Casopis Lekaru Ceskych[JOURNAL]
Sun
200 papers
Vnímání rizika antibiotické rezistence a znalost principů racionální ATB preskripce mezi českými praktickými lékaři - závěry z pilotního šetření.
Marhánková JH, Zielina M, Petrúšek I … +3 more , Bezdíčková L, Štefan M, Trojánek M
Cas Lek Cesk · 2024 · PMID 39581754
The issue of antibiotic resistance stands as one of the foremost contemporary global challenges in healthcare. This study presents findings from a pilot survey conducted among Czech general practitioners, concentrating o...
The issue of antibiotic resistance stands as one of the foremost contemporary global challenges in healthcare. This study presents findings from a pilot survey conducted among Czech general practitioners, concentrating on their perception of antibiotic resistance risk and their knowledge of the AWaRe classification. This classification, in accordance with international guidelines, serves as the principal indicator for monitoring the quality of antibiotic prescriptions. The results of the pilot research suggest that physicians perceive antibiotic resistance as a major problem, but one that is primarily related to health challenges outside the Czech healthcare system. We can also identify the influence of socio-demographic characteristics (mainly age and gender) on the perceived severity of the spread of antibiotic resistance. The second part of the analysis focuses on the ability of respondents to assess individual antibiotics in terms of their suitability for routine and rational, empirical antibiotic prescription according to the AWaRe classification. In particular, the research findings highlight the importance of regional differences and emphasize the need to consider structural aspects within the antibiotic prescribing debate.
Je obezita a malnutrice u geriatrických pacientů problémem z hlediska dávkování analgetik?
Dvořáčková E
Cas Lek Cesk · 2024 · PMID 39581753
Both obesity and malnutrition in the elderly population are raising concerns. As majority of pharmacokinetic data are obtained from subjects with a healthy weight range in productive age, administration of correct dosing...
Both obesity and malnutrition in the elderly population are raising concerns. As majority of pharmacokinetic data are obtained from subjects with a healthy weight range in productive age, administration of correct dosing of drugs to obese elderly patients is quite challenging. All phases of the pharmacokinetics of drugs (absorption, distribution, metabolism and elimination) are potentially affected by the effect of aging but also by obesity or malnutrition. These changes are often potentiated in the case of a combination of obesity and older age. The problem is also that not all drugs are affected in the same way, therefore it is necessary to know the influence of age and obesity on the kinetics of the particular substance being assessed. 50% of seniors suffer from pain at home and up to 80% during hospitalization. In addition to general knowledge about the effect of age but also obesity and malnutrition on the kinetics of drugs, this overview presents the pharmacokinetic changes of analgesics caused by both obesity and malnutrition.
Akatizie - častý, ale obtížně rozpoznatelný nežádoucí účinek?
Voláková J
Cas Lek Cesk · 2024 · PMID 39581752
Drug induced akathisia is classified as an extrapyramidal adverse effect. Although akathisia is quite common extrapyramidal adverse effect, it is often overlooked or mistaken for restlessness or agitation of another etio...
Drug induced akathisia is classified as an extrapyramidal adverse effect. Although akathisia is quite common extrapyramidal adverse effect, it is often overlooked or mistaken for restlessness or agitation of another etiology. Drugs associated with the risk of extrapyramidal adverse effects (antipsychotics, antiemetics, antidepressants) belong to frequently used pharmacotherapy. The use of these drugs is often complicated by serious condition of a patient and several other comorbidities, which increase the risk of the aforementioned adverse effects. In many situations, akathisia can be more difficult to recognize and more easily attributed to non-drug etiology, especially outside the fields of psychiatry and neurology. The variability of the clinical symptoms and the similarity to other clinical entities that occur frequently (anxiety, delirium, agitated depression, restless legs syndrome, etc.) can lead to difficult determination of the etiology and to the administration of medication, which tends to worsen the problem. At the same time, akathisia can be a source of very strong distress for a patient and fundamentally reduce his quality of life.
Možné přístupy v hodnocení adherence.
Pilková A
Cas Lek Cesk · 2024 · PMID 39581751
Many patients do not take their medication as prescribed by their physician, either intentionally or unintentionally. This phenomenon, most referred as nonadherence, leads to suboptimal treatment response and increased h...
