Papers by Theodoros Kyprianou
Cureus, Aug 18, 2021
Central line-associated bloodstream infections (CLABSIs) represent a severe systemic threat to pa... more Central line-associated bloodstream infections (CLABSIs) represent a severe systemic threat to patients admitted in ICUs and contribute to increased mortality, prolonged length of stay in ICUs, and increased costs. The majority of CLABSIs are preventable. The current systematic review aimed to investigate the effectiveness of educational methods on CLABSI rates in adult ICUs. A systematic literature search was conducted using the electronic databases of Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Cochrane Database of Systematic Reviews for studies published from the beginning of 1995 to March 2020. The terms used for the search were as follows: central venous catheters, infection, central line-associated bloodstream infections, intensive care unit, and education intervention in all possible combinations and using the word 'and' between them. Data were extracted independently and crosschecked by two authors using a standard data collection form. The quality of the studies included in the review was assessed using the Methodological Index for Non-randomized Studies (MINORS). The current systematic review included 27 interventional studies of central line insertion or maintenance or both in adult ICU settings with documentation of the CLABSI incidence expressed per 1,000 catheter days. A large deviation between the length of time and type of educational interventions was found. Statistical significance was found in all studies (except one) in terms of CLABSI reduction despite the large variation of the length or the type of the educational intervention. Continuing education on infection prevention may be necessary to maintain the post-intervention results and improve clinical outcomes.
Research Square (Research Square), Sep 18, 2020
Multi-omics data integration and network-based analysis drives a multiplex drug repurposing appro... more Multi-omics data integration and network-based analysis drives a multiplex drug repurposing approach to a shortlist of candidate drugs against COVID-19
Compassionate Critical Care: A “3C” Model
Springer eBooks, 2023
NeuroRehabilitation, Sep 24, 2020
BACKGROUND: Traumatic Brain Injury (TBI) is characterized by a highly heterogenous profile in ter... more BACKGROUND: Traumatic Brain Injury (TBI) is characterized by a highly heterogenous profile in terms of pathophysiology, clinical presentation and outcome. OBJECTIVE: This is the first population study investigating the epidemiology and outcomes of moderate-to-severe TBI in Cyprus. Patients treated in the Intensive Care Unit (ICU) of Nicosia General Hospital, the only Level 1 Trauma Centre in the country, were recruited between January 2013 and December 2016. METHODS: This was an observational cohort study, using longitudinal methods and six-month follow-up. Patients (N = 203) diagnosed with TBI were classified by the Glasgow Coma Scale at the Emergency Department as moderate (N = 36) or severe (N = 136). RESULTS: Compared to international multicentre studies, the current cohort demonstrates a different case mix that includes older age, more motor vehicle collisions and lower mortality rates. There was a significantly higher proportion of injured males. Females were significantly older than males. There were no sex differences in the type, severity or place of injury. Sex did not yield differences in mortality or outcomes or on injury indices predicting outcomes. In contrast, older age was a predictor of higher mortality rates and worse outcomes. CONCLUSION: Trends as described in the study emphasize the importance of continuous evaluation of TBI epidemiology and outcome in different countries.
Intensive Care Medicine Experimental, Oct 1, 2015
This paper introduces a novel, open source software named Intensive Care Window, ICW. ICW enables... more This paper introduces a novel, open source software named Intensive Care Window, ICW. ICW enables communication with intensive care unit bedside installed medical devices over standard and proprietary communication protocol stacks, facilitates the acquisition of vital signs and physiological parameters exported from patient attached medical devices and sensors. Moreover, ICW provides run-time and/or post analysis procedures for data annotation, data visualisation, data query and analysis. The ICW application can be deployed as a stand alone solution or in conjunction with existing clinical information systems providing a holistic solution to inpatient medical condition monitoring, early diagnosis and prognosis.
Background: Critical illness and hospitalization in the Intensive Care Unit have been linked to a... more Background: Critical illness and hospitalization in the Intensive Care Unit have been linked to adverse psychological effects for patients and their families. Although psychological support for adult family members gained growing research interest, studies regarding psychological support for the underage family members are still sporadic. Aim: The aim of this study was to develop a protocol for an innovative psychological assessment and support service (named “Ariadne”) for the underage family members (4 – 17 years old) of critically ill patients. Method: The following phases were implemented: a) Defining the needs of service’s users (underage family members and their guardians), b) Identifying potential assessment and intervention methods through semi-structured interviews with field experts and c) Consensus development with mental health professionals. Results: Users’ needs assessment phase highlighted the necessity for developing the service. Semi-structured interviews with field...
