Poor quality of sleep is a frequent problem among patients on dialysis. The aim of this study was to investigate the association of sociodemographic factors with sleep quality in patients on dialysis. The present study was conducted with 402 patients on dialysis using the Athens Insomnia Scale for the assessment of sleep disorders and a questionnaire about demographic characteristics. The results showed that 41

Device-associated infections (DAIs) are a major threat in intensive care units (ICUs), being linked with excess fatality, prolonged hospitalization and costs. We conducted a two‑year prospective surveillance study (2022-2024) in three adult general ICUs n Athens to estimate the incidence of DAIs and their clinical impact, using CDC/NHSN case definitions. Among 500 eligible patients (>3 ICU days, 10,482 ICU patient-days in total), 268 (51,6%) developed 288 DAI episodes. The overall DAI incidence was 31.2 episodes per 1,000 ICU patient‑days. Incidence by device was 19,2 per 1,000 ventilator-days for ventilator-associated events (VAE), 7,2 per 1,000 central line-days for central line-associated bloodstream infection (CLABSI) and 3,6 per 1,000 urinary catheter-days for catheter-associated urinary tract infection (CAUTI). The most frequent pathogens were Klebsiella pneumoniae (36.2%) and Acinetobacter baumannii (26.5%); among tested Gram-negative isolates, carbapenem resistance was universal. ICU fatality was 41,1% in patients with DAIs versus 23,2% without DAIs. Median ICU lengths of stay was 30 days (IQR 20-44) in patients with DAIs versus 11 days (IQR 8-19) in those without. The high burden of multidrug‑resistant organisms and the excess fatality and length of stay support the urgent implementation of structured antimicrobial-resistance surveillance, antimicrobial-stewardship and device-specific prevention bundles in Greek ICUs.

A large proportion of patients undergoing dialysis treatment have sleep disorders, while their psychosocial adjustment is reduced due to severe changes in patients’ daily life imposed by dialysis therapy. The aim of this study was to investigate the association between quality of sleep and psychosocial adjustment in dialysis patients. In this study, 402 patients on dialysis participated. Sleep quality was evaluated via the Athens Insomnia Scale (AIS) and Psychosocial adjustment via the Psychosocial Adjustment to Illness Scale (PAIS-SR). The Mann-Whitney test was utilized to compare the PAIS scale between patients with and without insomnia. Multiple linear regression analysis was utilized with the dependent variable, the PAIS scale. Adjusted regression coefficients (β) with standard errors (SE) were computed from the results of the linear regression analyses. Log transformations of the dependent variables were utilized in the multiple linear regression analysis. The results showed that having insomnia was significantly associated with greater difficulty in adjustment to vocational environment (p = 0.008), domestic environment (p < 0.001), sexual relationship (p < 0.001), extended family relationships (p < 0.001), social environment (p < 0.001), and psychological distress (p < 0.001). The findings of this study highlight the vital role of sleep quality in dialysis patients’ psychosocial adjustment. Administering individualized sleep management programs such as cognitive-behavioral therapy for insomnia, sleep hygiene education, and relaxation techniques could help dialysis patients achieve better sleep quality and improve their psychosocial adjustment. Routine screening for sleep disorders should be part of the regular care provided to dialysis patients.

