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Ymittos Athens, Greece

Boriani G.,S. Orsola Malpighi University Hospital | Manolis A.S.,EVAGELISMOS General Hospital | Tukkie R.,Kennemer Gasthuis | Mont L.,University of Barcelona | And 10 more authors.
Heart Rhythm | Year: 2015

Background Many patients who suffer from bradycardia and need cardiac pacing also have atrial fibrillation (AF). New pacemaker algorithms, such as atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), have been specifically designed to reduce AF occurrence and duration and to minimize the detrimental effects of right ventricular pacing. The randomized MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial established that DDDRP + MVP pacing modality reduced permanent AF in bradycardia patients as compared with standard dual-chamber pacing (DDDR). Objective The aim of this study was to estimate the cost savings due to lower AF-related health care utilization events based on health care costs from the United States and the European Union. Methods Dual-chamber pacemaker patients with a history of paroxysmal or persistent AF were randomly assigned to receive DDDR (n = 385) or the advanced features (DDDRP + MVP; n = 383). We used published health care costs from the United States and the European Union (Italy, Spain, and the United Kingdom) to estimate the costs associated with AF-related hospitalizations and emergency visits. Results The rate of AF-related hospitalizations was significantly lower in the DDDRP + MVP group than in the conventional pacemaker group (DDDR group; 42% reduction; incidence rate ratio 0.58). Similarly, a significant reduction of 68% was observed for AF-related emergency department visits (incidence rate ratio 0.32; P <.001). As a consequence, DDDRP + MVP could potentially reduce health care costs by 40%-44%. Over a ten-year period, the cost savings per 100 patients ranged from $35,702 in the United Kingdom to $121,831 in the United States. Conclusion New pacing algorithms such as DDDRP + MVP used in the MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial successfully reduced AF-related health care utilization, resulting in significant cost savings to payers. © 2015 Heart Rhythm Society. Source

Christakou A.,EVAGELISMOS General Hospital
Epitheorese Klinikes Farmakologias kai Farmakokinetikes | Year: 2013

The knowledge of theories of motor control and motor learning may rehabilitate neurological, muscoloskeletical and other pathological conditions. The present review describes three techniques of motor behavior, namely the mental imagery, the mirror therapy and the Wii-therapy. The aforementioned techniques are used to increase the range of motion, the strength, the endurance, the balance, the gait, the neuromuscular coordination, the functional ability, the pain's reduction and head's dizziness. Particularly, the imagery is used in patients with head injuries, spinal injuries, Parkinson, multiple sclerosis, and amputees. The mirror therapy issue deficiently by stroke patients, patients with pain syndromes, and phantom pain limp. Elderly and children with different neurological, musculoskeletical problems, burns and other pathological problems use successfully the Wii therapy programs. Source

Nomikos M.,Venizelion General Hospital | Pappas A.,Venizelion General Hospital | Kopaka M.-E.,EVAGELISMOS General Hospital | Tzoulakis S.,Venizelion General Hospital | And 4 more authors.
Advances in Urology | Year: 2011

Introduction. There is not much evidence regarding clinical behavior of bladder cancer in younger patients. We evaluated clinical characteristics, tumor recurrence and progression in patients younger than 40 years old with urothelial bladder carcinoma. Methods. We retrospectively reviewed the medical records of 31 patients less than 40 years old who were firstly managed with bladder urothelial carcinoma in our department. Data were analysed with the Chi-square test. Results. Mean age was 31.7 years. Mean followup was 38.52 months (11-72 months). Nineteen (61%) patients were diagnosed with GII and 2 (6%) patients with GIII disease. Five (16%) patients presented with T1 disease. Three (9%) patients with invasive disease underwent cystectomy and adjuvant chemotherapy and one developed metastatic disease. Ten (32%) patients recurred during followup with a disease free recurrence rate of 65% the first 2 years after surgery. From those, 1 patient progressed to higher stage and three to higher grade disease. No patient died during followup. Conclusions. Bladder urothelial carcinoma in patients younger than 40 years is usually low stage and low grade. Management of these patients should be according to clinical characteristics and no different from older patients with the same disease. Copyright © 2011 Michael Nomikos et al. Source

