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For many clinical goals like surgical planning and radiotherapy treatment planning is necessary to understand the anatomical structures of the organ that is targeted. At the same time the 2D/3D shape of the organ is important to be reconstructed for the benefit of the doctors. For that reason, accurate segmentation techniques must be proposed to overcome the big data medical image storage problem. The main purpose of this work is to apply segmentation techniques for the definition of 3D organs (anatomical structures) when big data information has been stored and must be organized by the doctors for medical diagnosis. The processes would be implemented in the CT images from patients with COVID-19.

Aim The aim and objective of this study was to understand how non‐specialized nurses understand the possible barriers and facilitators of inpatient care for type 1 diabetes. Design An interpretative phenomenology approach was conducted. Methods The sample consisted of non‐specialized nurses (N = 24) working in medical, surgical and nephrology wards in the state hospitals in Cyprus. The data were collected during 2016‐2018 from one focus group with nurses (N = 6) and individual semi‐structured interviews with nurses (N = 18) conducted. The Standards for Reporting Qualitative Research checklist used to ensure the quality of the study. Results It is evident from the study findings that nurses experience several barriers in diabetes inpatient care reported which are of great concern since this could have adverse effects on patients' outcomes. Only one facilitator has been reported by few nurses.

Daily, people are being exposed to an enormous amount of Covid-19 information, but not all of it is reliable. This phenomenon seriously affects the public health policy effectiveness, because there is a lot of misleading or inaccurate information, which is spreading rapidly and makes it more difficult to restrict the pandemic. Healthcare informatics has emerged as a diverse and important new field. Healthcare informatics applications are becoming more and more popular and are providing easy access to new sources of knowledge. This way, the quality of patient care will improve and productivity will increase. However, people should also learn how to navigate this infodemic properly.

Daily, people are being exposed to an enormous amount of Covid-19 information, but not all of it is reliable. This phenomenon seriously affects the public health policy effectiveness, because there is a lot of misleading or inaccurate information, which is spreading rapidly and makes it more difficult to restrict the pandemic. Healthcare informatics has emerged as a diverse and important new field. Healthcare informatics applications are becoming more and more popular and are providing easy access to new sources of knowledge. This way, the quality of patient care will improve and productivity will increase. However, people should also learn how to navigate this infodemic properly.

The aim of this work is to shortly provide the public with an overview about fake news and artificial intelligence (AI) technology. Especially in our days, where there is a high speed of spreading news, the impact of fake news on public health is crucial and the development of valid and effective means of technology to support the provision of safe and trustworthy information about public health issues is vital. The role of informatics in health area is profoundly important and AI in public health, so people will be able to distinguish the genuine information from the fake one.

International Organizations are seriously concerned about the fake news phenomenon. UNESCO has defined the term of misinformation/disinformation, which are the two faces of fake news. European Commission has conducted a survey about “Fake News” through EU citizens to estimate the awareness and people behaviour related to the appearance of fake news and disinformation on electronic. The findings are quite worrying, since about 40% come across fake news daily and 85% evaluate fake news as a problem. The aim of this work is to introduce an Artificial Intelligence approach, the Decision Trees algorithm to identify fake news on the COVID-19.

Introduction Vaccination is the best method for microbial and viral infections prevention. Especially for health professionals, flu vaccination is the best method to protect them, and the same applies for the patients and the general population from being infected. One of the most important preventive measure is vaccination and the main types of vaccines available, the limitations and side effects are briefly presented. Aim The aim of this paper is to present the necessity of the healthcare professionals to conceptualize the importance of flu vaccination ifor themselves and the general population. Healthcare professionals are influenced by their knowledge, attitudes, and beliefs. Epidemiological surveys on this issue are presented for Greece, European Union, and the USA. Methods A broad scope literature review was conducted based on a strict selection process of articles referring to the general population and the healthcare professionals with emphasis on the time period from the fall of 2018 until the spring of 2020 across Greece. The method used in this research obtained information through bibliographical references throughout Europe, USA, and relevant studies in Greece. Results The results of this research indicated that influenza vaccination among healthcare professionals in Greece in the time period 2018-2019 was higher in primary health centers (PHCs) with a percentage of 43.8% than in Hospitals which was 30.6%. In addition, in the time period 2019-2020 flu vaccination among health professionals was higher in PHCs with a percentage of 57.9% rather than in Hospitals with a percentage of 38.8%. Specifically, flu vaccination rate which took place in hospitals was higher among physicians than in other healthcare personnel. Furthermore, the fundamental reasons for recommending flu vaccination in healthcare professionals are presented, and issues related to denial or acceptance of it are highlighted. Measures and strategies are proposed in order to increase flu vaccination coverage in healthcare facilities in Greece. Conclusions Based on this research review healthcare professionals (HCPs) especially the ones working in ICUs, in ICUs for newborn children, in Departments for acute care infections, in Departments caring of persons with immunodeficiency or Units for transplantation, Oncology and Haematology Departments, and finally, in Emergency Care Units need directly to be vaccinated for the flu virus. Different measures have been undertaken to promote flu vaccination and the percentage of implementation has been highlighted.