Background Catheter-associated urinary tract infections (CAUTIs) remain among the most common healthcare-associated infections (HAIs) and are largely preventable through adherence to evidence-based infection prevention measures. Healthcare workers' (HCWs) knowledge, attitudes, and practices (KAP) play a critical role in the effective implementation of these strategies. However, there is no evidence regarding HCWs' KAP on CAUTI prevention in Greek healthcare settings. This study aimed to evaluate HCWs' knowledge, attitudes, and practices related to CAUTI prevention in a tertiary care hospital in Greece. Methods An analytical cross-sectional study was conducted between September 2023 and September 2024 at a tertiary hospital in Athens. Nurses, nursing assistants, and physicians working in departments with high urinary catheter utilization were invited to participate. Data were collected using a structured questionnaire developed in accordance with international CAUTI prevention guidelines. Descriptive statistics were calculated, and non-parametric test methods were employed. The Mann-Whitney U test was used for two-group comparisons, the Kruskal-Wallis test was used for comparisons across multiple groups, and Spearman's rank correlation coefficient was applied to examine associations with continuous variables. Logistic regression analyses were performed to identify factors associated with selected preventive practices. Results A total of 260 HCWs participated (response rate: 72.8%). Overall knowledge levels were moderate to high (mean score: 20.7 ± 2.1 out of 25). While most participants correctly identified key preventive measures, notable misconceptions were observed regarding prophylactic antimicrobial use after catheter insertion and appropriate catheter fixation techniques. Attitudes toward CAUTI prevention were generally positive, with the majority recognizing the importance of education and appropriate catheter management. Despite the high level of knowledge, a clear knowledge-practice gap was identified. Although the participants correctly identified key preventive measures, adherence to routine maintenance practices was markedly lower, particularly for hand hygiene before catheter manipulation (26.2%) and the maintenance of a continuously closed drainage system (66.5%). Greater professional experience (adjusted odds ratio {aOR}, 2.22; 95% confidence interval {CI}, 1.08-4.56) and higher knowledge scores (aOR, 1.18 per point; 95% CI, 1.02-1.37) were independently associated with correct catheter fixation. Additionally, positive perceptions regarding the role of catheter management in reducing morbidity were strongly associated with maintaining a closed drainage system (aOR, 6.65; 95% CI, 1.72-25.66). Conclusions Although HCWs demonstrated adequate knowledge and favorable attitudes toward CAUTI prevention, important gaps remain in the consistent implementation of recommended practices. Targeted educational initiatives and organizational strategies focusing on catheter maintenance and adherence to prevention guidelines may improve clinical practice and reduce CAUTI risk.

Background/Objectives: Patient dignity is one of the central values in nursing, equivalent to justice, freedom, and individuality. The purpose of this study was to investigate the psychometric properties of the Greek version of the Inpatient Dignity Scale (IPDS). Methods: In this descriptive, cross-sectional study, 280 patients from three Hemodialysis Units (HD) completed the IPDS, a self-completed questionnaire assessing patients' expectations regarding dignity and patients' satisfaction with dignity. Items are categorized into four dimensions, both for expectations and satisfaction: Respect as a Human Being, Respect for Personal Feeling and Time, Respect for Privacy, and Respect for Autonomy. For the translation into Greek, a double forward-backward translation process was followed, and subsequently, cultural adaptation was carried out. Construct validity was tested using the Confirmatory Factor Analysis (CFA) conducted in AMOS 26.0. Convergent validity was assessed through correlations with the Caring Behaviors Inventory-16 (CBI-16) and correlations between the dimensions of the IPDS. Repeatability was assessed using the Intraclass Correlation Coefficient (ICC), and internal consistency using Cronbach's alpha. The SPSS 26.0 statistical program was used for the descriptive and correlational analyses (p < 0.05). Results: The mean age of participants was 64.8 years old. CFA revealed an acceptable fit for the questionnaire (CFI 0.92-0.93, TLI 0.91-0.94, and RMSEA < 0.08 for both expectations and satisfaction). The IPDS was significantly and positively correlated with the CΒΙ-16, indicating good convergent validity. Cronbach's alpha was >0.70 in all dimensions of the IPDS, indicating good internal consistency. Conclusions: The Greek version of IPDS is a valid and reliable tool to measure patients' perceived dignity.

