Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
Chronické srdeční selhání (CHSS) je spojeno s vysokou mortalitou i morbiditou, významně ovlivňuje kvalitu života pacientů a péče o pacienty s CHSS je nákladná. Pravidelné cvičení je všeobecně spojováno se zlepšením zdravotního stavu u širokého spektra chronicky nemocných. Přiměřeně navržený cvičební program může být hodnotnou součástí komplexní péče o dospělé pacienty s CHSS a v tomto smyslu je pravidelná chůze považována za vhodný typ fyzické aktivity. Krokoměry jsou levné, jednoduché přístroje, které poskytují informaci o úrovni fyzické aktivity, která je snadno srozumitelná a hodnotitelná. Navíc je používání krokoměrů spojeno s významným zvýšením fyzické aktivity u řady různých skupin nemocných. Projekt je navržen jako multicentrická, randomizovaná studie, která by měla zhodnotit, zda šestiměsíční chodecká intervence s využitím krokoměru v kombinaci s osobními návštěvami a telefonickými kontakty ve srovnání s běžnou péčí zlepšuje fyzickou zdatnost (hodnocenou šestiminutovým testem chůze) a neurohumorální modulaci u pacientů s CHSS.; Chronic heart failure (CHF) is associated with high mortality and morbidity, significantly affects patient ́s quality of life and is resource demanding. Regular exercise training is generally associated with improved health outcomes in a wide spectrum of chronically ill individuals. Adequately designed exercise rehabilitation may be an effective part of complex care for adults with CHF. Regular walking is considered to be a suitable mode of physical activity for patients with CHF. Pedometers are low-cost, simple devices that provide information regarding physical activity level that is easy to understand and evaluate. Moreover, pedometer use is associated with significant increases in physical activity in different populations. The project is designed as a multicenter randomized trial to determine whether a 6-month pedometer-based intervention combinig regular face-to-face appointments and telephone contacts improves functional tolerance, as measured by 6-minute walk test (6MWT) and neurohumoral regulation in patients with chronic heart failure compared to usual care.
- Klíčová slova
- chronické srdeční selhání, chůze, krokoměr, chronic heart failure, walking, pedometer,
- NLK Publikační typ
- závěrečné zprávy o řešení grantu AZV MZ ČR
BACKGROUND: Refractory out-of-hospital cardiac arrest (OHCA) treated with standard advanced cardiac life support (ACLS) has poor outcomes. Transport to hospital followed by in-hospital extracorporeal cardiopulmonary resuscitation (ECPR) initiation may improve outcomes. We performed a pooled individual patient data analysis of two randomised controlled trials evaluating ECPR based approach in OHCA. METHODS: The individual patient data from two published randomised controlled trials (RCTs) were pooled: ARREST (enrolled Aug 2019-June 2020; NCT03880565) and PRAGUE-OHCA (enrolled March 1, 2013-Oct 25, 2020; NCT01511666). Both trials enrolled patients with refractory OHCA and compared: intra-arrest transport with in-hospital ECPR initiation (invasive approach) versus continued standard ACLS. The primary outcome was 180-day survival with favourable neurological outcome (defined as Cerebral Performance Category 1-2). Secondary outcomes included: cumulative survival at 180 days, 30-day favourable neurological survival, and 30-day cardiac recovery. Risk of bias in each trial was assessed by two independent reviewers using the Cochrane risk-of-bias tool. Heterogeneity was assessed via Forest plots. FINDINGS: The two RCTs included 286 patients. Of those randomised to the invasive (n = 147) and standard (n = 139) groups, respectively: the median age was 57 (IQR 47-65) and 58 years (IQR 48-66), and the median duration of resuscitation was 58 (IQR 43-69) and 49 (IQR 33-71) minutes (p = 0.17). In a modified intention to treat analysis, 45 (32.4%) in the invasive and 29 (19.7%) patients in the standard arm survived to 180 days with a favourable neurological outcome [absolute difference (AD), 95% CI: 12.7%, 2.6-22.7%, p = 0.015]. Forty-seven (33.8%) and 33 (22.4%) patients survived to 180 days [HR 0.59 (0.43-0.81); log rank test p = 0.0009]. At 30 days, 44 (31.7%) and 24 (16.3%) patients had favourable neurological outcome (AD 15.4%, 5.6-25.1%, p = 0.003), 60 (43.2%), and 46 (31.3%) patients had cardiac recovery (AD: 11.9%, 0.7-23%, p = 0.05), in the invasive and standard arms, respectively. The effect was larger in patients presenting with shockable rhythms (AD 18.8%, 7.6-29.4; p = 0.01; HR 2.26 [1.23-4.15]; p = 0.009) and prolonged CPR (>45 min; HR 3.99 (1.54-10.35); p = 0.005). INTERPRETATION: In patients with refractory OHCA, the invasive approach significantly improved 30- and 180-day neurologically favourable survival. FUNDING: None.