Hippokratia, 2016
BACKGROUND Patent foramen ovale (PFO) is an anatomic variant that may lead to several pathologica... more BACKGROUND Patent foramen ovale (PFO) is an anatomic variant that may lead to several pathological conditions, notably right to left shunt, paradoxical embolism, hypoxemia, and cerebral fat embolism. Mechanical positive pressure ventilation may increase the prevalence of PFO opening in Intensive Care Unit (ICU) patients; however, the respiratory and hemodynamic determinants of PFO opening have been poorly investigated. Contrast-enhanced transesophageal echocardiogram (ce-TEE) is considered the gold standard for PFO detection. We prospectively performed a multicenter study using ce-TEE in order to determine the respiratory and hemodynamic factors that may lead to PFO opening. METHODS One hundred and eight consecutive ICU adult patients under mechanical ventilation from three tertiary care hospitals, were included in the study. A standard multiplane ce-TEE was performed, and the dimensions and function of the right and left ventricle were studied. In each patient, the right ventricle ...
Prevention of Central Line Associated Bloodstream Infections by Implementation of Central Line Bundle
American Journal of Infection Control, 2012
femoral sites for extended periods of time. We recognized the need to address more than line plac... more femoral sites for extended periods of time. We recognized the need to address more than line placement to prevent BSI. We looked at NACHRI's multicenter PICU project progress in BSI prevention through standardizing line care and maintenance (LCM). When our Medical Center's Infection Prevention and Control (IPC) Department organized a team to customize an intravascular (IV) LCM bundle, key PICU nursing personnel joined the effort. A customized IV LCM bundle based on CDC and INS bloodstream infection (BSI) prevention guidellines was developed by the hospital's Zero BSI team. Mandating education of CL insertion and LCM bundles in the PICU was not enough. When the hospital committed to participating in the national Stop BSI project, the PICU volunteered and a multidisciplinary unit-based team was organized to eliminate CLABSI. Patient safety became part of the unit culture. Unit champions were identified and empowered. Medical and nursing staff were engaged. A daily patient goal sheet was put into practice. Line care audits were started. Days and then months since the unit's last CLABSI were counted. Results: This multidisciplinary project resulted in nearly 97% reduction in CLABSI with a mean rate of 0.2/1,000 CL days from November 2009 to November 2011 while decreasing the number of CL days. Using SHEA's published estimates that each CLABSI has an 18% fatality rate, costs $36,000 to treat, and increases length of stay an average of 13 days, we calculated an expected number of CLABSI. Based on our baseline rate, the PICU's CLABSI prevention program has saved an estimated 3 or 4 lives, $756,000 in patient charges, and 273 days of unnecessary hospitalization. Lesson Learned: We learned that CLABSI prevention requires a standardized continuous multidisciplinary effort. It involves creating a culture of safety. Frequent monitoring and regular reports of bundle audits and infection rates to maintain staff interest and engagement are needed. Active participation and visible involvement of the IPC Department in the process is important. Administrative support is essential. All of these have helped our PICU change what is possible in CLABSI prevention.
Psychology, Health & Medicine, 2016
This study is the first systematic effort to investigate psychological services provided to relat... more This study is the first systematic effort to investigate psychological services provided to relatives of ICU patients at Nicosia General Hospital. Documentation of psychological sessions provided to relatives of ICU patients for the years 2011-2014 was analyzed. To investigate possible differences in the total number of sessions for the referenced years, the records were analyzed using patients' demographics, the outcome of hospitalization and the total number of sessions with relatives. A questionnaire was sent to the ICU staff aiming to identify their perception towards the need for psychological support. A total number of 863 psychological sessions were conducted with 640 relatives of 345 patients hospitalized in the ICU. Results indicate that more sessions are recorded when the outcome of younger patients' condition worsens, whereas the number of sessions decreases for older patients' families. When comparing the personnel's beliefs, regarding the importance of providing psychological services to different age groups, significant difference was found suggesting that the older the patient the less sessions they believe are required indicating a possible ageism bias.
Abstract—This paper introduces a novel, open source software
Teaching and integrating eHealth technologies in undergraduate and postgraduate curricula and healthcare professionals’ education and training
Digital Innovations in Healthcare Education and Training, 2021
Abstract This book chapter offers a different insight into the methodology of teaching eHealth by... more Abstract This book chapter offers a different insight into the methodology of teaching eHealth by integrating digital innovation in healthcare education and training at the medical undergraduate level, the postgraduate level, and at the level of continuous professional education (CPE) in highly demanding clinical environments such as that of critical care. Many and significant challenges are posed to a healthcare profession student today, at both undergraduate and postgraduate levels, as one is required to learn and practice or even design the modern and technology-rich clinical environment. Even more challenges are faced by healthcare professionals that are responsible for “real patients” and require taking decisions on the job and occasionally under high pressure. Such decisions must be based on accurate and reliable data, complete and readily available. Conclusively, we discuss prospects of learning and practicing eHealth, the challenges in integrating innovative IT technologies to educational procedure and the concept of embedding those processes to a real time assess-educate-assess cycle that uses real time data analytics and advanced micro-learning tools to optimize outcome.