Background/Objectives: Pain is a common symptom in patients undergoing hemodialysis (HD) and may influence their quality of life. Pain self-efficacy may play an important role in self-management and adherence behaviors. This study aimed to examine the association between pain self-efficacy and adherence to the HD regimen in patients undergoing HD. Methods: In this descriptive and cross-sectional study, 199 patients undergoing HD from a single private hospital (convenience sample) in Athens, Greece, completed the Greek-Simplified Adherence Questionnaire-HD (GR-SMAQ-HD) to assess adherence and the Pain Self-efficacy Questionnaire (PSEQ) to assess pain self-efficacy. Sociodemographic and clinical data were also recorded. Bivariate analyses and multiple linear regression were performed to identify factors associated with adherence. Statistical significance was set at p < 0.05. Results: Patients demonstrated moderate levels of pain self-efficacy (mean PSEQ = 33.96 ± 9.74) and moderate adherence to the HD regimen (mean GR-SMAQ-HD = 4.78 ± 2.54). No significant correlation was found between pain self-efficacy and adherence in bivariate analysis (rho = 0.125, p = 0.221). However, in multivariate analysis, pain self-efficacy was a significant independent predictor of adherence (β = 0.056, p = 0.032). Longer duration of End-Stage Renal Disease (ESRD) (β = -0.158, p < 0.001), higher pill burden (rho = -0.237, p = 0.030) were associated with lower adherence. Marital status was also a significant predictor of adherence (β = 1.631, p = 0.016). The model explained 24% of the variance in adherence (Adjusted R2 = 0.24). Conclusions: Pain self-efficacy may indirectly affect adherence to the HD regimen, although its direct effect is modest. Adherence appears to be negatively influenced by pill burden and ESRD duration, while social support may play an important role.

AIM:This study assesses nursing students' attitudes toward artificial intelligence (AI) and examines the role of personality traits in shaping these attitudes.  Methods: A cross-sectional study was conducted in which 159 nursing students from the University of Thessaly participated. Data were collected using the General Attitudes Toward Artificial Intelligence Scale (GAAIS) to measure attitudes toward AI and the Ten Item Personality Inventory (TIPI) to assess personality traits. Statistical analysis included descriptive and inferential methods, such as correlation and factor analysis. The significant level was set to p<0.05.  Results: The findings revealed moderately positive attitudes toward AI (mean positive attitude score: 3.22 out of 5). Extraversion and openness to experience were positively correlated with positive attitudes, while maternal education was significantly associated with lower negative attitudes.  Conclusion: Nursing students demonstrate a cautious optimism toward AI, with personality traits and education playing a key role in shaping their perceptions. Addressing concerns about AI through targeted educational programs could enhance students' confidence and willingness to adopt AI in their professional practice. These findings emphasize the importance of integrating AI into nursing curricula to bridge knowledge gaps and promote the effective use of AI technologies in healthcare.

Aim: This study investigates dehumanization and attitudes toward LGBTQ+ individuals among primary healthcare nurses in Greece, exploring the influence of personality traits, empathy, and LGBTQ+ health knowledge. Materials and Methods: A cross-sectional design was used with 114 public-sector primary healthcare nurses completing self-report questionnaires between July and October 2023. Instruments included a culturally adapted dehumanization scale, the Ten-Item Personality Inventory, and the Toronto Empathy Questionnaire. Statistical analysis included Mann-Whitney and Kruskal-Wallis tests, Spearman’s correlations, and linear regression. Results: The sample was predominantly female (74.6%), heterosexual (93.9%), and Christian Orthodox (93%). Only 8.8% had attended LGBTQ+ healthcare courses, and 33.3% had cared for LGBTQ+ patients. Mechanistic dehumanization showed limited associations with personality traits, while animalistic dehumanization was negatively correlated with willingness to care (r = -0.441, p < 0.001) and comfort with LGBTQ+ care (r = -0.391, p < 0.001). Empathy and openness to experience influenced attitudes and willingness to care. Higher empathy unexpectedly reduced willingness to care, while emotional stability and conscientiousness predicted dehumanization. Conclusions: Findings highlight a moderate dehumanization trend among nurses, affecting LGBTQ+ patients’ care quality. Educational initiatives targeting LGBTQ+ health knowledge, empathy training, and the influence of personality traits are critical to fostering inclusive care and reducing dehumanization in healthcare settings.