Boriani G.,University of Bologna | Tukkie R.,Kennemer Gasthuis | Manolis A.S.,EVAGELISMOS General Hospital | Mont L.,University of Barcelona | And 9 more authors.
European Heart Journal | Year: 2014

Aims Atrial fibrillation (AF) is a common comorbidity in bradycardia patients. Advanced pacemakers feature atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), which minimizes unnecessary right ventricular pacing.We evaluated whether DDDRP and MVP might reduce mortality, morbidity, or progression to permanent AF when compared with standard dual-chamber pacing (Control DDDR).Methods and results In a randomized, parallel, single-blind, multi-centre trial we enrolled 1300 patients with bradycardia and previous atrial tachyarrhythmias, in whom a DDDRP pacemaker had recently been implanted. History of permanent AF and thirddegree atrioventricular block were exclusion criteria. After a 1-month run-in period, 1166 eligible patients, aged 74+9 years, 50% females, were randomized to Control DDDR, DDDRP + MVP, or MVP. Analysis was intention-to-treat. The primary outcome, i.e. the 2-year incidence of a combined endpoint composed of death, cardiovascular hospitalizations, or permanent AF, occurred in 102/385 (26.5%) Control DDDR patients, in 76/383 (19.8%) DDDRP + MVP patients [hazard ratio (HR) = 0.74, 95% confidence interval 0.55-0.99, P = 0.04 vs. Control DDDR] and in 85/398 (21.4%) MVP patients (HR = 0.89, 95% confidence interval 0.77-1.03, P = 0.125 vs. Control DDDR). When compared with Control DDDR, DDDRP + MVP reduced the risk for AF longer than 1 day (HR = 0.66, 95% CI 0.52-0.85, P, 0.001), AF longer than 7 days (HR = 0.52, 95% CI 0.36-0.73, P, 0.001), and permanent AF (HR = 0.39, 95% CI 0.21-0.75, P = 0.004).Conclusion In patients with bradycardia and atrial tachyarrhythmias, DDDRP + MVP is superior to standard dual-chamber pacing. The primary endpoint was significantly lowered through the reduction of the progression of atrial tachyarrhythmias to permanent AF. © 2014 The European Society of Cardiology. Source

Viazis N.,EVAGELISMOS General Hospital | Mantzaris G.,EVAGELISMOS General Hospital | Karmiris K.,Venizelion Hospital | Polymeros D.,Attikon Hospital | And 4 more authors.
Annals of Gastroenterology | Year: 2013

Background The aim of this study was to identify inflammatory bowel disease (IBD) patients' perspectives regarding everyday life issues. Methods From October 2010 till April 2011, 1,181 IBD patients completed an anonymous questionnaire through the internet (827 cases) or at the outpatient clinic of the participating centers (354 cases), aiming to identify: a) the impact of disease on social life, emotional status and work productivity; b) the source of disease information; and c) the level of support from family members and friends. Results Fifty-five percent of the patients reported that IBD interferes with their social life, while 65% felt stressed, 60% depressed and 19% tired because of it. Disease information (physician/ internet) was reported only by 31%, while 26% admitted not discussing their therapy with their gastroenterologist. Forty percent felt that the health service they receive is not satisfactory, with 76% desiring more gastroenterologists, 67% more outpatient clinics, 49% more dieticians and 42% more psychologists specialized in IBD. IBD interfered with working capacity in 40% of the participants, while 57% needed time off of work (ranging from 1-20 days per year). One of three patients (32%) has not informed his work environment about the disease; however, 88% had the support of their family and friends for coping with it. Conclusions Greek IBD patients claim that health-related social life, emotional status and work productivity are severely affected by their disease, whereas they complain about lack of information regarding the therapy. These unmet demands call for immediate action by healthcare providers and society. © 2013 Hellenic Society of Gastroenterology. Source

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