Many patients do not take their medication as prescribed by their physician, either intentionally or unintentionally. This phenomenon, most referred as nonadherence, leads to suboptimal treatment response and increased healthcare costs. To detect nonadherence, in addition to indirect methods, we also use direct methods that detect the presence of the drug in patient's body. However, by simple assessment based on the presence or the absence of a measurable concentration of the drug or its metabolite in a blood sample, it is difficult to distinguish complete adherence from partial adherence, i.e., a situation where the patient takes the drug irregularly, or from masked adherence, where the patient takes his medicine only once before a medical appointment. A possible refinement may be allowed using pharmacokinetic simulations, which estimate whether the measured value corresponds to the expected drug level after a single or short-term administration, or whether it represents steady state confirming long-term adherence. Not only an analysis of a parent drug, but also its metabolite with more favourable pharmacokinetic properties (especially with longer half-life) can be used. Since, in many cases, nonadherence can be caused by several different reasons, multiple approaches in its detection and management are required and a multidisciplinary approach should be involved.
Lékové interakce - rizika u pacientů s polypragmazií.
Russ K, Vaňková T
Cas Lek Cesk · 2024 · PMID 39581750
Polypharmacy, a phenomenon of today's medicine, brings a great risk of drug interactions. Some of them can lead to serious side effects or treatment failure, knowledge in this field is dramatically developing. Pharmacoki...
Polypharmacy, a phenomenon of today's medicine, brings a great risk of drug interactions. Some of them can lead to serious side effects or treatment failure, knowledge in this field is dramatically developing. Pharmacokinetic drug interactions can occur not only when drugs are metabolized by the cytochrome P450 isoenzyme system, but also at the level of transporters, a number of which have already been described. In order to assess their clinical significance, it is necessary to orient oneself in the pharmacodynamics and pharmacokinetics of drugs, but also to consider other factors that will influence the impact of drug interactions. The physician should be familiar with commonly prescribed drugs with a high interaction potential, be aware of strong inducers and inhibitors of CYP450, as well as the possible influence of genetic polymorphism of some of its isoforms. However, one should not rely on the interpretation of drug interactions only using available interaction databases. No software is yet capable of evaluating interactions comprehensively and in the context of a specific patient, their health status and comorbidities. Also, the information available from clinical studies and observations needs to be properly understood and translated into real practice. Nowadays, it is a great advantage a doctor can consult with a clinical pharmacist or pharmacologist on the issue of drug interactions in a specific patient. This article summarizes the issue of drug interactions, focusing on the less intuitive ones, with examples from practice.
Polypragmazie a jak jí předcházet.
Hartinger JM, Bobek DL
Cas Lek Cesk · 2024 · PMID 39581749
Polypharmacy is currently a serious problem that causes decrease in adherence and increased number of hospitalizations and mortality. WHO addresses polypharmacy in the Medication Without Harm campaign. Other initiatives...
Polypharmacy is currently a serious problem that causes decrease in adherence and increased number of hospitalizations and mortality. WHO addresses polypharmacy in the Medication Without Harm campaign. Other initiatives that deal with polypharmacy are the International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP) and Choosing Wisely campaign. The correct approach to address polypharmacy consists of its prevention, i.e. not prescribing inappropriate or unnecessary medication and providing clear timeframe for medication that should not be continued life-long. Further on we should actively seek patients suffering from polypharmacy and intervene it by deprescription. Correctly provided deprescription can be done by means of various tools beginning from simple lists of inappropriate drugs (Beers criteria, STOPP/START) to more comprehensive approaches that evaluate the importance of each particular drug in patient's medication list and help to identify the least important ones that are candidates for deprescription (Medication Appropriateness Index, Good Palliative Geriatric Practice Algorithm and others). When evaluating the appropriateness of pharmacotherapy, we always check if the treatment aim is achieved, if the indication persists, appropriateness of dosing and if the patient understands the pharmacotherapeutical regimen. By this approach we try to eliminate the pharmacotherapy with very low or no benefit for particular patient. Clinical pharmacologist or pharmacist can significantly help with this time-consuming process.
Window to the soul: the eye in medical discourse.
Blažek V, Šmejkalová M
Cas Lek Cesk · 2024 · PMID 39516024
Abstract loading — click title to view on PubMed.
