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Letsios A, Polyzos N, Poulopoulos C, Skamnakis C. Hospital managers' participation in operational planning: insights from a recent study in the Greek National Health System. Hippokratia 2022; 26:91-97. [PMID: 37324045 PMCID: PMC10266327] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND The performance of the public hospitals of the National Health System (NHS) of Greece, as reflected in their financial and operational results, is related to their strategic planning and the factors that influence the accomplishment of their objectives. METHOD The organizational performance of NHS hospitals was assessed by analyzing their operational and financial data for the period 2010-2020 (recorded by the "BI-Health" system of the Ministry of Health). Based on internationally accepted factors that influence the successful implementation of strategic planning and the achievement of its objectives, a structured questionnaire consisting of 11 demographic and 93 (on a scale of 1 to 7) factor-related questions was developed and addressed to 56 managers and senior executives. Their response was analyzed using descriptive statistical methods and inference, and "significant" factors were extracted using Principal Components Analysis. RESULTS Hospitals reduced their expenditure from 2010 to 2015 by 34.6 %, while the number of inpatients increased by 5.9 %. However, expenditure increased by 41.2 % in the period 2016-2020, while concurrently, inpatients rose by 14.7 %. Outpatient and emergency department visits remained almost stable (6.5 and 4.8 million/year, respectively), during 2010-2015, while increased by 14.5 % till 2020. The average length of stay decreased from 4.1 in 2010 to 3.8 in 2015 and 3.4 in 2020. The survey data showed that NHS hospitals' strategic plan is well "documented", but its "actual implementation" is moderate; The "achievement of the objectives" related to clinical work, quality improvement of services, human resources development, financial strategy, asset strategy, digital strategy, communication and engagement strategy, and research might be good; chief executive officers, nurses, laboratory physicians, and administrators receive a positive grade of participation while the Board of Directors, physicians, employee representatives and the School of Medicine/University receive a moderate grade. The factors: "elements of strategic planning" (33.6 %), "evaluation of services and staff" (20.5 %), "employees' commitment and involvement" (20.1 %), and "operational outcomes and performance" (8.9 %), as derived from the principal component analysis, had the highest impact on achieving their financial and operational objectives, as assessed by the views of the managers of the 35 NHS hospitals. CONCLUSION The NHS hospitals increased their efficiency from 2010 to 2020 but failed to maintain control over their expenditure. Through their clinical managers and other employees' representatives, chief executive officers and the Board of Directors need to improve planning formulation, staff involvement and utilization, financial performance, and outcomes as their primary commitment among health policy and management sectors in the Greek NHS. HIPPOKRATIA 2022, 26 (3):91-97.
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Affiliation(s)
- A Letsios
- Department of Social Work, School of Social, Political & Economical Sciences, Democritus University of Thrace, Komotini, Greece
| | - N Polyzos
- Department of Social Work, School of Social, Political & Economical Sciences, Democritus University of Thrace, Komotini, Greece
| | - Ch Poulopoulos
- Department of Social Work, School of Social, Political & Economical Sciences, Democritus University of Thrace, Komotini, Greece
| | - Ch Skamnakis
- Department of Social Policy, Panteion University, Athens, Greece
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Gonzalez-Foruria I, García S, Racca A, Álvarez M, Polyzos N, Coroleu B. O-241 Elevated serum progesterone levels before frozen embryo transfer do not negatively impact reproductive outcomes: a large retrospective cohort study. Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Do patients with high serum progesterone levels before frozen embryo transfer (FET) under hormonal replacement therapy (HRT) present worse reproductive outcomes?
Summary answer
Elevated serum progesterone levels before FET in artificially prepared cycles with vaginal or vaginal plus subcutaneous progesterone do not impair reproductive outcomes.
What is known already
Low serum progesterone levels before FET do negatively affect reproductive outcomes in terms of live birth rate. However, there is not robust data regarding the impact of high serum progesterone levels in the luteal phase of patients who undergo HRT for FET.
Study design, size, duration
Retrospective cohort study of 3183 blastocyst FET cycles under HRT performed in a university-affiliated fertility centre between March 2009 and December 2020. All the cycles presented adequate serum progesterone levels before FET (≥10.6 ng/ml). A total of 1360 cycles corresponded to frozen homologous embryo transfer (ET) (hom-FET), 1024 were euploid ET (eu-FET) after preimplantational genetic testing for aneuploidies (PGT-A), and 799 cycles were frozen heterologous ET (het-FET). The primary objective was live birth rate (LBR).
Participants/materials, setting, methods
Standard HRT was used. Luteal phase was covered with vaginal progesterone 200 mg/8h, or vaginal plus a daily subcutaneous injection of progesterone (25 mg). Serum progesterone levels were measured the day before FET. Elevated progesterone levels were considered in the 90th and 95th centiles. A generalized additive model (GAM) was performed to study the functional relationships between progesterone and LBR. A multivariable logistic regression was used to evaluate the effect of high progesterone over LBR.
Main results and the role of chance
Mean serum progesterone level before FET was 16.77±8.43 ng/ml. Progesterone levels were significantly higher in the group under vaginal plus subcutaneous progesterone (21.87±14.17 vs. 15.56±5.72, p < 0.001). No differences in clinical pregnancy, miscarriage and LBR were found according to the use of vaginal or vaginal plus subcutaneous progesterone for each of the groups (hom-FET, eu-FET and het-FET). Live birth rates were comparable among patients in the highest centile of serum progesterone levels (≥p90, ≥22.33 ng/ml) and the rest of patients (p < 90) (43.9 vs 41.3%; p = 0.381). Patients with progesterone levels ≥p90 presented lower BMI compared to those in the lower centiles (<p90) (22.62±3.82 vs. 23.32±4.06; P = 0.009). After dividing patients in deciles according to serum progesterone levels before, no differences in LBR were observed among groups (P = 0.938). No association was observed with GAM model between progesterone levels and LBR. A multivariable logistic regression adjusted by oocyte age, type of treatment and number of embryos transferred was applied for centile 90 and centile 95 of progesterone, and showed that serum progesterone in their highest levels did not negatively impact LBR.
Limitations, reasons for caution
The main limitation of this study is its retrospective design. The results only apply for patients under HRT with vaginal micronized progesterone alone or plus subcutaneous progesterone. Progesterone determination was measured before blastocyst FET. Extrapolation to other HRT protocols or timings of progesterone measurement needs to be validated.
Wider implications of the findings
The results of this study suggest that once a threshold of serum progesterone before FET is achieved, progesterone levels are not predictive of the clinical outcome. Actually, LBR are not negatively affected when progesterone levels are found in their highest centiles after luteal phase rescue with vaginal plus subcutaneous progesterone.
Trial registration number
Not applicable
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Affiliation(s)
- I Gonzalez-Foruria
- Dexeus University Hospital, Department of Obstetrics- Gynaecology and Reproductive Medicine , Barcelona, Spain
| | - S García
- Dexeus University Hospital, Department of Obstetrics- Gynaecology and Reproductive Medicine , Barcelona, Spain
| | - A Racca
- Dexeus University Hospital, Department of Obstetrics- Gynaecology and Reproductive Medicine , Barcelona, Spain
| | - M Álvarez
- Dexeus University Hospital, Department of Obstetrics- Gynaecology and Reproductive Medicine , Barcelona, Spain
| | - N Polyzos
- Dexeus University Hospital, Department of Obstetrics- Gynaecology and Reproductive Medicine , Barcelona, Spain
| | - B Coroleu
- Dexeus University Hospital, Department of Obstetrics- Gynaecology and Reproductive Medicine , Barcelona, Spain
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Clua Obradó E, Palacios-Verdú G, Sumarroca M, Martínez F, Polyzos N. O-144 Adverse pregnancy and neonatal outcomes in an oocyte donation program. Expanded Carrier Screening can substantially decrease the risk of recessive conditions. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
How frequent are adverse outcomes in oocyte donation (OD) programs and how many recessive conditions can be prevented with the implementation of expanded carrier screening(ECS)?