Background: The aim of this study was to comprehend how people with diabetes view their experiences of the possible barriers and facilitators in inpatient care for type 1 diabetes from non-specialized nurses. Design: An interpretative phenomenology analysis (IPA) was conducted. Methods: The sample consisted of people with type 1 diabetes 1 (n = 24) who use the services of the state hospitals in Cyprus. The data were collected in two phases: firstly, focus groups with people with diabetes (n = 2) were conducted and analysed, and then individual semi-structured interviews with people with diabetes (n = 12) were conducted. Results: It is evident from the findings that people with diabetes experienced several barriers in diabetes inpatient care, which is concerning since this can have adverse effects on patients&rsquo, outcomes. No facilitators were reported. Conclusion: Significant results were found in relation to the barriers to diabetes inpatient care. Crucially, the findings demonstrate that all these factors can negatively affect the quality of care of patients with diabetes, and most of these factors are related not only to diabetes care but also generally to all patients who receive inpatient care. Interestingly, no participant reported any facilitators to their care, which further affected the negative perceptions of the care received.

Introduction: Several research studies have started to investigate the health conditions of medical doctors and nurses in order to find a relationship if any between their work environment, their usually heavy duties and the result of these two parametric on patients' health. Aim: The present research study is an effort to investigate the relationship between the physical activity and sleep disorders among health care professionals, particularly among medical doctors and nurses. Methods: Participants of the study were asked to fill a questionnaire which was a mixture of other internationally accredited questionnaires regarding physical activity level as well as sleeping functions. Data were collected among 204 physicians and nurses. The statistical analysis revealed a correlation between physical activity and some aspects of sleep disorders. Results: A total number of 204 questionnaires have been distributed to medical doctors and nurses working in public hospitals in Athens Greece from the middle of February until the middle of April 2020. The hospitals were assigned by the health authorities to the fight of the pandemic of COVID 19. The majority of the participants were women 71,3% and 28,7% were men. From a total of 204 half of them were medical doctors and half of them were nurses. 43% were married, 49% were single and 8% were divorced and there were no widows. Regarding the participant nurses, 43% had a university degree and 38,4% had a technological education degree. The results of the statistical analysis showed that there are positive correlations between the level of physical activity during the daily work and the free time of the participants with parameters that are related to sleep disorders. Conclusion: The sample of the study was not a large one but nevertheless a stressful situation such as is the epidemic of COVID19 can provide useful information in order to better understand the relationship between physical activity and sleeping disorders in such working conditions. © 2020 Marianna Diomidous.

Introduction The aim of this research is to inform the health professionals about the ways of introducing and operating the the Diagnosis Related Groups (DRG's) system in the Hellenic National Health System, through the use of the development technologies. An effort is also made to explore the main dimensions of the implementation of the DRG's system, in specific European-Countries that have both adopted the public coverage schemes and the Bismarck health insurance institutions for countries with extensive experience in their implementation. Material and methods A review of the literature was attempted to investigate the ways of financing of the health services, and of the identification and functionality of the DRG's as well as of the methods used by European countries to investigate this prospective compensation system. Results The efficient application of DRGs gives the possibility to improve the economic management of Greek hospitals by retaining the costs and consequently contributing to the wise and effective management of hospital expenses. A short training of health professionals on the importance of DRGs in the effective running of Greek hospitals, led to the development of a website. This website will give information on this new method of pricing of hospital health services provided, and will contribute to the overall improvement of health services. Conclusion Introduction of DRGs, in Greek hospitals will establish a positive condition to solve many emerging health issues and to improve the overall functionality of the health system. Additionally, with the proper implementation of the DRG;s, the financial management of the Greek hospitals, can be improved by keeping the costs down through the proper utilization of the available resources.