Renal Failure, 2012
Objective: Most studies so far have focused on the performance of individual biomarkers to detect... more Objective: Most studies so far have focused on the performance of individual biomarkers to detect early acute kidney injury (AKI) in the adult intensive care unit (ICU) patients; however, they have not determined the predictive ability of their combinations. The aim of this study was to compare the predictive abilities of plasma neutrophil gelatinase-associated lipocalin (pNGAL), urine neutrophil gelatinase-associated lipocalin (uNGAL), plasma cystatin C (pCysC), serum creatinine (sCr), and their combinations in detecting AKI in an adult general ICU population. Methods: A total of 100 consecutive ICU patients were included in the analysis. AKI was defined according to RIFLE criteria. Biomarker predictive abilities were evaluated by area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results: AKI occurred in 36% of patients 7 days post-admission. All three novel biomarkers as well as sCr had moderate predictive abilities for AKI occurrence. The most efficient combinations (pNGAL þ sCr and pNGAL þ uNGAL þ sCr) were selected to participate in the subsequent analyses. Both combinations, when added to a reference clinical model, increased its AUC significantly (0.858, p ¼ 0.04). Their NRI (0.78, p ¼ 0.0002) was equal to that of pNGAL, but higher than that of the other three biomarkers, whereas their IDI was higher than that of any individual biomarker (0.23, p ¼ 0.0001). Both combinations had better specificities, positive likelihood ratios, and positive predictive values than those of any individual biomarker. Conclusion: The biomarker combinations had better predictive characteristics compared with those of each biomarker alone.
Pharmacology Biochemistry and Behavior, 1991
MUSCAT, R., T. KYPRIANOU, M. OSMAN, G. PHILLIPS AND P. WILLNER. Sweetness-dependent facilitation ... more MUSCAT, R., T. KYPRIANOU, M. OSMAN, G. PHILLIPS AND P. WILLNER. Sweetness-dependent facilitation of sucrose drinking by raclopride is unrelated to calorie content. PHARMACOL BIOCHEM BEHAV 40(2) 209-213, 1991.--Previous stud-ies have reported that dopamine receptor antagonists increase the intake of solid or liquid diets containing high concentrations of sucrose. In Experiment 1, different groups of rats were trained in two-bottle tests (sweet solution vs. water), using three concentrations of either sucrose (0.7, 7 or 34%) or saccharin (0.02, 0.2 or 0.8%). Both sweeteners showed an inverted-U-shaped concentration-intake function. Raclopride increased intake of 34% sucrose, bat not of 0.8% saccharin. In Experiment 2, raclopride had similar effects in three-bottle tests (all 3 concentrations available concurrently). However, whereas 34% was the most preferred sucrose solution, 0.2% saccharin was preferred to 0.8%. Thus, 0.8% saccharin differs from 34% sucrose in two ways, being not only noncaloric, but also aversive. In Experiment 3, 34% sucrose was rendered aversive by the addition of 0.08% quinine. Intake of this cocktail was not increased by raclopride. These results suggest that the difference between sucrose and saccharin in the effects of raclopride is related to the aversive properties of a concentrated solution of saccharin, rather than to its lack of calories.
Prolonged Oxygen Kinetics During Early Recovery From Maximal Exercise in Adult Patients With Cystic Fibrosis<xref rid="AFF1"><sup>*</sup></xref>
CHEST Journal, 2001
To explore the significance of oxygen kinetics during early recovery after maximal cardiopulmonar... more To explore the significance of oxygen kinetics during early recovery after maximal cardiopulmonary exercise testing (CPET) in the assessment of functional capacity and severity of the disease in cystic fibrosis (CF) patients. Eighteen patients with CF (9 male/9 female; mean +/- SD age, 23 +/- 13 years) and 11 healthy subjects (3 male/8 female; mean age, 29 +/- 4 years) underwent maximum CPET on a treadmill. Breath-by-breath analysis was used for measuring oxygen consumption (VO(2)), carbon dioxide production, and ventilation. Maximum VO(2) (VO(2)peak) and the first-degree slope of VO(2) decline during early recovery (VO(2)/t-slope) were calculated. To assess the severity of the disease, we used standard indexes like FEV(1) (% predicted), VO(2)peak, and a widely accepted system of clinical evaluation, the Schwachman score (SS). VO(2)/t-slope was significantly lower in CF patients compared to healthy subjects (0.61 +/- 0.31 L/min/min vs 1.1 +/- 0.13 L/min/min; p &lt; 0.01) and was closely correlated to FEV(1)(r = 0.90, p &lt; 0.001), VO(2)peak (r = 0.81, p &lt; 0.001), and the SS (r = 0.81, p &lt; 0.001). The multivariate analysis showed that the only independent predictor of the SS is the VO(2)/t-slope. We conclude that in CF patients, the prolonged oxygen kinetics during early recovery from maximal exercise is related to the disease severity.
Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated ... more Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated with significant morbidity and mortality. The aim of this study was to evaluate conditions that could predict a poor outcome. Design Retrospective analyse of 69 patients admitted to the ICU from 1996 to 2003. Demographic data included age, sex and medical history. Etiologic agents, multiorgan dysfunction, nosocomial infections, SAPS II and PORT scores were recorded for each patient. For statistical analysis we used a t test, chi-square test and Mann-Whitney U test on SPSS ® . A value of P less than 0.05 was considered significant. Results Forty-seven patients were male and 22 patients were female. Mean age was 52 years. Sixty-seven percent had serious pre-morbid conditions including pulmonary disease (34.8%), cardiac problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); 40.6% were smokers, drug abusers or alcohol dependents. Sixtyeight patients required invasive mechanical ventilation. The average length of ventilation was 13.5 days, median 8 days. The mean SAPS II score was 40.14 and the mean PORT score was 141. The mortality rate was 27.5% (SAPS II estimated mortality, 35%). Complications reported were ARDS (40.6%), septic shock (34.8%), acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association between crude mortality and SAPS II score (P = 0.003) and development of complications (P = 0.0028). Respiratory dysfunction (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded regarding age, comorbidities, PORT score, etiologic agents, nosocomial infections and length of invasive mechanical ventilation. Conclusions Previous hepatic chronic disease was strictly related to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best severity indicator of mortality.
Healthcare Information Systems are nowadays among the world's largest, fastest-growing and mo... more Healthcare Information Systems are nowadays among the world's largest, fastest-growing and most information intensive indus- tries. Additionally, Intensive Care Units are widely considered as the most technologically advanced environments within a hospital. In such environments, physicians are confronted with the challenge of storing and analyzing terabytes of data that stream in real-time from inpatients to centralized clinical information systems. In
Attitudes towards euthanasia among Greek intensive care unit physicians and nurses
Heart & lung : the journal of critical care, 2015
To investigate the attitudes of Greek intensive care unit (ICU) medical and nursing staff towards... more To investigate the attitudes of Greek intensive care unit (ICU) medical and nursing staff towards euthanasia. ICU physicians and nurses deal with end-of-life dilemmas on a daily basis. Therefore, the exploration of their stances on euthanasia is worthwhile. This was a descriptive quantitative study conducted in three ICUs in Athens. The convenience sample included 39 physicians and 107 nurses. Of respondents, 52% defined euthanasia inaccurately, as withholding or withdrawal of treatment, while 15% ranked limitation of life-support among the several forms of euthanasia, together with active shortening of the dying process and physician - assisted suicide. Only one third of participants defined euthanasia correctly. While 59% of doctors and 64% of nurses support the legalization of active euthanasia, just 28% and 26% of them, respectively, agree with it ethically. Confusion prevails among Greek ICU physicians and nurses regarding the definition of euthanasia. The majority of staff dis...
Development of a new bed system with improved decubitus prophylaxis for bed-ridden patients
2009 9th International Conference on Information Technology and Applications in Biomedicine, 2009
An adaptable bedding surface for the prophylaxis and treatment of decubitus ulcers was developed ... more An adaptable bedding surface for the prophylaxis and treatment of decubitus ulcers was developed and evaluated in a number of preclinical studies. The new bed reduced the average contact pressure peaks in prolonged supine bed rest while significantly decelerating the onset and progression of pressure sores. A special advantage of the surface is its discrete, independently-mobile pin elements that allow
Studies in health technology and informatics, 2008
Novel eHealth systems are being designed to provide a citizen-centered health system, however the... more Novel eHealth systems are being designed to provide a citizen-centered health system, however the even demanding need for computing and data resources has required the adoption of Grid technologies. In most of the cases, this novel Health Grid requires not only conveying patient's personal data through public networks, but also storing it into shared resources out of the hospital premises. These features introduce new security concerns, in particular related with privacy. In this paper we survey current legal and technological approaches that have been taken to protect a patient's personal data into eHealth systems, with a particular focus in Intensive Care Grids. However, thanks to a security analysis applied over the Intensive Care Grid system (ICGrid) we show that these security mechanisms are not enough to provide a comprehensive solution, mainly because the data-at-rest is still vulnerable to attacks coming from untrusted Storage Elements where an attacker may directly ...
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Papers by Theodoros Kyprianou