Summary answer
Adverse outcomes were reported only in 1.55% of cases. ECS prevented 2.66% autosomal recessive and X-linked-conditions, interpreted in a 63% decrease in adverse outcomes.
What is known already
Nowadays, oocyte donors undergo a rigorous selection process, including the evaluation of genetic risks. ECS has been widely implemented in the screening of gamete donors. Nevertheless, pregnancies conceived after OD cycles are still at risk for genetic adverse outcomes. There are very few reports in the literature regarding children born with an inherited genetic condition from a gamete donor, and they are reported in sperm donation-conceived offspring. To our knowledge, there is no published review of genetic adverse outcomes in oocyte donation offspring so far.
Study design, size, duration
This is a retrospective observational study that analyses the adverse events reported in 4573 OD cycles carried out between January 2014 and December 2021 in the Reproductive Medicine Unit of Dexeus University Hospital. The study also reviews the number of high-risk assignations that has been identified in the OD program where ECS was applied to the oocyte donors and the recipient’s male partner to avoid high-risk assignations.
Participants/materials, setting, methods
The study includes patients who underwent OD cycles and reported an adverse outcome with a potential genetic aetiology from 2014 to 2021. Moreover, genetic matchings were revised in the OD program and high-risk assignations were defined as matchings where oocyte donors and recipients’ male partners were carriers of the same autosomal recessive condition or as matchings where oocyte donor candidates were found to be carriers of X-linked conditions.
Main results and the role of chance
A total of 4.573 OD cycles were performed, including 1696 oocyte donors. Seventy-one recipients (1.55%) reported an adverse outcome of the pregnancy or children born from the OD. A confirmed genetic aetiology was reported in 23 (32.4%) cases including chromosomal abnormalities, microduplications and monogenic disorders. The reported remaining cases were due to congenital malformations, stillbirth, neurodevelopmental disorders, and other conditions for which a genetic aetiology has not been established to our knowledge.
Moreover, we identified 211 (4.6%) high-risk assignations due to oocyte donors and recipient’s male partners being carriers of the same autosomal recessive condition when initially assigned, which would have led to an additional 1,15% of children born with an autosomal recessive conditions (25% of 4.6% high-risk assignations). Additionally, we rejected 52 (3.07%) oocyte donor candidates that were carriers of X-linked conditions, which would have led to an additional 1.5% of children born with an X-linked disorder.
Based on our results, implementation of ECS, resulted in 63% risk reduction in adverse outcomes observed in our oocyte donation program from a potential adverse event rate of 4.2% to an actual 1.55% incidence of adverse outcomes.
Limitations, reasons for caution
The actual number of adverse outcomes and high-risk assignations in an OD program could be underestimated given that not all patients report the adverse outcome or in some cases adverse events have not yet developed. Additionally, the number of rejected/avoided high-risk assignations in ECS is not always collected.
Wider implications of the findings
This study provides evidence that ECS reduces the probability that children born from OD could inherit some autosomal recessive or X-linked conditions. However, there are still several genetic adverse events that cannot be avoided by implementing ECS, mostly caused by de novo monogenic changes, chromosomal abnormalities, or congenital malformations.
Trial registration number
Not applicable
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Affiliation(s)
- E Clua Obradó
- Reproductive Medicine Unit of Dexeus University Hospital, Reproductive Medicine Unit , Barcelona, Spain
| | - G Palacios-Verdú
- Dexeus University Hospital, Unit of Genomic Medicine , Barcelona, Spain
| | - M Sumarroca
- Dexeus University Hospital, Unit of Genomic Medicine , Barcelona, Spain
| | - F Martínez
- Dexeus University Hospital, Reproductive Medicine Unit , Barcelona, Spain
| | - N Polyzos
- Dexeus University Hospital, Reproductive Medicine Unit , Barcelona, Spain
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Hart R, D’Hooghe T, Dancet E, Aurell R, Lunenfeld B, Orvieto R, Pellicer A, Polyzos N, Zheng W. P–593 Self-monitoring of hormones via a urine-based hormonal assay — a topical endeavour into telemedicine in medically-assisted reproduction (MAR). Hum Reprod 2021. [PMCID: PMC8385867 DOI: 10.1093/humrep/deab130.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Study question How can cycle monitoring using a urine-based hormonal assay device improve current clinical practice in medically assisted reproduction (MAR)? Summary answer A urine-based hormonal assay has the potential to overcome the inconvenience of blood tests and reduce the frequency of appointments, waiting times and patient burden. What is known already Cycle monitoring via ultrasound and serum-based hormonal assays during MAR can provide information on the ovarian response and assist in optimising treatment strategies and reducing complications, such as ovarian hyperstimulation syndrome (OHSS). However, blood tests may cause inconvenience to patients due to repeated venepuncture and the need for frequent clinic appointments. Urine-based assays have been historically used by fertility specialists in clinics, but since got replaced by more practical and automated serum-based assays. Novel technology utilising rapid chromatographic immunoassay to test urinary reproductive hormones in a home setting could provide an alternative to current serum-based testing at clinics. Study design, size, duration A questionnaire was disseminated among 24 fertility specialists (2019–2020) on the use of ultrasound and serum-based hormone monitoring in clinical practice. In addition, the literature on the reliability of urine-based hormonal assays compared to serum-based hormonal assays during MAR was reviewed in order to examine if urine-based hormonal monitoring could be re-introduced in clinical practice using novel state-of-the-art technology. Participants/materials, setting, methods All 24 surveyed fertility specialists responded, representing 10 countries from across Europe, Asia and Latin America. Questions assessed the frequency and role of hormonal monitoring, the hormones tested and the drawbacks of blood tests. The PubMed search engine was used to search the Medline database for publications between 1960–2020 with (MeSH-) search terms related to cycle monitoring (e.g. fertility monitoring, controlled ovarian stimulation, ovulation confirmation) and hormonal assays (e.g. estrone–3-glucuronide or E1–3G). Main results and the role of chance The survey confirmed that many fertility practitioners (n = 22/24) routinely conducted hormone monitoring during MAR, primarily for guiding dose adjustments (n = 20/24) and indicating risk of OHSS (n = 20/24). The reported drawbacks of blood tests included validity of results from different service providers, long waiting times and discomfort to patients due to travelling to clinics for tests and repeated venepunctures. The hormones routinely checked were E2 (n = 22/22), P4 (n = 18/22) and LH (n = 15/22). The literature review revealed a relatively high correlation (correlation coefficients 0.85–0.95) between serum E2 and urinary E1–3G in gonadotrophin stimulated cycles (Lessing 1987, Catalan 1989, Rapi 1992 and Alper 1994). No studies assessed the correlation between serum P4 and urinary PdG or between serum LH and urinary LH in stimulated cycles. In natural cycles, the correlation coefficients between serum P4 and urinary PdG seemed to be slightly higher than those between serum E2 and urinary E1–3G (0.73–0.94 vs. 0.54–0.88) (Denari 1981, Munro 1991, Roos 2015, Stanczyk 1980). One study reported a moderate correlation coefficient (0.72) between serum and urinary LH in natural cycles (Roos 2015). Limitations, reasons for caution There is risk of selection-bias for fertility specialists included in survey, however, the 100% response rate is reassuring. The correlation coefficients between serum- and urine-based hormonal assay and the cost-effectiveness and time-efficiency of urinary assay should be confirmed in further clinical studies using a novel state-of-the-art remote urinary monitoring device. Wider implications of the findings: Remote hormonal monitoring can be part of a novel digital health solution that includes remote ultrasound and tele-counselling to link clinics and patients at home. Especially during the unprecedented times of the COVID–19 pandemic, the prospect of remote monitoring system has the potential to improve patient experience during fertility treatment. Trial registration number Not applicable
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Affiliation(s)
- R Hart
- University of Western Australia & Fertility Specialists of WA, Division of Obstetrics and Gynaecology, Perth- Western Australia, Australia
| | - T D’Hooghe
- Merck KGaA, Global Medical Affairs Fertility, Darmstadt, Germany
| | - E Dancet
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - R Aurell
- Fertility Campus Hospital Quirónsalud, IVF Unit, Barcelona, Spain
| | - B Lunenfeld