Background and Aims: Over the past two decades there was an upsurge of the use of Internet in human life. With this continuous development, Internet users are able to communicate with any part of the globe, to shop online, to use it as a mean of education, to work remotely and to conduct financial transactions. Unfortunately, this rapid development of the Internet has a detrimental impact in our life, which leads to various phenomena such as cyber bullying, cyber porn, cyber suicide, Internet addiction, social isolation, cyber racism etc. The main purpose of this paper is to record and analyze all these social and psychological effects that appears to users due to the extensive use of the Internet. Materials and Methods: This review study was a thorough search of bibliography data conducted through Internet and library research studies. Key words were extracted from search engines and data bases including Google, Yahoo, Scholar Google, PubMed. Findings: The findings of this study showed that the Internet offers a quick access to information and facilitates communication however; it is quite dangerous, especially for young users. For this reason, users should be aware of it and face critically any information that is handed from the website

Background: The aim of this review is to identify the roles and activities of nurses working with people with diabetes and to examine the facilitators and barriers in caring for such people. Methods: A systematic review was conducted. From 531 abstracts reviewed, 29 studies were included (18 studies comprised questionnaire surveys, one was an intervention study, two used both questionnaires and interviews, and eight of them used interviews). Barriers and facilitators were extracted and combined using qualitative synthesis. Results: The literature review revealed three major roles and a number of barriers. A model for achieving enhanced nursing care of patients with diabetes has been developed according to the findings of this literature. Specifically, a stepladder suggesting that through better nursing training and education and by providing adequate resources, time, and synergies to diabetes specialists, nurses will be able to correctly perform their diabetes care roles, which include patient education, advanced care, and psychological support. Conclusions: Taking into serious consideration that a large number of hospital users are people with diabetes and that there is an inconsistency among countries about the work settings of Diabetes Specialist Nurses (DSNs), it is important to give greater focus to inpatient care and perhaps to enhance nurses’ roles by eliminating any barriers that prevent them from providing adequate quality care. Furthermore, integrated care involving the role of DSNs within the inpatient care would have been more beneficial for patients.

Background: Parental and peer smoking are considered major predictors of smoking in adolescence. We investigate the impact of family and social environment and parental anti-smoking socialization on the intensive and extensive margins of smoking for Greek adolescents. Method and Material: Information on 873 adolescents was collected through a self-reported survey and regression analysis examined associations with five different smoking outcomes (current/lifetime smoking status/intensity and onset). Subgroup analyses and interactions provided further insights. Results: Prevalence of adolescent smoking is high. Family and peer smoking habits and smoking restrictions at home reduce probability and intensity of smoking. Parental smoking increases probability of current smoking by 5% (95% CI: 0.01-0.09) as does having all your friends smoking by 30% (95% CI: 0.16-0.45). Parental anti-smoking advice delays onset of smoking by 0.76 years (95% CI: 0.15-1.39) but does not affect current smoking. Conclusion: Family and social environments play a significant role in preventing or promoting smoking and should be regarded as crucial factors when devising policy to curb adolescent smoking.

rEViEw Abstract introduction: There is an increasing number of people who travel around the world. Every traveler is exposed to nearly all infectious risks which may occur during his travel time. Some of the main risk factors can be water quality, temperature and high humidity and the exposure to multi- resistant microorganisms. To tackle the upcoming problem there is an imperative need to develop a new branch of medicine with the name of travel medicine. review results: A consultation prior to departure for an upcoming trip is required, focusing to a personalized healthcare p lan, based on international scientific protocols and epidemiological studies.Travelers must acquire essential information about the prevailing hygie- ne conditions and climatic differentiations that occur in the region. Additionally there are several health risks upon the arrival at destination. A scheduled visit to a health professional is necessary, especially in the case of travelers suffering from chronic diseases or those taking medication, while vaccination is considered essential for specific destination countries. Healthcare professionals should be able to inform travelers and evaluate their needs. According to research studies on notion and attitudes travelers' specific risks, only few of them are well-informed during a trip. While most studies indicate that travelers have some kind of pre travel medical consultation, not all of them proceed to the required vaccinations and medications. Conclusion: Travelling for business or leisure around the world may be unhealthy. The importance of proper preparation prior to the travel requires to be adequately informed by specialized healthcare professionals, and to receive appropriate vaccinations and medications, when required. The results of the review of notions and attitudes of travelers during the trip indicate not only the need for further development of the branch of travel medicine but especially the need for the expansion and the availability of health services.