Introduction: Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of Type 1 Diabetes Mellitus (T1DM) characterized by hyperglycaemia, ketosis, and metabolic acidosis. Management of DKA in the Emergency Department (ED) requires high knowledge and competencies, and it is challenging due to the unique needs of children. Purpose: This study aimed to investigate emergency paediatric nurses’ (EPNs) knowledge of DKA management in paediatric patients and to evaluate the correlation between this knowledge and occupational stress (OS). Methods: The study recruited EPNs from Children Hospitals, using an adapted questionnaire to assess knowledge of DKA management, and the Expanded Nursing Stress Scale (ENSS) to evaluate OS. Data were analysed with SPSS v23.0, with significance set at α=0.05. Results: Eighty-three EPNS participated, revealing a low level of knowledge in DKA management, particularly regarding insulin administration, fluid management, and bicarbonate use. EPNs reported mild OS, with higher stress levels related to patient care and life-threatening situations, and lower stress levels associated with discrimination and colleague issues. An unrevised DKA management protocol was linked to higher stress in situations involving death (p=.049), therapeutic uncertainty (p=.020), and disputes with doctors (p=.012). Conclusion: Overall, EPNs in Greece exhibit low knowledge in managing DKA and experience mild OS. These findings highlight the need for supportive training programs to enhance EPNs’ knowledge and reduce OS, optimizing nursing care in first line clinical settings.

IntroductionMigraine is a chronic, debilitating neurological disease affecting more than 1 billion patients, worldwide. Even though migraines are not life-threatening, they have profound effects on individuals, families, and society.ObjectiveThe aim of this study was to describe patients’ perspectives on socioeconomic and humanistic burden of migraine, as well as the unmet medical needs in the clinical management of migraine, in Greece.MethodsA mixed study design of a Delphi panel and a focus group was conducted, in which 16 and 9 episodic migraine patients from the two Greek migraine patient associations participated, respectively. A structured questionnaire of 45 statements regarding burden of disease diagnosis, treatment and unmet needs was used to collect data at Delphi consensus panel. An open and balanced discussion with all participants took place, under the co-ordination of one moderator during the focus group. At each round of the Delphi panel, the percentage of participants who responded “Agree/Strongly Agree,” “Disagree/Strongly disagree” and “Neither Agree nor Disagree” was calculated. The consensus threshold was set at 70% of responses. A thematic analysis was performed for the focus group.ResultsConsensus was achieved on 34 out of 45 statements. Thematic analysis revealed that patients face severe problems at work due to a lack of understanding and awareness of migraine burden from colleagues and employees, they are forced to modify their daily activities to avoid migraine attacks, and they experience prolonged diagnostic and treatment journey since they visit different medical specialties until they find the one who will be able to effectively help them manage their migraine. Additionally, they expressed concerns regarding the management of their disease due to patient-physician communication gap, dissatisfaction with traditional oral preventive therapies and lack of therapeutic options for older ages and in case of existence of specific comorbidities.ConclusionParticipants agreed that Migraine has a multifaceted impact on several aspects of patients’ lives. Patient-centered care, better training for healthcare providers, targeted therapies, and improved communication tools emerged as key factors in addressing the unmet medical needs of migraine sufferers.

BACKGROUND:Chronic kidney disease-associated pruritus (CKD-aP) is a condition that causes significant distress to people undergoing haemodialysis (HD). It significantly impacts individuals' sleep habits, everyday activities, social interactions, mental health and overall quality of life. A number of tools have been developed to evaluate the severity of pruritus. The 5-D itch scale is one of the most widely used tools for assessing various aspects of pruritus. In Greece, there is no validated and culturally adapted tool to assess pruritus in individuals with CKD receiving HD. Hence, this study aimed to evaluate the reliability and validity of the Greek version of the 5-D itch scale. MATERIALS AND METHODS:The English version of the 5-D itch scale was translated into the Greek language according to international guidelines and was cross-culturally adapted in people with CKD on HD (Ν = 120). The intraclass correlation coefficient was used to assess the reliability of the instrument after the test-retest procedure (n = 30). Confirmatory factor analysis was conducted in order to test how well the 5-D itch scale one-factor model fits the data. Internal consistency reliability was determined by the calculation of Cronbach's alpha coefficient (n = 120). Convergent validity was tested through the correlation with the Kidney Disease Quality of Life Instrument Short-Form (KDQOL-SF) scale and the visual analogue scale. Statistical significance was set at p < 0.05. Analyses were conducted using IBM SPSS Statistics for Windows, version 26.0 (released 2019, IBM Corp., Armonk, NY). RESULTS:The sample consisted of 120 people with CKD receiving HD (60.0% males, n = 72), with a mean age of 65.7 years (SD ±13 years), of whom 80 individuals reported CKD-aP. Regarding confirmatory factor analysis, this solution had a good model fit (χ2/df = 1.93; root mean square error of approximation (RMSEA) = 0.03; comparative fit index (CFI) = 0.92; Tucker Lewis index (TLI) = 0.93 and standardized root mean square residual (SRMR) = 0.05). The intraclass correlation coefficients were significant (p < 0.001) in all items and over 0.85. Cronbach's alpha for the 5-D itch scale total score was 0.75, indicating good reliability. The reliability index had minor changes after removing its items; thus, no item needed to be removed from the scale. The correlation of the 5-D itch scale with the KDQOL-SF (p = 0.002) indicates the good convergent validity of the scale. CONCLUSION:The Greek version of the 5-D itch scale is an instrument with good reliability and validity, possessing the potential to be utilised by healthcare professionals for the purpose of the assessment of CKD-aP among Greek-speaking people undergoing HD.