- Bar-Ilan University, Faculty of Life Sciences, Ramat Gan, Israel
| | - R Orvieto
- Chaim Sheba Medical Center Tel Hashomer, Infertility and IVF Unit- Department of Obstetrics and Gynecology, Ramat Gan, Israel
| | - A Pellicer
- IVIRMA, Reproductive Medicine, Rome, Italy
| | - N Polyzos
- Dexeus Mujer- Dexeus University Hospital, Department of Obstetrics Gynecology and Reprodutive Medicine, Barcelona, Spain
| | - W Zheng
- Merck KGaA, Global Medical Affairs Fertility- R&D Biopharma, Darmstadt, Germany
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Petropoulos SA, Di Gioia F, Polyzos N, Tzortzakis N. Natural Antioxidants, Health Effects and Bioactive Properties of Wild Allium Species. Curr Pharm Des 2020; 26:1816-1837. [PMID: 32013820 DOI: 10.2174/1381612826666200203145851] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/16/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is an increasing interest from the pharmaceutical and food industry in natural antioxidant and bioactive compounds derived from plants as substitutes for synthetic compounds. The genus Allium is one of the largest genera, with more than 900 species, including important cultivated and wild species, having beneficial health effects. OBJECTIVE The present review aims to unravel the chemical composition of wild Allium species and their healthrelated effects, focusing on the main antioxidant compounds. For this purpose, a thorough study of the literature was carried out to compile reports related to health effects and the principal bioactive compounds. Considering the vast number of species, this review is divided into subsections where the most studied species are presented, namely Allium ampeloprasum, A. flavum, A. hookeri, A. jesdianum, A. neapolitanum, A. roseum, A. stipitatum, A. tricoccum, and A. ursinum, with an additional composite section for less studied species. METHODS The information presented in this review was obtained from worldwide accepted databases such as Scopus, ScienceDirect, PubMed, Google Scholar and Researchgate, using as keywords the respective names of the studied species (both common and Latin names) and the additional terms of"antioxidants" "health effects" and "bioactive properties". CONCLUSION The genus Allium includes several wild species, many of which are commonly used in traditional and folklore medicine while others are lesser known or are of regional interest. These species can be used as sources of natural bioactive compounds with remarkable health benefits. Several studies have reported these effects and confirmed the mechanisms of action in several cases, although more research is needed in this field. Moreover, considering that most of the studies refer to the results obtained from species collected in the wild under uncontrolled conditions, further research is needed to elucidate the effects of growing conditions on bioactive compounds and to promote the exploitation of this invaluable genetic material.
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Affiliation(s)
- Spyridon A Petropoulos
- Department of Agriculture, Crop Production and Rural Environment, University of Thessaly, N. Ionia, Magnissia, Greece
| | - Francesco Di Gioia
- Department of Plant Science, Pennsylvania State University, Pennsylvania, United States
| | - Nikos Polyzos
- Department of Agriculture, Crop Production and Rural Environment, University of Thessaly, N. Ionia, Magnissia, Greece
| | - Nikos Tzortzakis
- Department of Agricultural Sciences, Biotechnology and Food Science, Cyprus University of Technology, Limassol, Cyprus
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Gaggiotti-Marre S, Martinez F, Coll L, Garcia S, Álvarez M, Parriego M, Barri PN, Polyzos N, Coroleu B. Low serum progesterone the day prior to frozen embryo transfer of euploid embryos is associated with significant reduction in live birth rates. Gynecol Endocrinol 2019; 35:439-442. [PMID: 30585507 DOI: 10.1080/09513590.2018.1534952] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
A retrospective cohort study was performed to examine whether, in artificial endometrial preparation for frozen embryo transfer (FET) cycles, progesterone (P) levels the day prior to embryo transfer of euploid embryos have an impact on pregnancy outcomes. In a private university clinic, 244 FETs between January 2016 and June 2017 were analyzed. Endometrial preparation was achieved with estradiol valerate and vaginal micronized progesterone. Serum P and estradiol levels the day prior to embryo transfer were measured. A multivariable analysis to assess the relationship between serum P level and pregnancy outcomes was performed, adjusted for confounding variables. Mean P value was 11.3 ± 5.1 ng/ml. Progesterone levels were split in quartiles: Q1: ≤ 8.06 ng/ml; Q2: 8.07-10.64 ng/ml; Q3: 10.65-13.13 ng/ml; Q4: > 13.13 ng/ml. Patients included in the lower P quartile had a significantly higher miscarriage rate and significantly lower live birth rate (LBR) compared to the higher ones. A low serum P level (≤ 10.64 ng/ml) one day before FET is associated with a lower pregnancy and LBR following FET of euploid embryos.
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Affiliation(s)
- S Gaggiotti-Marre
- a Dexeus Mujer, Department of Obstetrics, Gynecology and Reproduction , University Hospital Dexeus , Barcelona , Spain
| | - F Martinez
- a Dexeus Mujer, Department of Obstetrics, Gynecology and Reproduction , University Hospital Dexeus , Barcelona , Spain
| | - L Coll
- a Dexeus Mujer, Department of Obstetrics, Gynecology and Reproduction , University Hospital Dexeus , Barcelona , Spain
| | - S Garcia
- a Dexeus Mujer, Department of Obstetrics, Gynecology and Reproduction , University Hospital Dexeus , Barcelona , Spain
| | - M Álvarez
- a Dexeus Mujer, Department of Obstetrics, Gynecology and Reproduction , University Hospital Dexeus , Barcelona , Spain
| | - M Parriego
- a Dexeus Mujer, Department of Obstetrics, Gynecology and Reproduction , University Hospital Dexeus , Barcelona , Spain
| | - P N Barri
- a Dexeus Mujer, Department of Obstetrics, Gynecology and Reproduction , University Hospital Dexeus , Barcelona , Spain
| | - N Polyzos
- a Dexeus Mujer, Department of Obstetrics, Gynecology and Reproduction , University Hospital Dexeus , Barcelona , Spain
| | - B Coroleu
- a Dexeus Mujer, Department of Obstetrics, Gynecology and Reproduction , University Hospital Dexeus , Barcelona , Spain
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Polyzos N, Drakopoulos P, Tournaye H, Schiettecatte J, Anckaert E, Donner H, Bobba G, Miles G, Verhagen-Kamerbeek W, Bosch E. Estradiol and progesterone in in vitro fertilization (ESPRIT): evaluation of the third versus second generation estradiol and progesterone elecsys® assays. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sole M, Polyzos N, Llagostera CG, Carrasco B, Coroleu B, Veiga A, Boada M. Automatic vs manual vitrification of human oocytes. preliminary results of the first randomised controlled trial using sibling oocytes. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Farmakas A, Theodorou M, Galanis P, Karayiannis G, Ghobrial S, Polyzos N, Papastavrou E, Agapidaki E, Souliotis K. Public engagement in setting healthcare priorities: a ranking exercise in Cyprus. Cost Eff Resour Alloc 2017; 15:16. [PMID: 28808427 PMCID: PMC5551077 DOI: 10.1186/s12962-017-0078-3] [Citation(s) in RCA: 9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In countries such as Cyprus the financial crisis and the recession have severely affected the funding and priority setting of the health care system. There is evidence highlighting the importance of population' preferences in designing priorities for health care settings. Although public preferences have been thorough analysed in many countries, there is a research gap in terms of simultaneously investigating the relative importance and the weight of differing and competing criteria for determining healthcare priority settings. The main objective of the study was tο investigate public preferences for the relative utility and weight of differing and competing criteria for health care priority setting in Cyprus. METHODS The 'conjoint analysis' technique was applied to develop a ranking exercise. The aim of the study was to identify the preferences of the participants for alternative options. Participants were asked to grade in a priority order 16 hypothetical case scenarios of patients with different disease and of diverse socio-economic characteristics awaiting treatment. The sample was purposive and consisted of 100 Cypriots, selected from public locations all over the country. RESULTS It was revealed that the "severity of the disease" and the "age of the patient" were the key prioritization criteria. Participants assigned the smallest relative value to the criterion "healthy lifestyle". More precisely, participants older than 35 years old assigned higher relative importance to "age", while younger participants to the "severity of the disease". The "healthy lifestyle" criterion was assigned to the lowest relative importance to by all participants. CONCLUSION In Cyprus, public participation in health care priority setting is almost inexistent. Nonetheless, it seems that the public's participation in this process could lead to a wider acceptance of the healthcare system especially as a result of the financial crisis and the upcoming reforms implemented such as the establishment of the General System of Health Insurance.