- Publikační typ
- časopisecké články MeSH
Tuberkulóza je stále závažným globálním zdravotním problémem. Každoročně jí onemocní přes 10 milionů lidí a vyžádá si přes 1,5 milionu obětí. Přestože se jedná o onemocnění provázející lidstvo po tisíce let, teprve moderní technologie a rozvoj molekulární biologie pomáhají odhalit a vysvětlit mnohdy jen tušené souvislosti a pravdy o samotném původci, patogenezi onemocnění i jeho prevenci. Současná příznivá epidemiologická situace ve vyspělých zemích je daná spíše socioekonomickými změnami a celkovým zlepšením zdravotního stavu populace než vlivem zavedeného očkování BCG vakcínou. Naopak země strádající chudobou a válečnými konflikty stále patří mezi ty s nejvyšší nemocností i úmrtností na toto onemocnění. Světová pandemie infekce HIV/AIDS a postupný nárůst antimikrobiální rezistence původce tuberkulózy (Mycobacterium tuberculosis) celou situaci do značné míry dále komplikují a nutí odborníky znovu intenzivně zaměřit svou pozornost na studium tohoto onemocnění, na jeho diagnostiku, léčbu a zejména na hledání nových cest prevence včetně vývoje nových vakcín. Tato práce přináší přehled dosud známých informací o původci infekce, způsobu a podmínkách jeho šíření, aktuální epidemiologické situaci, samotném onemocnění a jeho prevenci s důrazem na nové poznatky, které přinášejí podněty k přehodnocení zažitých náhledů.
Tuberculosis is still a major global health problem. It affects over 10 million people each year and claims over 1.5 million victims. Although it is a disease that has been with mankind for thousands of years, it is only modern technology and the development of molecular biology that have enabled to reveal and explain the often unsuspected links and truths about the causative agent, the pathogenesis of the disease and its prevention. The current favourable epidemiological situation in developed countries is due to socio-economic changes and a general improvement in the health of the population rather than to the effect of the introduction of the BCG vaccine. On the other hand, countries suffering from poverty and war are still among those with the highest morbidity and mortality from this disease. The global pandemic of HIV/AIDS infection and the gradual increase in antimicrobial resistance of the causative agent of tuberculosis (Mycobacterium tuberculosis) have greatly complicated the situation and have forced experts to focus renewed attention on the study of the disease, its diagnosis, treatment and, above all, the search for new avenues of prevention, including the development of new vaccines. This paper presents an overview of what is known so far about the causative agent of the infection, the mode and conditions of its spread, the current epidemiological situation, the disease itself and its prevention, with an emphasis on new findings that provide incentives to rethink the experiential views.