BACKGROUND:Chronic kidney disease-associated pruritus is a debilitating condition affecting people on haemodialysis, and nephrology nurses have the potential to play a crucial role in its early identification and management. OBJECTIVES:To investigate the nephrology nurses' perceptions and roles in the identification and management of chronic kidney disease-associated pruritus among people receiving haemodialysis. DESIGN:A survey-based, cross-sectional study was conducted by the European Dialysis Transplant Nurses Association/European Renal Care Association, using a structured questionnaire designed by the researchers and distributed online. PARTICIPANTS:Nephrology nurses working in the haemodialysis field. RESULTS:A total of 286 questionnaire submissions were received from 15 European countries. The study sample comprised 48 male and 238 female nurses. The findings reveal that 71.9% of nurses participating in the study widely agreed that the people on haemodialysis under their care tend to withhold reporting symptoms of chronic kidney disease-associated pruritus. Nurses perceived that approximately 25% of their people on haemodialysis did not openly discuss their symptoms of pruritus with their care team. Most nurses (76.4%) reported being involved in recommending or prescribing treatments for chronic kidney disease-associated pruritus, with 71.4% specifically addressing treatments for itching. However, 35.5% of healthcare professionals do not fully recognise the link between pruritus and kidney disease. CONCLUSION:The study highlights the complex challenges nephrology nurses face in identifying and managing chronic kidney disease-associated pruritus. It emphasises the significant impact of pruritus on people's quality of life and the crucial role nurses can play in early detection and management.

The objective of this review of reviews was to identify the reasons for missed nursing care and to shed light on how nurses prioritize what care they miss. Missed nursing care refers to essential nursing activities or tasks that are omitted or not completed as planned during a patient's care. This omission can result from various factors, such as staffing shortages, time constraints, or communication issues, and it can potentially compromise the quality of patient care and safety. Identifying and addressing missed nursing care is crucial to ensure optimal patient outcomes and the well-being of healthcare professionals. To be included, reviews had to use the systematic review process, be available in the English language, examine missed care in hospitals and at home, and include participants who were over eighteen years old. The review intended to answer the following questions: 'Why nursing care is missed?' 'How nurses prioritize what care they missed?'. An umbrella review was developed guided by the JBI methodology and using PRISMA-ScR. A total of 995 reviews were identified. According to the inclusion criteria, only nine reviews were finally evaluated. The findings indicate that care is missed due to staffing levels, organizational problems, and the working climate. Prioritization of care depends on acute care needs as well as educational and experiential background. Missed nursing care is associated with patient safety and the quality of provided nursing care. Specifically, it has negative impacts on patients, healthcare professionals, and healthcare service units. Organizational characteristics, nursing unit features, and the level of teamwork among nursing staff affect Missed Nursing Care. Individual demographic characteristics of the staff, professional roles, work schedules, and adequate staffing may potentially contribute to the occurrence of Missed Nursing Care, which is why they are under investigation. However, further consideration is needed regarding the management of patient needs and nurse prioritization.