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Affiliation(s)
- Antonis Farmakas
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Mamas Theodorou
- Faculty of Economics and Management, Open University of Cyprus, Nicosia, Cyprus
| | - Petros Galanis
- Research Associate Center for Health Services Management and Evaluation, Faculty of Nursing, University of Athens, Athens, Greece
| | | | | | - Nikos Polyzos
- Department of Social Administration and Political Science, Democritus University of Thrace, Komotini, Greece
| | | | - Eirini Agapidaki
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, 25 Alexandroupoleos st., Athens, Greece
| | - Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece
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Xenos P, Yfantopoulos J, Nektarios M, Polyzos N, Tinios P, Constantopoulos A. Efficiency and productivity assessment of public hospitals in Greece during the crisis period 2009-2012. Cost Eff Resour Alloc 2017; 15:6. [PMID: 28450811 PMCID: PMC5405486 DOI: 10.1186/s12962-017-0068-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 04/19/2017] [Indexed: 12/03/2022] Open
Abstract
Background This study is an initial effort to examine the dynamics of efficiency and productivity in Greek public hospitals during the first phase of the crisis 2009–2012. Data were collected by the Ministry of Health after several quality controls ensuring comparability and validity of hospital inputs and outputs. Productivity is estimated using the Malmquist Indicator, decomposing the estimated values into efficiency and technological change. Methods Hospital efficiency and productivity growth are calculated by bootstrapping the non-parametric Malmquist analysis. The advantage of this method is the estimation efficiency and productivity through the corresponding confidence intervals. Additionally, a Random-effects Tobit model is explored to investigate the impact of contextual factors on the magnitude of efficiency. Results Findings reveal substantial variations in hospital productivity over the period from 2009 to 2012. The economic crisis of 2009 had a negative impact in productivity. The average Malmquist Productivity Indicator (MPI) score is 0.72 with unity signifying stable production. Approximately 91% of the hospitals score lower than unity. Substantial increase is observed between 2010 and 2011, as indicated by the average MPI score which fluctuates to 1.52. Moreover, technology change scored more than unity in more than 75% of hospitals. The last period (2011–2012) has shown stabilization in the expansionary process of productivity. The main factors contributing to overall productivity gains are increases in occupancy rates, type and size of the hospital. Conclusions This paper attempts to offer insights in efficiency and productivity growth for public hospitals in Greece. The results suggest that the average hospital experienced substantial productivity growth between 2009 and 2012 as indicated by variations in MPI. Almost all of the productivity increase was due to technology change which could be explained by the concurrent managerial and financing healthcare reforms. Hospitals operating under decreasing returns to scale could achieve higher efficiency rates by reducing their capacity. However, certain social objectives should also be considered. Emphasis perhaps should be placed in utilizing and advancing managerial and organizational reforms, so that the benefits of technological improvements will have a continuing positive impact in the future. Electronic supplementary material The online version of this article (doi:10.1186/s12962-017-0068-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P Xenos
- School of Finance and Statistics, University of Piraeus, 80 Karaoli & Dimitriou Str, 18534 Piraeus, Greece
| | - J Yfantopoulos
- School of Economics and Political Science, University of Athens, 6 Themistokleous Str., 10678 Athens, Greece
| | - M Nektarios
- School of Finance and Statistics, University of Piraeus, 80 Karaoli & Dimitriou Str, 18534 Piraeus, Greece
| | - N Polyzos
- School of Social, Political and Economic Science, University of Thrace, 12 Vasilisis Sofias Str, 67100 Xanthi, Greece
| | - P Tinios
- School of Finance and Statistics, University of Piraeus, 80 Karaoli & Dimitriou Str, 18534 Piraeus, Greece
| | - A Constantopoulos
- School of Economics and Political Science, University of Athens, 6 Themistokleous Str., 10678 Athens, Greece
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Agathokleous MN, Nena E, Chadolias D, Zissimopoulos A, Polyzos N, Jelastopoulou E, Constantinidis TC. Estimating life expectancy of the population in Cyprus with the use of life tables. Hippokratia 2016; 20:99-103. [PMID: 28416904 PMCID: PMC5388527] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM The aim of this study was to investigate the life expectancy of the Cypriot population between 1986 and 2012. MATERIAL AND METHODS We used the data reported in the annual editions of the Statistical Service of Cyprus and constructed life tables of the Cypriot population between 1986 and 2012. RESULTS For both genders, and for males and females separately, in the year 1986 life expectancy accounted 74.47, 72.2, and 76.76 years respectively, while in 2012 values increased to about 81.28, 79.02, and 83.50 years respectively. The longitudinal trend of life expectancy is to increase over the calendar years. The largest increase in life expectancy occurred at birth and was approximately seven years for both males and females. Until the age of 55, this gain was approximately six years of life. From age 60 to 65 years, the gain was about five years of life, and in the oldest age groups, the gain was four years of life. The values corresponding to male were lower compared to those corresponding to females, with the exception of the age 0 (at birth). CONCLUSIONS A significant increase in life expectancy of the Cypriot population was noted in the period 1986-2012, which was more obvious at younger ages and in females. Hippokratia 2016, 20(2): 99-103.