Introduction: Social networks (1) have been embedded in our daily life for a long time. They constitute a powerful tool used nowadays for both searching and exchanging information on different issues by using Internet searching engines (Google, Bing, etc.) and Social Networks (Facebook, Twitter etc.). In this paper, are presented the results of a research based on the frequency and the type of the usage of the Internet and the Social Networks by the general public and the health professionals. Objectives: The objectives of the research were focused on the investigation of the frequency of seeking and meticulously searching for health information in the social media by both individuals and health practitioners. The exchanging of information is a procedure that involves the issues of reliability and quality of information. Methods: In this research, by using advanced statistical techniques an effort is made to investigate the participant’s profile in using social networks for searching and exchanging information on health issues. Results: Based on the answers 93 % of the people, use the Internet to find information on health-subjects. Considering principal component analysis, the most important health subjects were nutrition (0.719 %), respiratory issues (0.79 %), cardiological issues (0.777%), psychological issues (0.667%) and total (73.8%). Conclusions: The research results, based on different statistical techniques revealed that the 61.2% of the males and 56.4% of the females intended to use the social networks for searching medical information. Based on the principal components analysis, the most important sources that the participants mentioned, were the use of the Internet and social networks for exchanging information on health issues. These sources proved to be of paramount importance to the participants of the study. The same holds for nursing, medical and administrative staff in hospitals.

SummaryBackground: Medicine and biomedical sciences have become data-intensive fields, which, at the same time, enable the application of data-driven approaches and require sophisticated data analysis and data mining methods. Biomedical informatics provides a proper interdisciplinary context to integrate data and knowledge when processing available information, with the aim of giving effective decision-making support in clinics and translational research.Objectives: To reflect on different perspectives related to the role of data analysis and data mining in biomedical informatics. Methods: On the occasion of the 50th year of Methods of Information in Medicine a symposium was organized, which reflected on opportunities, challenges and priorities of organizing, representing and analysing data, information and knowledge in biomedicine and health care. The contributions of experts with a variety of backgrounds in the area of biomedical data analysis have been collected as one outcome of this symposium, in order to provide a broad, though coherent, overview of some of the most interesting aspects of the field.Results: The paper presents sections on data accumulation and data-driven approaches in medical informatics, data and knowledge integration, statistical issues for the evaluation of data mining models, translational bioinformatics and bioinformatics aspects of genetic epidemiology.Conclusions: Biomedical informatics represents a natural framework to properly and effectively apply data analysis and data mining methods in a decision-making context. In the future, it will be necessary to preserve the inclusive nature of the field and to foster an increasing sharing of data and methods between researchers.

According to a common definition, interprofessional education (IPE) is described as "occasions when two or more professions learn from and about each other to improve collaboration and the quality of care". The Leonardo project under the name European Interprofessional Education Network (EIPEN) in health and social care, has been dealing with the challenges of interprofessional education. The EIPEN project tries to develop a transnational network of universities and employers in the six participating countries and at the same time to promote good practices in interprofessional learning and teaching in health and social care. IPE provides opportunities for students and practitioners to learn with, from and about each other during qualifying and post-qualifying training and in their practice. IPE in health and social care includes the education and training of practitioners in human and animal medicine, dentistry, nursing, physiotherapy, occupational therapy, pharmacy and all other health professions including public and environmental health and health promotion, and social work. The outcomes of the EIPEN Project will provide means, material and guidelines for the enhancement of professional education in the multi-disciplinary field of Health Informatics. The methodology on the development of the Greek Interprofessional Network was based on a series of workshops aiming to document the educational process in healthcare institutes and universities followed by the assessment of the needs for the development of an interprofessional environment. The outcomes will provide means, material and guidelines for the enhancement of professional education in the multi-disciplinary field of Health Informatics.