- MeSH
- lidé MeSH
- Mycobacterium tuberculosis patogenita MeSH
- náchylnost k nemoci MeSH
- tuberkulóza * imunologie přenos prevence a kontrola MeSH
- vakcinace MeSH
- vakcíny proti tuberkulóze imunologie terapeutické užití MeSH
- vyvíjení léků MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
- MeSH
- dostupnost zdravotnických služeb MeSH
- glifloziny * terapeutické užití MeSH
- lidé MeSH
- metaanalýza jako téma MeSH
- randomizované kontrolované studie jako téma MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- srdeční selhání * farmakoterapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
- rozhovory MeSH
Importance: Out-of-hospital cardiac arrest (OHCA) has poor outcome. Whether intra-arrest transport, extracorporeal cardiopulmonary resuscitation (ECPR), and immediate invasive assessment and treatment (invasive strategy) is beneficial in this setting remains uncertain. Objective: To determine whether an early invasive approach in adults with refractory OHCA improves neurologically favorable survival. Design, Setting, and Participants: Single-center, randomized clinical trial in Prague, Czech Republic, of adults with a witnessed OHCA of presumed cardiac origin without return of spontaneous circulation. A total of 256 participants, of a planned sample size of 285, were enrolled between March 2013 and October 2020. Patients were observed until death or day 180 (last patient follow-up ended on March 30, 2021). Interventions: In the invasive strategy group (n = 124), mechanical compression was initiated, followed by intra-arrest transport to a cardiac center for ECPR and immediate invasive assessment and treatment. Regular advanced cardiac life support was continued on-site in the standard strategy group (n = 132). Main Outcomes and Measures: The primary outcome was survival with a good neurologic outcome (defined as Cerebral Performance Category [CPC] 1-2) at 180 days after randomization. Secondary outcomes included neurologic recovery at 30 days (defined as CPC 1-2 at any time within the first 30 days) and cardiac recovery at 30 days (defined as no need for pharmacological or mechanical cardiac support for at least 24 hours). Results: The trial was stopped at the recommendation of the data and safety monitoring board when prespecified criteria for futility were met. Among 256 patients (median age, 58 years; 44 [17%] women), 256 (100%) completed the trial. In the main analysis, 39 patients (31.5%) in the invasive strategy group and 29 (22.0%) in the standard strategy group survived to 180 days with good neurologic outcome (odds ratio [OR], 1.63 [95% CI, 0.93 to 2.85]; difference, 9.5% [95% CI, -1.3% to 20.1%]; P = .09). At 30 days, neurologic recovery had occurred in 38 patients (30.6%) in the invasive strategy group and in 24 (18.2%) in the standard strategy group (OR, 1.99 [95% CI, 1.11 to 3.57]; difference, 12.4% [95% CI, 1.9% to 22.7%]; P = .02), and cardiac recovery had occurred in 54 (43.5%) and 45 (34.1%) patients, respectively (OR, 1.49 [95% CI, 0.91 to 2.47]; difference, 9.4% [95% CI, -2.5% to 21%]; P = .12). Bleeding occurred more frequently in the invasive strategy vs standard strategy group (31% vs 15%, respectively). Conclusions and Relevance: Among patients with refractory out-of-hospital cardiac arrest, the bundle of early intra-arrest transport, ECPR, and invasive assessment and treatment did not significantly improve survival with neurologically favorable outcome at 180 days compared with standard resuscitation. However, the trial was possibly underpowered to detect a clinically relevant difference. Trial Registration: ClinicalTrials.gov Identifier: NCT01511666.
- MeSH
- čas zasáhnout při rozvinutí nemoci MeSH
- kardiopulmonální resuscitace metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- mimotělní membránová oxygenace MeSH
- senioři MeSH
- transport pacientů * MeSH
- zástava srdce mimo nemocnici diagnóza mortalita terapie MeSH
- zbytečná diagnóza a terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
The main reason for the emergency implantation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) is the restoration of adequate systemic perfusion, while protecting the failing heart and promoting myocardial recovery are equally important goals. Following initial haemodynamic stabilization and often the urgent revascularization of the culprit lesion, the clinical focus is then directed towards the most efficient strategy for cardioprotection. Frequent echocardiography measurements may help to estimate the degree of unwanted left ventricular (LV) overloading during VA-ECMO. Additionally, the estimation of high LV filling pressures by Doppler echocardiography or their (in-)direct measurement using a dedicated surgical left atrial pressure line and conventional pulmonary artery catheter in a wedge position or a pigtail catheter in the left ventricle can be performed. Mechanical overload of the left ventricle is the major adverse effect and an obvious mechanistic and prognostic challenge of contemporary ECMO care. Many efforts are under way to overcome this phenomenon by LV unloading, which was effectively achieved by the current combined approach using an axial decompression device, while novel technical developments and approaches are tested and urgently anticipated. The aim of this report is to introduce in depth pathophysiological background, current concepts, and future perspectives in LV unloading strategies.
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- sakubitril/valsartan, studie TRANSITION,
- MeSH
- kombinovaná farmakoterapie MeSH
- lidé MeSH
- neprilysin * antagonisté a inhibitory MeSH
- srdeční selhání * farmakoterapie MeSH
- valsartan terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- rozhovory MeSH