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Affiliation(s)
- M N Agathokleous
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - E Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - D Chadolias
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - A Zissimopoulos
- Laboratory of Nuclear Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - N Polyzos
- Department of Social Administration and Political Science, Democritus University of Thrace, Komotini, Greece
| | - E Jelastopoulou
- Laboratory of Hygiene, Medical School, University of Patras, Patras, Greece
| | - T C Constantinidis
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Polyzos N, Karakolias S, Dikeos C, Theodorou M, Kastanioti C, Mama K, Polizoidis P, Skamnakis C, Tsairidis C, Thireos E. The introduction of Greek Central Health Fund: Has the reform met its goal in the sector of Primary Health Care or is there a new model needed? BMC Health Serv Res 2014; 14:583. [PMID: 25421631 PMCID: PMC4255662 DOI: 10.1186/s12913-014-0583-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 11/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The National Organization for Healthcare Provision (EOPYY) originates from the recent reform in Greek healthcare, aiming amidst economic predicament, at the rationalization of health expenditure and reactivation of the pivotal role of Primary Health Care (PHC). Health funding (public/private) mix is examined, alongside the role of pre-existing health insurance funds. The main pursuit of this paper is to evaluate whether EOPYY has met its goals. METHODS The article surveys for best practices in advanced health systems and similar sickness funds. The main benchmarks focus on PHC provision and providers' reimbursement. It then turns to an analysis of EOPYY, focusing on specific questions and searching the relevant databases. It compares the best practice examples to the EOPYY (alongside further developments set by new legislation in L 4238/14), revealing weaknesses relevant to non-integrated PHC network, unbalanced manpower, non-gatekeeping, under-financing and other funding problems caused by the current crisis. Finally, a new model of medical procedures cost accounting was tested in health centers. RESULTS An alternative operation of EOPYY functioning primarily as an insurer whereas its proprietary units are integrated with these of the NHS is proposed. The paper claims it is critical to revise the current induced demand favorable reimbursement system, via per capita payments for physicians combined with extra pay-for-performance payments, while cost accounting corroborates a prospective system for NHS's and EOPYY's units, under a combination of global budgets and Ambulatory Patient Groups (APGs) CONCLUSIONS Self-critical points on the limitations of results due to lack of adequate data (not) given by EOPYY are initially raised. Then the issue concerning the debate between 'copying' benchmarks and 'a la cart' selectively adopting and adapting best practices from wider experience is discussed, with preference to the latter. The idea of an 'a la cart' choice of international examples is proposed. The 'results' discussing EOPYY's dual function and induced-demand favorable reimbursement system are further critically examined. International experience shows evidence of effective alternatives, such as per capita and pay-for-performance payments for practicing doctors as well as per case reimbursement for health centers under global budget principles.
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Affiliation(s)
- Nikos Polyzos
- />Department of Social Administration and Political Science, Democritus University of Thrace, Komotini, Greece
| | - Stefanos Karakolias
- />Department of Social Administration and Political Science, Democritus University of Thrace, Komotini, Greece
| | - Costas Dikeos
- />Department of Social Administration and Political Science, Democritus University of Thrace, Komotini, Greece
| | - Mamas Theodorou
- />Faculty of Economics and Management, Open University of Cyprus, Nicosia, Cyprus
| | - Catherine Kastanioti
- />Department of Management of Enterprises and Organizations, ATEI of Peloponnese, Kalamata, Greece
| | - Kalomira Mama
- />Department of Social Administration and Political Science, Democritus University of Thrace, Komotini, Greece
| | - Periklis Polizoidis
- />Department of Social Administration and Political Science, Democritus University of Thrace, Komotini, Greece
| | - Christoforos Skamnakis
- />Department of Social Administration and Political Science, Democritus University of Thrace, Komotini, Greece
| | - Charalampos Tsairidis
- />Department of Social Administration and Political Science, Democritus University of Thrace, Komotini, Greece
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Karampli E, Souliotis K, Polyzos N, Kyriopoulos J, Chatzaki E. Pharmaceutical innovation: impact on expenditure and outcomes and subsequent challenges for pharmaceutical policy, with a special reference to Greece. Hippokratia 2014; 18:100-6. [PMID: 25336869 PMCID: PMC4201392] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Over the recent decades, advances in healthcare technology have led to significant improvements in the quality of healthcare and in population health. At the same time, technological change in healthcare, rising national income and expansion of insurance coverage have been acknowledged as the main determinants of the historical growth in health spending in industrialized countries. The pharmaceutical sector is of particular interest as it constitutes a market characterized by rapid technological change and high expenditure growth rates. The purpose of this article is to provide an overview of research findings on the impact of pharmaceutical innovation on pharmaceutical expenditure growth, total health expenditure and population health outcomes and to bring forward the challenges that arise for pharmaceutical policy in Greece.
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Affiliation(s)
- E Karampli
- Department of Health Economics, National School of Public Health, Athens, Greece ; Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - K Souliotis
- Faculty of Social Sciences, University of Peloponnese, Corinth, Greece
| | - N Polyzos
- Department of Social Administration, Democritus University of Thrace, Komotini, Greece
| | - J Kyriopoulos
- Department of Health Economics, National School of Public Health, Athens, Greece
| | - E Chatzaki