Vaccination decreases children mortality and its' application, especially in the developing world, is a means towards the achievement of the United Nations Millennium Development Goals. Objects: We sought to develop, apply and, evaluate a web-based immunization registry system that logs and calculates the vaccination timetable based on the age, gender, and previously administered vaccine doses. Method: We designed and created a computational system based on the Greek National Immunization Program. The system was used by pediatricians and parents for a period of 4 months (01/09/2009-31/12/2009) in Patra, Greece. Participants were asked to answer to a questionnaire. Results: In total 60 parents and 60 pediatricians used the online system and 500 vaccinations were logged. We observed time-application errors and missed doses, mainly among children older than 2 years (27%). A considerable 17% of the participants did not have the essential vaccination card and 7% of them had lost it. Parents had a positive opinion (56) about the online system mainly based on the usability and high availability. On the other hand, health-care professionals considered that the electronic assistance in calculating dosage intervals and the logging capabilities of the system, that offers the possibility to extract and statistically analyze data, were the main advantages of the system (54). Conclusion: The use of information technology may help parents to keep up with the immunization schedules, health-care professionals to calculate dosage intervals, provide them with a valuable data analysis tool and, contribute in the effective application of the national immunization policy.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) and obstructive sleep apnea syndrome are two diseases, which often coexist in one person. The sleep apnea is often caused by an interruption to breath when sleeping, due to an obstruction of the upper airway during inhalation, causing chronic snoring, morning headaches, increased body weight, blood pressure and sleepiness during the day. Aim: The purpose of this study is to investigate the extend of this problem among a large group of elderly people living in the Attica Basin. Material and Methods: Material of the study was 500 people aged 70 and above years old, including 274 men and 226 women. Data collection was facilitated with the use of an anonymous questionnaire with the purpose to identify patients with apnea, after a personal interview with the researcher. Data analysis was performed with the use of the statistical package SPSS 17. Results: Based on their responses to the questionnaires, it was found that 98.0% of the participants have abnormal sleepiness during the day. The 35.4% of them show no apnea, while 36.0% of the sample suffer from mild sleep apnea. It is important though, the fact that about one out of three seniors, 28.6%, shows sleep apnea in a high risk level. Conclusions: COPD is a complex disease that occurs in a large proportion of the elderly. Emphasis should be given on early diagnosis and treatment of sleep apnea syndrome, in order to improve the quality of the elderly life.

Original paper SUMMARY Introduction: Successful research manage- ment requirements include; equal teamwork and efficient coordination, in order to in- crease the impact of the research outcomes and provide added value knowledge. Aim of this paper is to discuss the strategies that have been followed during the RN4CAST study, the largest nursing multi-country research project ever conducted in Europe. The paper focuses on the core research strategies rather than on the administrative activities, which are inevitably also required for the success of a large scale research. Results and discussion: This paper is an extension of a conference presentation in the International Conference of the Eu- ropean Federation for Medical Informatics (MIE) 2011 in Oslo, and was subsequently published in the Studies in Health Technol- ogy and Informatics book series (IOS Press) under the title "Research management: the case of RN4CAST." Management of a multi- country nursing survey requires the use of common data collection tools, applicable to every context, research protocols supporting the scope of the research, data models for multi-country analyses and global dissemina- tion strategies. Challenges that may be faced during the implementation of the study include the individualized confrontation of obstacles during data collection, the coher- ence of national procedures (for example permissions for data collection) in European level, and the challenge to gain information of added value for the EU, by aggregating the national survey results through a powerful data analysis model. Communication strate- gies are also discussed. Keywords. Research Management, Nurs- ing, RN4CAST.

During a 2-year period (April 2005–March 2007), 31 intensive care unit (ICU) patients in a Greek hospital were infected or colonised with imipenem-resistant isolates of Acinetobacter baumannii. Twelve patients died, with imipenem-resistant A. baumannii infection contributing to the death of seven patients. The 31 representative A. baumannii isolates were multidrug-resistant and clustered in four distinct clones, each of which contained different carbapenemase genes: clone I was predominant and contained bla VIM-1 , bla OXA-58 and the intrinsic bla OXA-66 gene; clone II contained bla VIM-4 , bla OXA-58 and the intrinsic bla OXA-69 gene; clone III contained bla OXA-58 and the intrinsic bla OXA-69 gene; and clone IV contained only the intrinsic bla OXA-66 gene. I SAba1 was not associated with the intrinsic bla OXA-51-like alleles, whereas I SAba3 was found upstream and downstream of bla OXA-58 in isolates of clone I, and upstream of bla OXA-58 in isolates of clone III, but was not detected in isolates of clone II. PCR, curing and hybridisation experiments indicated that the bla VIM alleles were chromosomally located, whereas the bla OXA-58 alleles were plasmid-located. This study provides the first description of the clonal spread of multidrug-resistant A. baumannii isolates carrying bla VIM-1 and bla VIM-4 metallo-β-lactamase genes, and revealed that distinct carbapenem-resistant A. baumannii clusters bearing different carbapenemase genes may emerge and cause severe infections, even in a well-defined regional hospital setting.