after implant placement and after four months. Results The mean value of the implant stability quotient immediately after implant placement was 75.97 in non-diabetics and 76.85 in diabetics (p=0.42). The mean value of the implant stability quotient after four months was 78.92 in non-diabetics and 78.44 in diabetics (p=0.58). The mean value of the implant stability quotient in non-diabetics increased statistically significantly in the first four months from 75.97 to 78.92 (p<0.001). The mean value of the implant stability quotient in diabetics increased statistically significantly in the first four months from 76.85 to 78.44 (p=0.011). No implant loss was recorded in both diabetics and non-diabetics (p=1). According to multivariate analysis, patients who did not have bio-materials placed during implantation, patients who had not undergone previous surgical procedures and patients who had implants placed in the mandible had better implant stability. Conclusions The stability of the implants increased statistically significant in the first four months of implant placement. No relationship was found between diabetes mellitus and dental implants stabilization and osseointegration. However, studies with a larger sample size and longer follow-up of patients are needed to better clarify the risks and benefits of dental implants in diabetic patients.