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Nazzaro A, Salerno A, Di Iorio L, Landino G, Marino S, Pastore E, Fabregues F, Iraola A, Casals G, Creus M, Peralta S, Penarrubia J, Manau D, Civico S, Balasch J, Lindgren I, Giwercman YL, Celik E, Turkcuoglu I, Ata B, Karaer A, Kirici P, Berker B, Park J, Kim J, Rhee J, Krishnan M, Rustamov O, Russel R, Fitzgerald C, Roberts S, Hapuarachi S, Tan BK, Mathur RS, van de Vijver A, Blockeel C, Camus M, Polyzos N, Van Landuyt L, Tournaye H, Turhan NO, Hizli D, Kamalak Z, Kosus A, Kosus N, Kafali H, Lukaszuk A, Kunicki M, Liss J, Bednarowska A, Jakiel G, Lukaszuk K, Lukaszuk M, Olszak-Sokolowska B, Lukaszuk K, Kunicki M, Liss J, Jakiel G, Bednarowska A, Wasniewski T, Neuberg M, Lukaszuk M, Cavalcanti V, Peluso C, Lechado BL, Cordts EB, Christofolini DM, Barbosa CP, Bianco B, Venetis CA, Kolibianakis EM, Bosdou J, Tarlatzis BC, Onal M, Gungor DN, Acet M, Kahraman S, Kuijper E, Twisk J, Caanen M, Korsen T, Hompes P, Kushnir M, Rockwood A, Meikle W, Lambalk CB, Hizli D, Kamalak Z, Kosus A, Kosus N, Turhan NO, Kafali H, Yan X, Dai X, Wang J, Zhao N, Cui Y, Liu J, Yarde F, Maas AHEM, Franx A, Eijkemans MJC, Drost JT, van Rijn BB, van Eyck J, van der Schouw YT, Broekmans FJM, Martyn F, Anglim B, Wingfield M, Fang T, Yan GJ, Sun HX, Hu YL, Chrudimska J, Krenkova P, Macek M, Macek M, Teixeira da Silva J, Cunha M, Silva J, Viana P, Goncalves A, Barros N, Oliveira C, Sousa M, Barros A, Nelson SM, Lloyd SM, McConnachie A, Khader A, Fleming R, Lawlor DA, Thuesen L, Andersen AN, Loft A, Smitz J, Abdel-Rahman M, Ismail S, Silk J, Abdellah M, Abdellah AH, Ruiz F, Cruz M, Piro M, Collado D, Garcia-Velasco JA, Requena A, Kollmann Z, Bersinger NA, McKinnon B, Schneider S, Mueller MD, von Wolff M, Vaucher A, Kollmann Z, Bersinger NA, Weiss B, Stute P, Marti U, von Wolff M, Chai J, Yeung WYT, Lee CYV, Li WHR, Ho PC, Ng HYE, Kim SM, Kim SH, Jee BC, Ku S, Suh CS, Choi YM, Kim JG, Moon SY, Lee JH, Kim SG, Kim YY, Kim HJ, Lee KH, Park IH, Sun HG, Hwang YI, Sung NY, Choi MH, Cha SH, Park CW, Kim JY, Yang KM, Song IO, Koong MK, Kang IS, Kim HO, Haines C, Wong WY, Kong WS, Cheung LP, Choy TK, Leung PC, Fadini R, Coticchio G, Renzini MM, Guglielmo MC, Brambillasca F, Hourvitz A, Albertini DF, Novara P, Merola M, Dal Canto M, Iza JAA, DePablo JL, Anarte C, Domingo A, Abanto E, Barrenetxea G, Kato R, Kawachiya S, Bodri D, Kondo M, Matsumoto T, Maldonado LGL, Setti AS, Braga DPAF, Iaconelli A, Borges E, Iaconelli C, Setti AS, Braga DPAF, Figueira RCS, Iaconelli A, Borges E, Kitaya K, Taguchi S, Funabiki M, Tada Y, Hayashi T, Nakamura Y, Snajderova M, Zemkova D, Lanska V, Teslik L, Calonge RN, Ortega L, Garcia A, Cortes S, Guijarro A, Peregrin PC, Bellavia M, Pesant MH, Wirthner D, Portman L, de Ziegler D, Wunder D, Chen X, Chen SHL, Liu YD, Tao T, Xu LJ, Tian XL, Ye DSH, He YX, Carby A, Barsoum E, El-Shawarby S, Trew G, Lavery S, Mishieva N, Barkalina N, Korneeva I, Ivanets T, Abubakirov A, Chavoshinejad R, Hartshorne GM, Marei W, Fouladi-nashta AA, Kyrkou G, Trakakis E, Chrelias CH, Alexiou E, Lykeridou K, Mastorakos G, Bersinger N, Kollmann Z, Mueller MD, Vaucher A, von Wolff M, Ferrero H, Gomez R, Garcia-Pascual CM, Simon C, Pellicer A, Turienzo A, Lledo B, Guerrero J, Ortiz JA, Morales R, Ten J, Llacer J, Bernabeu R, De Leo V, Focarelli R, Capaldo A, Stendardi A, Gambera L, Marca AL, Piomboni P, Kim JJ, Choi YM, Kang JH, Hwang KR, Chae SJ, Kim SM, Yoon SH, Ku SY, Kim SH, Kim JG, Moon SY, Iliodromiti S, Kelsey TW, Anderson RA, Nelson SM, Lee HJ, Weghofer A, Kushnir VA, Shohat-Tal A, Lazzaroni E, Lee HJ, Barad DH, Gleicher NN, Shavit T, Shalom-Paz E, Fainaru O, Michaeli M, Kartchovsky E, Ellenbogen A, Gerris J, Vandekerckhove F, Delvigne A, Dhont N, Madoc B, Neyskens J, Buyle M, Vansteenkiste E, De Schepper E, Pil L, Van Keirsbilck N, Verpoest W, Debacquer D, Annemans L, De Sutter P, Von Wolff M, Kollmann Z, Vaucher A, Weiss B, Bersinger NA, Verit FF, Keskin S, Sargin AK, Karahuseyinoglu S, Yucel O, Yalcinkaya S, Comninos AN, Jayasena CN, Nijher GMK, Abbara A, De Silva A, Veldhuis JD, Ratnasabapathy R, Izzi-Engbeaya C, Lim A, Patel DA, Ghatei MA, Bloom SR, Dhillo WS, Colodron M, Guillen JJ, Garcia D, Coll O, Vassena R, Vernaeve V, Pazoki H, Bolouri G, Farokhi F, Azarbayjani MA, Alebic MS, Stojanovic N, Abali R, Yuksel A, Aktas C, Celik C, Guzel S, Erfan G, Sahin O, Zhongying H, Shangwei L, Qianhong M, Wei F, Lei L, Zhun X, Yan W, Vandekerckhove F, De Baerdemaeker A, Gerris J, Tilleman K, Vansteelandt S, De Sutter P, Oliveira JBA, Baruffi RLR, Petersen CG, Mauri AL, Nascimento AM, Vagnini L, Ricci J, Cavagna M, Massaro FC, Pontes A, Franco JG, El-khayat W, Elsadek M, Foroozanfard F, Saberi H, Moravvegi A, Kazemi M, Gidoni YS, Raziel A, Friedler S, Strassburger D, Hadari D, Kasterstein E, Ben-Ami I, Komarovsky D, Maslansky B, Bern O, Ron-El R, Izquierdo MP, Ten J, Guerrero J, Araico F, Llacer J, Bernabeu R, Somova O, Feskov O, Feskova I, Bezpechnaya I, Zhylkova I, Tishchenko O, Oguic SK, Baldani DP, Skrgatic L, Simunic V, Vrcic H, Rogic D, Juras J, Goldstein MS, Garcia De Miguel L, Campo MC, Gurria A, Alonso J, Serrano A, Marban E, Peregrin PC, Hourvitz A, Shalev L, Yung Y, Yerushalmi G, Giovanni C, Dal Canto M, Fadini R, Has J, Maman E, Monterde M, Gomez R, Marzal A, Vega O, Rubio JM, Diaz-Garcia C, Pellicer A, Eapen A, Datta A, Kurinchi-selvan A, Birch H, Lockwood GM, Ornek MC, Ates U, Usta T, Goksedef CP, Bruszczynska A, Glowacka J, Kunicki M, Jakiel G, Wasniewski T, Jaguszewska K, Liss J, Lukaszuk K, Oehninger S, Nelson S, Verweij P, Stegmann B, Ando H, Takayanagi T, Minamoto H, Suzuki N, Maman E, Rubinshtein N, Yung Y, Shalev L, Yerushalmi G, Hourvitz A, Saltek S, Demir B, Dilbaz B, Demirtas C, Kutteh W, Shapiro B, Witjes H, Gordon K, Lauritsen MP, Loft A, Pinborg A, Freiesleben NL, Mikkelsen AL, Bjerge MR, Andersen AN, Chakraborty P, Goswami SK, Chakravarty BN, Mittal M, Bajoria R, Narvekar N, Chatterjee R, Bentzen JG, Johannsen TH, Scheike T, Andersen AN, Friis-Hansen L, Sunkara S, Coomarasamy A, Faris R, Braude P, Khalaf Y, Makedos A, Kolibianakis EM, Venetis CA, Masouridou S, Chatzimeletiou K, Zepiridis L, Mitsoli A, Lainas G, Sfontouris I, Tzamtzoglou A, Kyrou D, Lainas T, Tarlatzis BC, Fermin A, Crisol L, Exposito A, Prieto B, Mendoza R, Matorras R, Louwers Y, Lao O, Kayser M, Palumbo A, Sanabria V, Rouleau JP, Puopolo M, Hernandez MJ, Diaz-Garcia C, Monterde M, Marzal A, Vega O, Rubio JM, Gomez R, Pellicer A, Ozturk S, Sozen B, Yaba-Ucar A, Mutlu D, Demir N, Olsson H, Sandstrom R, Grundemar L, Papaleo E, Corti L, Rabellotti E, Vanni VS, Potenza M, Molgora M, Vigano P, Candiani M, Andersen AN, Fernandez-Sanchez M, Bosch E, Visnova H, Barri P, Garcia-Velasco JA, De Sutter P, Fauser BJCM, Arce JC, Sandstrom R, Olsson H, Grundemar L, Peluso P, Trevisan CM, Cordts EB, Cavalcanti V, Christofolini DM, Fonseca FA, Barbosa CP, Bianco B, Bakas P, Vlahos N, Hassiakos D, Tzanakaki D, Gregoriou O, Liapis A, Creatsas G, Adda-Herzog E, Steffann J, Sebag-Peyrelevade S, Poulain M, Benachi A, Fanchin R, Gordon K, Zhang D, Andersen AN, Aybar F, Temel S, Kahraman S, Hamdine O, Macklon NS, Eijkemans MJC, Laven JS, Cohlen BJ, Verhoeff A, van Dop PA, Bernardus RE, Lambalk CB, Oosterhuis GJE, Holleboom CAG, van den Dool-Maasland GC, Verburg HJ, van der Heijden PFM, Blankhart A, Fauser BCJM, Broekmans FJ, Bhattacharya J, Mitra A, Dutta GB, Kundu A, Bhattacharya M, Kundu S, Pigny P, Dassonneville A, Catteau-Jonard S, Decanter C, Dewailly D, Pouly J, Olivennes