During the COVID-19 pandemic, numerous studies have shown the high prevalence of occupational stress (OS) of health workers, affecting the quality of health care provided. To date, there is no study regarding OS of emergency care pediatric nurses working in Greece. This study aimed to examine the pediatric nurses' OS working in tertiary public hospitals in Greece. In this cross-sectional study, a total of 104 pediatric nurses were recruited randomly from summer 2020 to summer 2021. The Expanded Nursing Stress Scale (ENSS), which consists of 59 items grouped into nine categories, was used to assess nurses OS. The overall OS mean score was 141.04 (SD = 33.48), indicating mild stress. Among nine categories, pediatric nurses were more stressed about patients and families (mean = 22.83, SD = 5.71), as well as death and dying (mean = 19.33, SD = 5.22), whereas they were less stressed about discrimination (mean = 4.21, SD = 4.09) and problems with peer support (mean = 12.11, SD = 4.58). Sex, age, and shifts did not correlate with OS. Borderline correlation was present between age and inadequate emotional preparation for less experienced nurses (p = 0.047), while higher educated pediatric nurses were more stressed because of workload than lower educated pediatric nurses (p = 0.044). Greek pediatric nurses suffered mild OS during the COVID-19 pandemic. There is a great need for further research and implementation of supportive sustainable programs aimed to the minimization of OS and the optimization of health care provided during and after the COVID-19 pandemic.

The purpose of this study was to evaluate spirituality, religiosity, self-esteem, depression, and stress in people with spinal cord injuries. The Royal Free Questionnaire for Spiritual and Religious Beliefs, the Rosenberg Self-Esteem Scale, the Center for Epidemiologic Studies Depression Scale, and the Spielberger State–Trait Anxiety Scale were all designed for the current study to collect demographic and injury-related information. In the study, 88 patients with traumatic SCI and 88 healthy subjects were included. Half of the participants and healthy subjects were women, while the mean age of the healthy subjects was 42.8 years and that of the subjects was 42.4 years. The majority of participants were Greek (97.2

Nurses’ caring behaviors are affected by several determinants. The aim of this study was to explore the factors affecting nurses’ caring behaviors. Nurses (N=309) from three public general hospitals in Greece completed the Factors of Nurses’ Caring Behaviors Scale. The data analysis was carried out with the Statistical Package for the Social Sciences (SPSS), version 26.0. Demographic and occupational data were, also, recorded. The statistical significance level was set at <0.05. The total mean score on the FNCB Scale was 100.4 (SD±26). The dimensions of Workplace Circumstances (Mean: 24.6, SD±8.0) and Workload/Management (Mean: 24.5, SD±6.4) were the most important factors of caring behaviors. On the opposite, nurses perceived the dimensions of Patients’ Demographic Characteristics (Mean: 9.3, SD± 4.4) and Patients’ Clinical Characteristics (Mean: 12.5 SD±4.2) as the least important factors. Men scored higher than women in the dimension of Patients’ Demographic Characteristics (t=3.022, p=0.003). Secondary Education Graduates scored lower in the dimensions of Workplace Circumstances (Tukey, p=0.035) and Workload/Management (Tukey, p=0.033) than MSc/Ph.D. Graduates. Nurses of surgical departments scored lower in total score than ICU nurses (Tukey, p = 0.026). Workplace conditions, workload, and management seem to be the most important factors in nurses’ caring behaviors.

Exogenous and endogenous advanced glycation end products (AGEs) contribute to the pathogenesis and progression of renal disease. This is a one-month controlled dietary counseling trial that restricts nutritional AGEs in patients with end-stage renal disease (ESRD) undergoing haemodialysis (n = 22 participants in the intervention and n = 20 participants in the control group). Haematological, biochemical markers, the soluble form of the receptor for AGEs (sRAGE), and carboxymethyl lysine (CML) were measured at baseline and at follow-up. Mononuclear cells were isolated and the protein expression of RAGE and the inflammatory marker COX-2 was measured using Western immunoblotting. The intervention group presented a lower increase in CML compared to the control group (12.39% median change in the intervention vs. 69.34% in the control group, p = 0.013), while RAGE (% mean change −56.54 in the intervention vs. 46.51 in the control group, p < 0.001) and COX-2 (% mean change −37.76 in the intervention vs. 0.27 in the control group, p < 0.001) were reduced compared to the control group. sRAGE was reduced in both groups. In addition, HbA1c (at two months), total cholesterol, and triglycerides were reduced in the intervention versus the control group. The adoption of healthy cooking methods deserves further research as a possible way of modulating inflammatory markers in patients with CKD.