Roma people in the Czech Republic and cultural differences in health and health care.
Hnilicová H
Cas Lek Cesk · 2024 · PMID 39516023
From anthropometrics point of view, the Roma have retained a distinct individuality and thus differ from the majority population. They are also distinguished by cultural differences, which are reflected in the concept of...
From anthropometrics point of view, the Roma have retained a distinct individuality and thus differ from the majority population. They are also distinguished by cultural differences, which are reflected in the concept of health and health care consumption. The available data show socially and culturally determined health inequalities and disadvantages of the Roma compared to the majority population, which do not change in the long term. Among others, the low level of cultural competence and sensitivity of health professionals to the needs of minorities and specifically to the Roma ethnicity also plays a role. The article describes health-relevant cultural differences in the context of Roma culture and way of life of the Czech Roma and outlines some of the barriers faced by Roma in healthcare.
Culturally sensitive health care - cultural specifics of Roma patients.
Hnilicová H
Cas Lek Cesk · 2024 · PMID 39516022
Globally increasing ethnic diversity of patients brings new challenges for physicians regarding the provision of medical care to patients with different ethnic backgrounds. The starting point is the postulate that it is...
Globally increasing ethnic diversity of patients brings new challenges for physicians regarding the provision of medical care to patients with different ethnic backgrounds. The starting point is the postulate that it is above all a certain culture that shapes the environment in which the patient meets and communicates with medical professionals, and this is reflected in the relationship between doctors and patients and their mutual communication. The article describes the cultural specifics of Roma patients and defines the most important principles of providing culturally sensitive health care to this unique group, which differs from the major population in many respects. The described principles and recommendations can also be used within the framework of health care for migrants and refugees, whose representation among our patients is increasing.
Diabetic foot attack.
Flekač M
Cas Lek Cesk · 2024 · PMID 39516021
Diabetic foot attack is an acute manifestation of diabetic foot syndrome that requires rapid diagnosis and early initiation of complex therapy based on multidisciplinary team cooperation to save the affected limb. The te...
Diabetic foot attack is an acute manifestation of diabetic foot syndrome that requires rapid diagnosis and early initiation of complex therapy based on multidisciplinary team cooperation to save the affected limb. The term "attack" evokes the need for a rapid reaction as for "heart attack". Patients with diabetes mellitus and acute manifestations of diabetic foot syndrome have high risk for amputation of the lower limb, which is associated with higher morbidity and mortality. Complex therapy includes systemic antibiotic therapy, surgical debridement of ulceration, revascularization in the case of proven lower limb ischemia and an individualized offloading. Without the subsequent outpatient podiatric follow-up, the risk of recurrence increases significantly.
Automated insulin delivery systems - settings in specific situations.
Šoupal J, Radovnická L, Hásková A … +1 more , Do QD
Cas Lek Cesk · 2024 · PMID 39516020
Automated insulin delivery systems (AID) represent a major advance in the treatment of type 1 diabetes. These systems automate insulin delivery by integrating continuous glucose monitoring, control algorithms and insulin...
Automated insulin delivery systems (AID) represent a major advance in the treatment of type 1 diabetes. These systems automate insulin delivery by integrating continuous glucose monitoring, control algorithms and insulin pump actions. Despite their advances, there is a need to adjust the settings in specific situations, either by using special features or even by manually adjusting the dose. The article provides an overview of the possibilities of adjustments in the insulin dosing for intercurrent disease, alcohol consumption and increased physical activity for four certified automatic insulin delivery systems available in the Czech Republic.
Glycation in diabetes: is it the same in all patients?
Škrha J
Cas Lek Cesk · 2024 · PMID 39516019
Glycation plays a crucial role in the development of chronic vascular complications in diabetes. The total individual glycation is a result of interaction between proglycation and deglycation mechanisms and can be expres...
Glycation plays a crucial role in the development of chronic vascular complications in diabetes. The total individual glycation is a result of interaction between proglycation and deglycation mechanisms and can be expressed by hemoglobin glycation index (HGI). There is increasing evidence that patients with higher glycation (and higher HGI) suffer from more frequent diabetic complications. In practice, it would therefore be advantageous to identify and treat such patients to stricter glycemic goals.
Glucose variability and diabetic microvascular complications.