F, Massin N, Celle M, Caizergues N, Fleming R, Gaudoin M, Messow M, McConnachie A, Nelson SM, Dewailly D, Vanhove L, Peigne M, Thomas P, Robin G, Catteau-Jonard S. Reproductive endocrinology. Hum Reprod 2013. [DOI: 10.1093/humrep/det221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Polyzos N. A three-year Performance Evaluation of the NHS Hospitals in Greece. Hippokratia 2012; 16:350-355. [PMID: 23935316 PMCID: PMC3738611] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE The purpose of this study was to access the performance of 117 Greek National Health System (NHS) hospitals for the year 2011, to compare the findings with the results from similar studies of the previous years (2009 and 2010) and to investigate the changes during the last three years of financial crisis. METHOD An input-oriented Data Envelopment Analysis was used to measure three indicators, technical, pure technical and scale efficiency indicators. Data was collected from the reports of the web-based facility (ESY.net) which was developed by the General Secretary of Ministry of Health and Social Solidarity. The input variables were the number of physicians, the number of nurses and other personnel, the number of beds and expenditures of every hospital. The output variables were the number of inpatient and outpatient visits. Hospitals were categorized into three size groups. RESULTS Between the years 2009-2011, all hospitals, especially middle-sized hospitals showed performance improvement on all three indicators. Specific problems were noticed mainly in large-sized hospitals. The technical efficiency of Large-sized hospitals was estimated at 80%, of Middle-sized hospitals at 82% and of Small hospitals-Health Care Centres at 89%. Pure technical and scale efficiency varied between satisfactory levels throughout the study period. CONCLUSION Comparing the 2009-2011 data, an improvement of technical efficiency in NHS hospitals has been achieved up to 100%, mainly in the middle-sized hospitals. Specifically, an increase of best practice hospitals has been noted, especially in the middle and small-sized hospitals, when certain units were added the technical efficiency reached over 80%. The consequences of the spending-cuts and the constant reforms appear to have a positive effect on hospitals' efficiency.
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Affiliation(s)
- N Polyzos
- Department of Social Administration, Democritus University of Thrace, Komotini, Greece
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Anifandis G, Dafopoulos K, Messini CI, Polyzos N, Messinis IE. The BMI of men and not sperm parameters impact on embryo quality and the IVF outcome. Andrology 2012; 1:85-9. [PMID: 23258634 DOI: 10.1111/j.2047-2927.2012.00012.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 08/02/2012] [Accepted: 08/06/2012] [Indexed: 11/29/2022]
Abstract
It has been reported that increased body mass index (BMI) of men influences fecundity but it is not clear if it impacts on sperm parameters. Whether or not BMI of men influence sperm parameters and subsequently in vitro fertilization (IVF) result remains to be clarified. The aim of the present study was primarily to investigate the relationship between the BMI of men and sperm parameters (volume, concentration and motility) and whether or not it impacts on embryo quality and IVF outcome. Secondly, to investigate the impact of BMI of both men and women, in combination with their age, on IVF result. Three hundred and one couples were categorized according to their BMI. Group 1 (n = 64, both men and women had BMI l ≤ 25 kg/m(2) ), group 2 (n = 79, both men and women had BMI > 25 kg/m(2) ), group 3 (n = 142, men had BMI > 25 kg/m(2) and their wives had BMI ≤ 25 kg/m(2) ) and group 4 (n = 16, men had BMI ≤ 25 kg/m(2) and their wives had BMI > 25 kg/m(2) ). Overall (n = 301) BMI and age of men did not correlate with sperm parameters. Group 1 and group 4, regardless of the BMI of their women, demonstrated the highest quality of embryos and consequently the highest percentage of pregnancy. Furthermore, the score of the combination of both BMI and age of both men and women resulted in a threshold level of less than 800 with a relative high per cent of pregnancy. BMI of men does not correlate with sperm parameters, but influences the quality of produced embryos in such a way that impacts on pregnancy rate.
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Affiliation(s)
- G Anifandis
- Department of Obstetrics and Gynaecology, University of Thessalia, Medical School of Larisa, Larisa, Greece.
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Papanikolaou EG, Humaidan P, Polyzos N, Kalantaridou S, Kol S, Benadiva C, Tournaye H, Tarlatzis B. New algorithm for OHSS prevention. Reprod Biol Endocrinol 2011; 9:147. [PMID: 22054506 PMCID: PMC3230134 DOI: 10.1186/1477-7827-9-147] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 11/03/2011] [Indexed: 11/10/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) still remains a life-threatening complication of in vitro fertilization treatment (IVF), keeping patients and especially those, who previously experienced OHSS, from attempting infertility treatment and childbearing. The recent implementation of four new modalities: the GnRH antagonist protocol, GnRH agonist (GnRHa) triggering of ovulation, blastocyst transfer and embryo/oocyte vitrification, renders feasible the elimination of OHSS in connection with ovarian hyperstimulation for IVF treatment. The proposed current algorithm is based on the number of follicles developed after ovarian stimulation, setting a cut-off level at the development of 18 or more follicles. Further, fulfilling this criterion, the algorithm is based on four decision-making points: the final day of patient work-up, the day of triggering final oocyte maturation, day-1 post oocyte pick-up (OPU) and day-5 post OPU. If the physician decides to administer hCG for final oocyte maturation regardless the type of analogue used, he has the option on day-1 to either freeze all embryos or to proceed to day-5. On this day, based on the clinical condition of the patient, a decision should be made to either transfer a single blastocyst or to vitrify all blastocysts available. However, this strategy will not guarantee an OHSS free luteal phase especially if a pregnancy occurs. If the physician decides to trigger ovulation with GnRHa, feasible only with the antagonist protocol, embryos can be cultured until day-5. On this day a transfer can be performed with no risk of OHSS and spare blastocysts may be vitrified. Alternatively, on day-1 or day-2 post OPU, all embryos could be frozen. Hopefully, in a near future, GnRHa triggering and vitrification of oocytes will become everyday practice. Only the combined use of a GnRH antagonist protocol with GnRHa triggering and subsequent single blastocyst transfer or embryo/oocyte freezing will completely abolish the risk of OHSS after ovarian hyperstimulation.