Background/Synopsis Advanced glycation end-products (AGEs) are glycosylated proteins or lipids formed in the presence of hyperglycemia and several diseases, such as chronic kidney disease. Carboxymethyl lysine (CML) is one of the major AGEs structures found in tissues and plasma. AGEs play a key role in endothelial dysfunction, atherosclerosis, and renal function impairment, partly through interaction with their receptor (RAGE). Objective/Purpose The aim was to assess the effects of a 1-month AGEs-restricted diet on circulating CML, RAGE, lipid, and inflammatory indices in patients undergoing hemodialysis. Methods Patients with end-stage renal disease (ESRD) undergoing haemodialysis (n=22 participants in the intervention and n=20 participants in the control group) were recruited from the General Hospital of Molaoi. The dietary counseling included an individualized dietary plan that excluded foods high in AGEs and recommended boiling, poaching, stewing, or steaming foods over frying and oven re-heating. Hematological and biochemical markers were measured in an automatic analyzer. The soluble form of the receptor for AGEs (sRAGE), and CML were measured with ELISA. Mononuclear cells were isolated and the protein expression of RAGE and the inflammatory marker COX-2 was measured using Western immunoblotting. All measurements were performed at baseline and follow-up. Results The intervention group presented a lower increase in CML compared to the control group (12.39 % median change in the intervention vs. 69.34% in the control group, p=0.013), while RAGE (% mean change -56.54 in the intervention vs. 46.51 in the control group, p<0.001) and COX-2 (% mean change -37.76 in the intervention vs. 0.27 in the control group, p<0.001) were reduced compared to the control group. sRAGE was reduced in both groups. Total cholesterol and triglycerides were reduced in the intervention versus the control group (mean % change -7.17 vs. -0.05 % and -22.1 vs. -3.89, correspondingly). In parallel, HbA1c (at 2 months) was reduced in the intervention group (-8.44 vs. 1.90 % median change). It is noted that total cholesterol and triglycerides were positively correlated with RAGE (Spearman rho=0.376, p=0.018 and Spearman rho=0.317, p=0.049, respectively). Conclusions A low-AGEs diet may minimize AGEs accumulation in the body and have beneficial effects on lipid, glucose and inflammatory indices in patients with ESRD. The accumulation of AGEs can be restricted directly (by adopting healthy eating habits) or indirectly (by modifying other risk factors), minimizing the AGEs related complication and progression of cardiovascular disease.

Aim School nurses often use diabetes mellitus devices as part of the care provided to students with Type 1 Diabetes Mellitus. The aim of this study was to explore the psychometric properties of the Greek version of the Diabetes Devices Confidence Scale (DDCS). Methods In this cross-sectional, descriptive study, 143 school nurses completed the DDCS. This is a self-administered questionnaire exploring the nurses' confidence in the use of diabetes devices. The scale was translated and culturally adapted according to the WHO guidelines. The Intraclass Correlation Coefficient and Cronbach's Alpha Index were used to explore the reliability and internal consistency, respectively. The construct validity was tested via exploratory and confirmatory factor analysis (EFA, CFA). Data were analyzed via Statistical Package for the Social Sciences (SPSS), version 22.0 (IBM Corp., Armonk, NY, USA). Results Significant correlations were observed between the two administrations (p<0.001) indicating the good reliability of the scale (ICC = 0525, p<0.001) while Cronbach's Alpha was 0.966 suggesting excellent internal consistency. The EFA resulted in a unidimensional solution explaining 53.7% of the total variance. The CFA showed that the model presents good fit to the data. Conclusions The DDCS is a reliable and valid tool to test the nurses' confidence in diabetes devices.

Due to the increase in life expectancy, the number of elderly people undergoing dialysis has been increasing in recent years. Knowledge about the structural and functional alterations in the aging kidney, comorbidity, the dialysis modality, health-related quality of life problems, and decision-making at end of life is constantly being updated. Therefore, understanding the changes that occur in old age is the key element in the management of elderly people.