Prázný M, Škrha J, Šoupal J … +2 more , Horová E, Kováčová M
Cas Lek Cesk · 2024 · PMID 39516018
Microvascular diabetes complications are linked to inadequate long-term diabetes control, as indicated by glycated haemoglobin (HbA1c) levels. Fluctuations in glucose levels are connected to oxidative stress, endothelial...
Microvascular diabetes complications are linked to inadequate long-term diabetes control, as indicated by glycated haemoglobin (HbA1c) levels. Fluctuations in glucose levels are connected to oxidative stress, endothelial dysfunction, and inflammation, all of which are traditionally linked to the development of vascular damage. While some studies have linked glucose variability to macrovascular disease, its association with microvascular disease is still debated. The major question is whether short-term glucose variability should be regarded as an independent risk factor for microvascular complications in diabetes. This summary reviews research on glucose variability and its potential connections to diabetic retinopathy, nephropathy, and neuropathy. Current data indicate the need for further research into the parameters of both short-term and long-term glucose variability. These variability parameters may be important for selecting optimal treatment strategies and for estimating the risk of chronic diabetic complications.
Portraits of Jan Evangelista Purkyně in the collections of the National Museum in Prague and two previously unknown artifacts.
Sucharda P, Svačina Š
Cas Lek Cesk · 2024 · PMID 39251375
Abstract loading — click title to view on PubMed.
An international comparison and development of health system efficiency in the Czech Republic.
Dlouhý M, Havlík P
Cas Lek Cesk · 2024 · PMID 39251374
The objective of this paper is to evaluate the long-term development of main health system inputs and outputs and to evaluate the development of the efficiency of the Czech health system. We evaluate the health system ef...
The objective of this paper is to evaluate the long-term development of main health system inputs and outputs and to evaluate the development of the efficiency of the Czech health system. We evaluate the health system efficiency by two indices of efficiency, which contain 4 inputs and 2, respectively 3 outputs of the health system. The weights of inputs and outputs were obtained by a questionnaire survey among experts. The developed efficiency indices show that the efficiency of the Czech health system has a downward trend.
Vocational rehabilitation of patients after injury or with chronic illness.
Džambasov P, Povolná P
Cas Lek Cesk · 2024 · PMID 39251373
Vocational rehabilitation plays a key role in the overall improvement of the quality of life for patients with chronic illness or after injury. Physicians have an important role in identifying suitable patients and recom...
Vocational rehabilitation plays a key role in the overall improvement of the quality of life for patients with chronic illness or after injury. Physicians have an important role in identifying suitable patients and recommending vocational rehabilitation as part of a comprehensive rehabilitation treatment. This article provides an overview of the use of vocational rehabilitation in the treatment of various patients with different types of illnesses and suggests criteria for selecting appropriate patients for involvement in vocational rehabilitation. The review presents the current state of vocational rehabilitation, its possibilities, limitations, and challenges for further development. One of the main challenges is the potential use of vocational rehabilitation for patients on temporary disability leave. Although employment law has allowed this possibility for 20 years, in practice, the tool of vocational rehabilitation has not yet been used for this group of individuals. The article also brings new findings revealed by research conducted within an experimental project that pilot tested the concept of so-called "vocational rehabilitation centers." The research showed, among other things, that the early involvement of individuals with disabilities in vocational rehabilitation, combined with a multidisciplinary approach, more than triples their chances of obtaining or retaining employment.
Geriatric patient at emergency department.
Šeblová J
Cas Lek Cesk · 2024 · PMID 39251372
Emergency departments in the Czech Republic have been established in recent years. Seniors are typical patients of these departments. Emergency medicine´s approach is based on symptoms' evaluation and on deciding about t...
Emergency departments in the Czech Republic have been established in recent years. Seniors are typical patients of these departments. Emergency medicine´s approach is based on symptoms' evaluation and on deciding about the priority of the care needed. The approach to older patients is specific both in diagnostics and in therapy. The triage of geriatric patients is more accurate when we also evaluate patient´s cognition, when we use geriatric frailty scales and screening tools for detection of delirium. Comprehensive geriatric evaluation is a time demanding process and thus inadequate for emergency department however we must maintain its basic components. The therapeutical approach must be complex, and it must include biological, psychological, and social aspects and environmental risk analysis. Trauma management in seniors requires evaluation of different vital function´s values compared to common triage criteria, the influence of medication on adaptive mechanisms and the risk of low energy trauma mechanisms. Therapy of trauma must be timely and complex and the continuity of care between intensive and standard level and then rehabilitation must be ensured. Palliative approach is appropriate for terminally ill patients.