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Affiliation(s)
- Evangelos G Papanikolaou
- Human Reproduction & Genetics Foundation, Adrianoupoleos 6, 55133 Kalamaria, Thessaloniki, Greece
- Assisted Reproduction Unit, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece
| | - Peter Humaidan
- The Fertility Clinic Odense University Hospital (OUH) Boulevard 29, entrance 55 5000 Odense C, Denmark
| | - Nikos Polyzos
- Centrum voor Reproductieve Geneeskunde, UZ Brussel, Flemish Free university of Brussels, Belgium
| | | | - Sahar Kol
- Department of Obstetrics and Gynecology, IVF Unit, Rambam Medical Center, Haifa, Israel
| | - Claudio Benadiva
- Center for Advanced Reproductive Services, University of Connecticut School of Medicine, Department of Obstetrics and Gynecology, Farmington, Connecticut, USA
| | - Herman Tournaye
- Centrum voor Reproductieve Geneeskunde, UZ Brussel, Flemish Free university of Brussels, Belgium
| | - Basil Tarlatzis
- Assisted Reproduction Unit, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece
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Kamijo T, Milart P, Wojcik K, Szkodziak P, Wozniak S, Czuczwar P, Paszkowski T, Landolsi H, Yacoubi MT, Stita W, Gribaa M, Hmissa S, Molenaar N, van Besouw NH, Steegers EAP, Visser W, de Kuiper P, de Krijger R, Exalto N, Lagrand R, Kaandorp SP, Mellink CHM, van Wely M, Redeker EJW, Knegt AC, Goddijn M, Vidal C, Giles J, Meseguer M, Zuzuarregui JL, Bosch E, Pellicer A, Schust D, Sugimoto M, Sugimoto J, Reus AD, Stephenson MD, Steegers EAP, Krijger de RR, Dunne van FM, Exalto N, Exacoustos C, Vaquero E, Di Giovanni A, Romeo V, Lazzarin N, Arduini D, Brahem S, Mehdi M, Atig F, Ghedir H, Ibala S, Ajina M, Saad A, Chang C, Wang H, Huang S, Pai S, Soong Y, Papanikolaou E, Pantos G, Grimbizis G, Bili E, Polyzos N, Karastefanou K, Humaidan P, Esteves S, Tarlatzis B, McNamee K, Topping A, Farquharson RG, Dawood F, Ruiz Galdon M, Lendinez AM, Palomares AR, Martinez F, Perez-Nevot B, Jimenez Fernandez A, Reyes-Engel A, Horcajadas JA, Savaris RF, Kovac V, Reljic M, Vlaisavljevic V, Colicchia A, Pergolini I, Gilio B, Rampini MR, Alfano P, Marconi D, Verlengia C, Alviggi E, Bellver J, Cruz F, Martinez MC, Ramirez J, Ferro J, Garrido N, Brown JK, Lauer KB, Inglis NF, Critchley HOD, Horne AW, Samli H, Cetinkaya Demir B, Ozgoz A, Atalay MA, Uncu G, Yan Y, Cai-hong MA, Jie QIAO, Xin-na CHEN, Weimar CHE, Kavelaars A, Gellersen B, Brosens JJ, de Vreeden-Elbertse JMT, Heijnen CJ, Macklon NS, Castillo JC, Dolz M, Caballero O, Abad L, Perez-Panades J, Bonilla-Musoles F, Eggert - Kruse W, Scholz S, Klopsch I, Strowitzki T. POSTER VIEWING SESSION - EARLY PREGNANCY. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yarde F, Oudendijk JF, Broekmans FJ, Broer SL, Setti AS, Braga DPAF, Figueira RCS, Pasqualotto FF, Iaconelli Jr. A, Borges Jr. E, Rittenberg V, Seshadri S, Sunkara S, Sobaleva S, Oteng-Ntim E, El-Toukhy T, Peeraer K, Debrock S, De Legher C, Laenen A, De Neubourg D, De Loecker P, Spiessens C, D'Hooghe TM, Ochalski M, Wakim K, Wakim A, Nyboe Andersen A, Pellicer A, Devroey P, Arce JC, Blockeel C, Polyzos N, Ermini B, Riva A, Stoop D, Tournaye H, Devroey P. SELECTED ORAL COMMUNICATION SESSION, SESSION 72: FEMALE FERTILITY AND ART Wednesday 6 July 201114:00 - 15:45. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tang AW, Alfirevic Z, Turner MA, Drury J, Topping J, Dawood F, Farquharson R, Quenby S, Adam K, Entwisle M, O'Toole K, Bhima G, Palep-Singh M, Edi-Osagie E, Abediasl Z, Moini M, Jansen E, Stoop D, Ermini B, Haentjens P, De Vos M, Polyzos N, Verheyen G, Devroey P, Cabar FR, P. Pereira P, Francisco RP, Zugaib M, Horiuchi R, Miyaji S, Haruki A, Fukuda A, Morimoto Y. SELECTED ORAL COMMUNICATION SESSION, SESSION 34: EARLY PREGNANCY LOSS PROGNOSIS AND TREATMENT, Tuesday 5 July 2011 10:00 - 11:30. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Vassena R, Boue S, Gozalez-Roca E, Aran B, Auer H, Veiga A, Izpisua Belmonte JC, Ermini B, Stoop D, Haentjens P, De Vos M, Polyzos N, Verheyen G, Devroey P, Montag M, Ebner T, Xanthopoulou L, Mantzouratou A, Mania A, Ghevaria H, Ghebo C, Serhal P, Delhanty JDA, Martikainen H, Niinimaki M, Suikkari AM, Hiraoka K, Tamaki T, Matsumura Y, Kiriake C, Uto H, Yoshida H, Kitamura S, Monzo C, Assou S, Haouzi D, Bruno C, Dechaud H, Hamamah S. SELECTED ORAL COMMUNICATION SESSION, SESSION 68: EMBRYOLOGY - THE OOCYTE Wednesday 6 July 2011 14:00 - 15:45. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Theodorou M, Samara K, Pavlakis A, Middleton N, Polyzos N, Maniadakis N. The public's and doctors' perceived role in participation in setting health care priorities in Greece. Hellenic J Cardiol 2010; 51:200-208. [PMID: 20515851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION The Greek public is currently not represented at any level of the healthcare system's organisational structure. This study aimed to investigate the opinions of Greek citizens as well as doctors regarding their representation in priority setting and to compare these two groups' preferences when prioritising competing resources. METHODS A sample of 300 citizens and 100 doctors were asked by means of a standardised questionnaire: (a) whether their views should inform healthcare decisions; (b) to rank in terms of importance other groups that should participate in the process; and (c) to allocate competing resources to a series of alternative prevention programmes, medical procedures or across different population groups. RESULTS As many as 83% of the citizens stated that their opinions should inform decisions regarding prevention and population-group programmes, while a slightly lower 70% believed their opinions should also be heard regarding medical procedures. However, when asked to rank six different population groups in terms of their importance, the public ranked their role quite low. Generally, doctors and patients, and their families were ranked highest, while politicians were ranked last by both groups. Regarding allocation of funds, a remarkable consensus was observed between doctors and the public. CONCLUSION This study documents for the first time in Greece the clear preference for active involvement of both the public and healthcare professionals in the process of priority setting and resource allocation. There is great urgency in complementing these findings with qualitative research methods, such as in-depth interviews and discussions with focus groups, so that a more democratic, participative and transparent process for healthcare priority setting can be initiated, based on the actual needs and health problems of the public.
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Affiliation(s)
- Mamas Theodorou
- Open University of Cyprus, Faculty of Humanities, Health Care Management, Nicosia, Cyprus
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Abstract
An examination of Greece's experience with health care reform planning over the past half century reveals a remarkable consistency in reform themes pursued by planners. However, few of the plans resulted in legislation, and of the legislation that was passed even fewer were implemented. The present paper traces out reform plans since the early 1950s and argues that legislative and implementation failures have been due to a lack of political will, insufficient attention to consensus-forming mechanisms, and inadequate consideration of the technical, administrative, and institutional feasibility of reform plans. By contrast, developments in the 1990s, which have seen three pieces of health care reform legislation, suggest that processes of health care planning and change are becoming more focused, rational and pragmatic. Macroeconomic constraints, and consensus on broader economic policies focusing on the EU convergence requirements have produced a consensus regarding the imperative of change in the health sector, and have given rise to mechanisms which facilitate the task of implementation. The most recent health care reform act (of 17 July 1997) is less radical than many of its predecessors, but includes issues that had entered the health care reform agenda as early as 1952, as well as the more current issues of health care reform agenda as early as 1952, as well as the more current issues of health sector rationalization. Implementation of the most recent legislative act has already begun.
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Affiliation(s)
- E Tragakes
- WHO, Regional Office for Europe, Athens, Greece
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