Palliative versus intensive care from the perspective of the medical rescue service.
Knor J, Kabelka L, Pekara J … +2 more , Slabý M, Dušek L
Cas Lek Cesk · 2024 · PMID 39251371
According to surveys conducted over the last 10 years, more than 80 % of our population want to live with their loved ones at the end of life. With the ageing of the population and the success of medicine in the early st...
According to surveys conducted over the last 10 years, more than 80 % of our population want to live with their loved ones at the end of life. With the ageing of the population and the success of medicine in the early stages of terminal illness, the trajectory and needs at the end of life are gradually changing. The need for health care support is increasing, and for most patients this means the need for 24/7 availability of health care, in this context in the home environment of the terminally ill patient. The question of how palliative care should be organised in an appropriate, meaningful and effective way, the role of specialised health care teams (mobile specialised palliative care), the role of general practitioners, and if, when and how the medical rescue service should/could/should effectively intervene in care, is becoming increasingly urgent. The article combines the experiences and views of an emergency physician and a doctor specialising in geriatrics and palliative medicine.
The topic of not initiating resuscitation from the perspective of Czech law not only in the context of palliative care.
Bláha D, Böhm P
Cas Lek Cesk · 2024 · PMID 39251370
In the age of advanced modern medicine, prolonging the lives of patients is becoming easier and easier. Science is even going so far that some authors are beginning to see the need to advocate for the patient's right to...
In the age of advanced modern medicine, prolonging the lives of patients is becoming easier and easier. Science is even going so far that some authors are beginning to see the need to advocate for the patient's right to die. The authors of the recommended resuscitation procedures themselves state that prolonging the inevitable dying process should be considered a harm (dysthanasia). The issue of not initiating urgent resuscitation is part of not only clinical practice, but also the study of physicians and other health professionals. The various criteria, indications, and contraindications for this action are repeatedly discussed in the course of study and practice, but rarely does this discussion go into significant detail. The teaching is limited to their enumeration or description of some of the more clearly understood ones, which are, for example, certain signs of death and their presence. The terminal stage of an incurable chronic disease is only marginally mentioned as a contraindication to urgent resuscitation, perhaps due to its ethical and legal overlap. The article includes an analysis of the sources of regulation of this issue, focusing mainly on legal and professional sources and their relationship. It also describes the actual process of decision making about the initiation of palliative care, decision making about end-of-life care, including the issue of not initiating urgent resuscitation.
COVID-19: to vaccinate or not to vaccinate - that is the question.
Městecký J, Raška M
Cas Lek Cesk · 2024 · PMID 39251369
SARS-CoV-2 is a virus which infects the respiratory tract and may cause severe, occasionally life-threatening disease COVID-19. In more than 5% of symptomatic patients the infection is associated with post-acute symptoms...
SARS-CoV-2 is a virus which infects the respiratory tract and may cause severe, occasionally life-threatening disease COVID-19. In more than 5% of symptomatic patients the infection is associated with post-acute symptoms. The initial contact of the virus with the immune system of the nasopharynx and oropharynx induces a mucosal immune response manifested by the production of secretory IgA (sIgA) antibodies which may contribute to the restriction of the infection to the upper respiratory tract and an asymptomatic or clinically mild disease. The current systemically administered vaccines protected against the severe COVID-19 infection and its post-acute sequelae. However, they do not induce antibodies in mucosal secretions in SARS-CoV-2-naive individuals. In contrast, in those who previously experienced mucosal infection, systemically administered vaccines may stimulate sIgA production. The clinical benefit of systemic vaccination convincingly documented in tens of millions of individuals overshadows the rare, sometimes controversial reports of complications encountered after vaccination. The inability of current SARS-CoV-2 vaccines to induce mucosal immune responses and to prevent the spreading of the virus by external secretions demonstrates the mutual independence of mucosal and systemic compartments of the immune system, and thus emphasizes need for the development of vaccines inducing protective immune responses in both compartments.
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